Failing to Complain: Do Nursing Homes with more Residents with Dementia have Fewer Complaints?

The majority of nursing home (NH) residents have Alzheimer’s Disease or Related Dementias (ADRD). However, the association of ADRD prevalence and NH quality is unclear. The objective of the current study is to understand the association of NH characteristics, including the proportion of ADRD residents, with the prevalence of NH complaints as an indicator of quality of care and quality of life. We merged data from the ASPEN Complaints/Incident Tracking System with national NH data from the Certification and Survey Provider Enhanced Reports, the Minimum Data Set, the Area Health Resource File, and zip-code level rural-urban codes in 2017. Three groups of NHs were created, including those whose proportion of residents with ADRD was in the top decile (i.e., high-dementia NHs (N=1,473)) and those whose proportion of ADRD residents was in the lowest decile (i.e., low-dementia NHs (N=1,524)). Bivariate results revealed high-ADRD NHs had higher percentages of Medicaid-paying residents, were less likely to be for-profit and chain-affiliated, had lower staffing hours and lower percentages of Black, Hispanic, and Asian residents. Using NHs in the middle deciles as reference, negative binomial regression models showed that having a low proportion of ADRD residents was significantly associated with higher numbers of total complaints (p<.001) and substantiated complaints (p<.001), whereas having a high proportion of ADRD residents was significantly associated with lower numbers of substantiated complaints (p=.001). The findings suggest the proportion of residents with ADRD in NHs is associated with quality, as measured by complaints. Policy implications of these findings will be discussed.

Is Rural Kansas Prepared? An Assessment of Resources Related to the COVID-19 Pandemic

INTRODUCTION. This study investigated rural Kansas healthcare system capacity and critical care-related resources relevant to the care of COVID-19 patients in at the county level in the context of population characteristics. METHODS. The federal Area Health Resource File was used to assess system capacity and critical care-related resources and COVID-19-related population risk factors at the county level. Data were described with summary statistics, cross-tabulations, and bivariate tests to discern differences across frontier, rural, and urban counties using 2013 Rural-Urban Continuum Code classifications. RESULTS. Kansas has 105 counties. Urban counties had an average of 2 physicians per 1,000 people, while rural and frontier counties had 1. 63.5% of frontier counties had no anesthesia providers and 100.0% of frontier counties had no pulmonary disease physicians. While 96 counties have at least one hospital, nearly 90% frontier counties had no ICU services. The percent of the population estimated to be over 65 was higher among frontier counties (24.2%) than urban counties (19.3%). On average, frontier counties had approximately twice as many deaths per 1,000 people by cardiovascular diseases and COPD than urban and `rural counties. CONCLUSIONS. Our findings showed that Kansas faces limited ICU capabilities and physician workforce shortages in frontier counties, both in primary care and specialties such as anesthesia and pulmonology. In addition, rural and frontier population age structures and mortality rates demonstrate an increased risk to potentially overwhelm local healthcare systems. This may have serious implications for rural health, particularly in the context of the COVID-19 pandemic.

Optimasi Kecepatan Loading Time Web Template Dengan Implementasi Teknik Front-End

AbstrakSitus web merupakan sekumpulan dokumen Hypertext Markup Language (HTML) statis yang dibangun untuk memudahkan setiap orang berbagi informasi, selama terhubung ke dalam jaringan internet. Salah satu bagian dari sistem sebuah situs web adalah web template. Web template adalah komponen dasar dari sistem web template berguna untuk memudahkan pengembang web merancang ulang sebuah halaman web. Salah satu yang mempengaruhi kinerja halaman web yaitu loading time, dimana loading time adalah waktu yang dibutuhkan oleh browser agar dapat menampilkan halaman web secara menyeluruh oleh pengguna ketika pengguna melakukan request, selain itu loading time merupakan salah satu bagian penting dari optimasi situs web. Optimasi merupakan suatu proses dimana memodifikasi atau merubah sesuatu yang telah ada agar efektifitasnya meningkat. Dalam sebuah situs web, terdapat beberapa konsep dalam optimasi, yaitu First Paint, Time To Interactivity (TTI), First Meaningful Paint (FMP) dan Long Task. Berdasarkan penelitian-penelitian yang sudah ada, diketahui bahwa optimasi loading time web dapat dilakukan dari sisi front-end. Oleh karena itu pada penelitian ini melakukan teknik optimasi dengan menggunakan critical rendering path, above the fold, priority resource, bundle and minify, gzip, dan splitting code. Hasil dari peforma web berdasarkan metriks first meaningful paint (FMP), first contetful paint (FCP), dan time to interactivity (TTI) mengalami peningkatan rata-rata kecepatan (perosentase) yaitu FMP sebesar 73%, FCP sebesar 60%, TTI sebesar 50%, dan loading time sebesar 29%. Selanjutnya, pada resource file rata-rata ukuran file menurun sebesar 59% dan jumlah request file menurun sebesar 21%.AbstractWebsite is a collection of HTML documents that are built to make it easy for everyone to share information, as long as they are connected to the internet. One part of a website system is a web template. Web templates are the basic components of a web template system useful for making it easy for web developers to redesign a web page. One that affects the performance of web pages is loading time, where loading time is the time needed by the browser to be able to display the web page as a whole by the user when the user makes a request, besides that loading time is one important part of website optimization. Optimization is a process where modifying or changing something that already exists in order to increase its effectiveness. In a website, there are several concepts in optimization, namely First Paint, Time To Interactivity, and First Meaningful Paint Based on existing research, it is known that web loading time optimization can be done from the front-end side. Therefore, in this study, optimization techniques using critical rendering path, above the fold, priority resources, bundle and minify, gzip, and splitting code. The implementation of matrics first meaningful paint (FMP), first contetful paint (FCP), dan time to interactivity (TTI) make increase average of speed FMP as 73%, FCP as 60%, TTI as 50%, and loading time as 29%. And then average of resource file decrease as 59% and total file of request decrease as 21%.

The Impact of Leadership Styles on Quality and Financial Performance in High Medicaid Nursing Homes

This study examined the association between leadership styles (autocrat, consultative autocrat, consensus manager, and shareholder manager) and resident quality and financial performance in under-resourced nursing homes. Survey data from 391 Directors of Nursing were merged with secondary data from LTCFocus, Area Health Resource File, Medicare Cost Reports, and Nursing Home Compare. Two multivariate regressions were used to model the relationship between leadership styles and the dependent variables: nursing home star ratings (1-5) and operating margin. The independent variables were composite scores for leadership styles, while control variables included organizational and county-level factors. Results show that compared to autocratic leadership, the consultative autocrat (solicits feedback but has total authority) was associated with lower quality (p < 0.05), while the consensus manager (delegates authority to the group) was associated with lower profit margin (p < 0.05). Under-resourced facilities need to recognize trade-offs of different decision making styles for performance.

CONSISTENT ASSIGNMENT: AN UPDATE ON THE QUALITY IMPACT

The association of consistent assignment of Nurse Aides (NAs) with nursing home quality indicators is examined. Consistent assignment is defined as the same caregivers consistently caring for the same residents almost (80% of their shifts) every time they are on duty. Data used came from a survey of nursing home administrators, Nursing Home Compare, the Certification and Survey Provider Enhanced Reporting (CASPER) data, and the Area Resource File. All of the data was from 2015, and included 3,550 facilities. Several multivariate logistic regression models (using GEE) were used, including staffing variables (turnover, agency use, staffing levels), facility factors (size, ownership, occupancy rate), and market characteristics (competition, Medicaid rates). An average of 77% of nursing homes reported using at least some level of consistent assignment; although some were at low levels. In the multivariate analyses, accepted levels of consistent assignment were used. Turnover and family satisfaction quality were significantly (p<.01) better in facilities with the highest levels of consistent NA assignment. 7 of the 9 Quality Measures and 3 of the 5 Five-Star measures examined were significantly (p<.01) better in facilities with the highest levels of consistent NA assignment. Consistent assignment has developed as a preferred practice in nursing homes based on little empirical evidence. The findings presented here provide substantial justification for the use of this staffing practice for NAs.

MFBS: Multiple Factor Bandwidth Strategy Scheme for Anonymity Assessment

This paper proposes a multiple factor bandwidth strategy (MFBS), an anonymity assessment scheme based on bandwidth strategy. We first analyzed the path selection algorithm mechanism based on bandwidth strategy and anonymity constraint conditions and then elaborated the overall architecture and the key module design of the MFBS scheme. A detailed design was carried out so that it can be applied for the evaluation of Tor's anonymous communication system. Finally, according to the running data in the node resource file in the anonymous network, we analyzed anonymity from different dimensions. By evaluating the bandwidth consumed by Tor in the actual network, the anonymity of the Tor could be calculated, and a more comprehensive anonymity assessment could be performed.

Multitasking in Nursing Homes: Differences Between For-Profit and Nonprofit Quality Outcomes

Background and Objectives Nursing homes (NHs) in the United States face increasing pressures to admit Medicare postacute patients, given higher payments relative to Medicaid. Changes in the proportion of residents who are postacute may initiate shifts in care practices, resource allocations, and priorities. Our study sought to determine whether increases in Medicare short-stay census have an impact on quality of care for long-stay residents. Research Design and Methods This study used panel data (2005–2010) from publicly-available sources (Nursing Home Compare, Area Health Resource File, LTCFocus.org) to examine the relationship between a 1-year change in NH Medicare census and 14 measures of long-stay quality among NHs that experienced a meaningful increase in Medicare census during the study period (N = 7,932). We conducted analyses on the overall sample and stratified by for- and nonprofit ownership. Results Of the 14 long-stay quality measures examined, only one was shown to have a significant association with Medicare census: increased Medicare census was associated with improved performance on the proportion of residents with pressure ulcers. Stratified analyses showed increased Medicare census was associated with a significant decline in performance on 3 of 14 long-stay quality measures among nonprofit, but not for-profit, facilities. Discussion and Implications Our findings suggest that most NHs that experience an increase in Medicare census maintain long-stay quality. However, this may be more difficult to do for some, particularly nonprofits. As pressure to focus on postacute care mount in the current payment innovation environment, our findings suggest that most NHs will be able to maintain stable quality.

Research on a Scheme for Improving the Chord Routing Algorithm

The research and application on Peer-to-Peer (P2P) is a topical issue in the present computer network field. The current P2P systems can be separated into two types. One is structured and the other non-structured. The Structured P2P system is based on the principle of DHT which aims to solve some of the problems which exist in the Chord Routing Algorithm. It is a representative structured P2P system. This thesis puts forward a scheme for improving the system. Based on the structural improvement mentioned, this thesis presents a PHFChord system which can improve the file availability and routing efficiency as well as increase the speed of the requiring resource file. In this thesis, the design of PHF Chord system is explained in detail, including the routing strategy, the joining of new nodes and exiting of old nodes.

Association of a higher density of specialist neuroscience providers with fewer deaths from stroke in the United States population

Object Stroke is a leading cause of death and disability. Given that neurologists and neurosurgeons have special expertise in this area, the authors hypothesized that the density of neuroscience providers is associated with reduced mortality rates from stroke across US counties. Methods This is a retrospective review of the Area Resource File 2009–2010, a national county-level health information database maintained by the US Department of Health and Human Services. The primary outcome variable was the 3-year (2004–2006) average in cerebrovascular disease deaths per million population for each county. The primary independent variable was the combined density of neurosurgeons and neurologists per million population in the year 2006. Multiple regression analysis was performed, adjusting for density of general practitioners (GPs), urbanicity of the county, and socioeconomic status of the residents of the county. Results In the 3141 counties analyzed, the median number of annual stroke deaths was 586 (interquartile range [IQR] 449–754), the median number of neuroscience providers was 0 (IQR 0–26), and the median number of GPs was 274 (IQR 175–410) per million population. On multivariate adjusted analysis, each increase of 1 neuroscience provider was associated with 0.38 fewer deaths from stroke per year (p < 0.001) per million population. Rural location (p < 0.001) and increased density of GPs (p < 0.001) were associated with increases in stroke-related mortality. Conclusions Higher density of specialist neuroscience providers is associated with fewer deaths from stroke. This suggests that the availability of specialists is an important factor in survival after stroke, and underlines the importance of promoting specialist education and practice throughout the country.