Age-dependent Differences in Short-term Outcome after Surgical or Endovascular Treatment of Unruptured Intracranial Aneurysms in the United States, 1996–2000

Neurosurgery ◽  
2004 ◽  
Vol 54 (1) ◽  
pp. 18-30 ◽  
Author(s):  
Fred G. Barker ◽  
Sepideh Amin-Hanjani ◽  
William E. Butler ◽  
Brian L. Hoh ◽  
James D. Rabinov ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Long Term Care ◽  
The United States ◽  
Short Term ◽  
Term Care ◽  
End Points ◽  
Unruptured Aneurysms ◽  
Discharge Disposition ◽  
Significant Difference

Abstract INTRODUCTION Unruptured intracranial aneurysm patients are frequently eligible for both open surgery (“clipping”) and endovascular repair (“coiling”). We compared short-term end points (mortality, discharge disposition, complications, length of stay, and charges) for clipping and coiling in a nationally representative discharge database. METHODS We conducted a retrospective cohort study using Nationwide Inpatient Sample data from 1996 to 2000. Multivariate logistic regression analyses adjusted for age, sex, race, payer status, geographic region, presenting signs and symptoms, admission type and source, procedure timing, hospital caseload, and possible clustering of outcomes within hospitals. The results were confirmed by performing propensity score analysis. RESULTS A total of 3498 patients had clipping, and 421 underwent coiling. Clipped patients were slightly younger (P < 0.001). Medical comorbidity was similar between the groups. More clipped patients had urgent or emergency admissions (P = 0.02). More coiling procedures were performed on hospital Day 1 (P = 0.007). When only death and discharge to long-term care were counted as adverse outcomes, there was no significant difference between clipping and coiling. On the basis of a four-level discharge status outcome scale (dead, long-term care, short-term rehabilitation, or discharge to home), coiled patients had a significantly better discharge disposition (odds ratio, 2.1; P < 0.001). With regard to patient age, most of the difference in discharge disposition was in patients older than 65 years of age. The degree of difference between treatments increased from 1996 to 2000. Neurological complications were coded twice as frequently in clipped patients as in coiled patients (P = 0.002). Length of stay was longer (5 d versus 2 d, P < 0.001) and charges were higher ($21,800 versus $13,200, P = 0.007) for clipped patients than for coiled patients. CONCLUSION There was no significant difference in mortality rates or discharge to long-term facilities after clipping or coiling of unruptured aneurysms. When discharge to short-term rehabilitation was counted as an adverse event, coiled patients had significantly better outcomes than clipped patients at the time of hospital discharge, but most of the coiling advantage was concentrated in patients older than 65 years of age. Even in older patients, long-term end points—including long-term functional status in patients discharged to rehabilitation and efficacy in preventing hemorrhage—will be critical in determining the best treatment option for patients with unruptured aneurysms.

scholarly journals Prevalence of advanced directives in the geriatric population with in long-term care facilities in the United States

2021 ◽  
Vol 12 (2) ◽  
pp. 173-178
Author(s):  
Ateequr Rahman ◽  
Druti Shukla ◽  
Lejla Cukovic ◽  
Kirstin Krzyzewski ◽  
Noopur Walia ◽  
...  
Keyword(s):  
United States ◽  
Long Term Care ◽  
The United States ◽  
Living Wills ◽  
Term Care ◽  
Advanced Directive ◽  
Advanced Directives ◽  
Significant Difference ◽  
Care Facilities

Advanced directives, such as Living Wills and Do Not Resuscitate (DNR) orders, provide the ability to identify, respect, and implement an individual's wishes for medical care during serious illness or end-of-life care. The aim of this study was to evaluate the prevalence of advanced directives amongst the residents of long-term care facilities in the United States. A total of 527 cases were extracted from 2018 National Study of Long-Term Care Providers, which was collected by the National Center for Health Statistics through the surveys of residential care communities and adult day services centers. Advanced directive rates were higher in patients 90 years of age and above as compared to other age groups. Nursing home residents were more likely to have advanced directives than other long term care facilities. There was no significant difference among males and females in the rate of advanced directives. Nursing home and Hospice residents had more advanced directives compared to other facilities. The Black population had the highest rate of advanced directive preparedness. Overall, the finding of this study revealed that there was a significant difference in the preparedness of DNR orders and Living Wills by patient demographics and the type of long-term care facility. Offering advanced directive services at public health/social services facilities can enhance the rate of advanced directive preparedness. Advanced directives ease the stress and anxiety of patients, family, and friends during difficult times.

Cross-cultural comparison of long-term care in the United States and Finland: Research done through a short-term study-abroad experience

2016 ◽  
Vol 38 (1) ◽  
pp. 104-118 ◽  
Author(s):  
Tina M. Kruger ◽  
Sarah Gilland ◽  
Jacquelyn B. Frank ◽  
Bridget C. Murphy ◽  
Courtney English ◽  
...  
Keyword(s):  
Long Term Care ◽  
The United States ◽  
Cross Cultural ◽  
Cultural Comparison ◽  
Short Term ◽  
Term Study ◽  
Term Care ◽  
Cross Cultural Comparison ◽  
Short Term Study

Abstract 2467: Factors Affecting the Discharge Disposition after Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Hung-Pin Tseng ◽  
Chin-Hsiung Liu ◽  
Chun-Liang Lin ◽  
Hung-Chih Lin ◽  
Pi-Tzu Chen ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Long Term Care ◽  
Heart Diseases ◽  
Relative Weight ◽  
Stroke Patients ◽  
Term Care ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Patient Disposition

Background and Purpose: Stroke is the third leading cause of death and is the leading cause of adult disability in Taiwan. Stroke patients are frequently in need of professional care and assistance in activities of daily living. Home care may not provide adequate support for some of the disabled stroke patients. Discharge disposition after stroke is an important long-term care issue affecting the families and societies in every country, developed or developing. We have made analyses of more than 20,000 disposition arrangements 3 month after stroke in the Taiwan Stroke Registry to explore key demographic and clinical factors that may determine the disposition. Methods: The Taiwan Stroke Registry (TSR), sponsored by Taiwan Department of Health and engaging 39 academic and community hospitals, covers broadly the entire country with 4 steps of quality control to ensure reliability of entered data (Hsieh FI et al, Circulation, 2010). The 3 month follow-up data of 21,786 stroke admissions between 2006 and 2008 was used for analysis. Under the stratification of age and separating discharge destinations into home and nursing home, we investigated the influences of patients’ demographics, clinical characteristics, and disability levels by the Cochran-Mantel-Haenszel method. We calculated the odds ratios of factors of significant impact based on the multiple logistic regression model. Results: Education level, living place, main caregiver, hypertension, diabetes mellitus, heart diseases, previous stroke history, snoring, stroke types, length of stay, rehabilitation, number of complications (pneumonia, urinary tract infection, or upper gastrointestinal bleeding), and National Institute of Health Stroke Scale (NIHSS) significantly affect the discharge dispositions (p<0.05) after adjustment by age. Independent from the above variables, age carries a high impact based on yearly increase (1.02, 95% CI=1.01-1.03). Male gender (1.57, 1.35-1.82), education (0.81, 0.69-0.96), location of residence (1.70, 1.45-2.00), availability of employed caregivers (2.19, 1.82-2.63), snoring (0.84, 0.71-0.99), hemorrhagic stroke (1.46, 1.22-1.75), increase of length of stay by one day (1.01, 1.005-1.015), rehabilitation (0.78, 0.61-0.98), one complication (1.56, 1.32-1.84), and increase in NIHSS by one point (1.14, 1.13-1.15). Conclusions: Results showing relative weight of key determinants of patient disposition 3 months after stroke may be useful in acute care of stroke patients in facilitating disposition and in planning long-term care preparation from the perspective of individual families, institutions caring for stroke patients and the government agencies. Whether findings derived from the present study are applicable across countries remain to be determined.

Medicaid Threats on the Horizon

2020 ◽  
Vol 35 (3) ◽  
pp. 145-145
Author(s):  
Paul Baldwin
Keyword(s):  
United States ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
The United States ◽  
Care Hospital ◽  
Short Term ◽  
Term Care ◽  
Episodes Of Care ◽  
Primary Payer

Those of you who have been around for a while understand that Medicaid is the primary payer for long-term care in the United States. While Medicare pays for the short-term episodes of care associated with rehabilitation following a three-day stay in an acute-care hospital, it?s Medicaid that foots the bill for live-in residents who are unable to afford it themselves.

scholarly journals Trends of Clinical Outcomes and Health Care Resource Use in Heart Failure in the United States

2020 ◽  
Vol 9 (14) ◽  
Author(s):  
Safi U. Khan ◽  
Muhammad Zia Khan ◽  
Mohamad Alkhouli
Keyword(s):  
United States ◽  
Heart Failure ◽  
Coronary Artery ◽  
Resource Use ◽  
Long Term Care ◽  
The United States ◽  
Inpatient Mortality ◽  
Term Care ◽  
Discharge Disposition

Background Heart failure (HF) imparts a significant clinical and economic burden on the health system in the United States. Methods and Results We used the National Inpatient Sample database between September 2002 and December 2016. We examined trends of comorbidities, inpatient mortality, and healthcare resource use in patients admitted with acute HF. Outcomes were adjusted for demographic variables, comorbidities, and inflation. A total of 11 806 679 cases of acute HF hospitalization were identified. The burden of coronary artery disease, peripheral vascular disease, valvular heart disease, diabetes mellitus, hypertension, anemia, cancer, depression, and chronic kidney disease among patients admitted with acute HF increased over time. The adjusted mortality decreased from 6.8% in 2002 to 4.9% in 2016 ( P‐ trend<0.001; average annual decline, 1.99%), which was consistent across age, sex, and race. The adjusted mean length of stay decreased from 8.6 to 6.5 days ( P <0.001), but discharge disposition to a long‐term care facility increased from 20.8% to 25.6% ( P <0.001). The inflation adjusted mean cost of stay increased from $14 301 to $17 925 ( P <0.001) (average annual increase, 1.52%), which was partially explained by the higher proportion of procedures (echocardiogram, right heart catheterization, use of ventricular assist devices, coronary artery bypass grafting) and the higher incidence of HF complications (cardiogenic shock, respiratory failure, ventilator, and renal failure requiring dialysis). Conclusions This national data set showed that despite increasing medical complexities, there was significant reduction in inpatient mortality and length of stay. However, these measures were counterbalanced by a higher proportion of discharge disposition to long‐term care facilities and expensive cost of care.

scholarly journals Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 704-704
Author(s):  
Yuchi Young ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Systems ◽  
Long Term Care ◽  
The United States ◽  
World Population ◽  
Term Care ◽  
The Usa ◽  
Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

scholarly journals The Influence of Race and Gender on Staff-Resident Interactions in Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 185-185
Author(s):  
Rachel McPherson ◽  
Barbara Resnick ◽  
Elizabeth Galik
Keyword(s):  
Racial Differences ◽  
Long Term Care ◽  
Analysis Of Covariance ◽  
Positive Interactions ◽  
Term Care ◽  
Race And Gender ◽  
Significant Difference ◽  
And Gender

Abstract Communication and interactions are an integral part of care in long-term care settings. Resident variables, such as race and gender, shape communication and interaction between staff and residents. The Quality of Interactions Schedule (QuIS) was developed to measure the quality of verbal and nonverbal interactions among nursing staff and older adults initially for those in acute care and later used as well in a variety of long term care settings. A quantified measurement of the quality of interactions between residents and staff was created to quantify the QuIS. The purpose of this study was to describe the gender and racial differences in scored quality of interactions. Data for the present study was based on baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) implementation study. A total of 535 residents from 55 settings were included in the analyses. An analysis of covariance was conducted to determine a difference in QuIS scores between males and females while controlling for age. The second model tested for differences in QuIS scores between blacks and whites while controlling for age and gender. There was not a statistically significant difference in QuIS scores between male and female residents. There was a significant difference in QuIS scores between those who were black versus white, such that those who were black received more positive interactions from staff than those who were white. Future work should focus on a deeper examination of resident factors and staff factors that may influence these interactions.

scholarly journals Understanding contributors to quality of care in long-term care and changes under COVID-19

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 960-960
Author(s):  
Sara Luck ◽  
Katie Aubrecht
Keyword(s):  
Quality Of Care ◽  
Long Term Care ◽  
The United States ◽  
Control Measures ◽  
Qualitative Description ◽  
Care Staff ◽  
Term Care ◽  
The Impact

Abstract Nursing home facilities are responsible for providing care for some of the most vulnerable groups in society, including the elderly and those with chronic medical conditions. In times of crisis, such as COVID-19 or other pandemics, the delivery of ‘regular’ care can be significantly impacted. In relation to COVID-19, there is an insufficient supply of personal protective equipment (PPE) to care for residents, as PPE not only protects care staff but also residents. Nursing homes across the United States and Canada have also taken protective measures to maximize the safety of residents by banning visitors, stopping all group activities, and increasing infection control measures. This presentation shares a research protocol and early findings from a study investigating the impact of COVID-19 on quality of care in residential long-term care (LTC) in the Canadian province of New Brunswick. This study used a qualitative description design to explore what contributes to quality of care for residents living in long-term care, and how this could change in times of crisis from the perspective of long-term care staff. Interviews were conducted with a broad range of staff at one LTC home. A semi-structured interview guide and approach to thematic analysis was framed by a social ecological perspective, making it possible to include the individual and proximal social influences as well as community, organizations, and policy influencers. Insights gained will improve the understanding of quality of care, as well as potential barriers and facilitators to care during times of crisis.

scholarly journals FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
Rebecca L Mauldin ◽  
Kathy Lee ◽  
Antwan Williams
Keyword(s):  
Long Term Care ◽  
Federal Policy ◽  
Care Facility ◽  
Well Being ◽  
The United States ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities

Abstract Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.

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