Utilization and Expenditures of High-Need, High-Cost Older Adults With Disabilities

The factors that lead people to have high needs for care can vary greatly, with implications for the best approaches to serving their needs. One high need group of interest is older adults with disabilities and multiple comorbidities. There is variation in need within this group. Of particular interest is the subset that is both high need and high cost (HNHC). We present work describing Medicare and Medicaid utilization and expenditures for this high need group and the HNHC subset. Over 7.6 million people were identified as high need; 13.6% of them also were defined as HNHC. Patterns of utilization differed between these groups, with the HNHC group more likely to use inpatient care and nursing home care, but less likely to use community-based long-term services and supports. These findings have implications for the development of care models that might best meet the needs of this population.

Emergency Department Utilization Patterns Among Physical Elder Abuse Victims in Comparison to Other Older Adults

Background Physical elder abuse is common and has serious health consequences. Little is known, however, about the patterns of health care utilization among these victims, including whether opportunities may exist for earlier identification and intervention. Our goal was to describe Emergency Department (ED) utilization known physical elder abuse victims compared with non-victims. Methods We used Medicare insurance claims to examine ED utilization patterns among a well-characterized cohort of 139 known physical elder abuse victims in the year before abuse was identified and compared this to control subjects matched on age, sex, race, and residential zip code. Results Physical elder abuse victims were significantly more likely than control subjects to visit the ED (47.5% vs. 35.9%, p=0.01) during the year before identification and to have at least one visit for an injury-related complaint (14.4% vs. 8.3%, p=0.03). Victims were also more likely to have multiple visits (18.7% vs. 14.6%, p=0.24), visit multiple EDs (7.9% vs. 6.7%, p=0.63), or be high frequency utilizers (≥4 visits, 3.6% vs. 2.7%, p=0.58), but differences did not reach statistical significance. The most common diagnoses in ED visits among victims were: open wound of knee/ankle, exacerbation of chronic bronchitis, pneumonia, and chest pain. Conclusion This work provides preliminary evidence that physical elder abuse victims use the ED more frequently and potentially have different patterns of utilization than other older adults. We plan to further characterize these different patterns to potentially to use them to develop tools for earlier identification.

REGULATIONS FOR MANAGEMENT OF WAKF ASSETS BY STAKEHOLDERS IN TANJUNG JABUNG TIMUR REGENCY, JAMBI PROVINCE

In Law Number 41 of 2004 concerning waqf and Government Regulation Number 42 of 2006 concerning the implementation of Law Number 41 of 2004 concerning waqf which regulates immovable and movable waqf to provide opportunities for those whose lives are simple but want to do good. Of the eleven City Regencies in Jambi Province, one of them is Tanjung Jabung Timur Regency. Tanjung Jabung Timur Regency has 11 sub-districts, 20 sub-districts and 73 villages (out of a total of 141 sub-districts, 163 sub-districts and 1,399 villages throughout Jambi). In 2017, the population was 222,834 people with an area of 5,445.00 km² and a population distribution of 41 people/km². The research methodology used is sociological/empirical research and uses a qualitative approach, referring to all regulations or laws and regulations relating to the legal issues under study, namely research on the norms contained in the Qur'an and Al-Hadith. The results of the study, namely the regulation of waqf property management, show that the current waqf property management regulatory system is a pattern of regulation of waqf property management which is still considered traditional-consumptive. This can be known through several aspects: Leadership, Recruitment of nazira human resources, Operationalization of empowerment, Patterns of utilization of results, and control and accountability systems.

Design of the RESILIENT Study: Rehabilitation at home using mobile health in older adults after hospitalization for ischemic heart disease (Preprint)

UNSTRUCTURED ABSTRACT Background: Participation in ambulatory cardiac rehabilitation (CR) remains low, especially among older adults. While mobile health CR (mHealth-CR) provides a novel opportunity to deliver care, age specific impairments may limit older adults’ uptake, and efficacy data are currently lacking. Methods/Design: The RESILIENT trial (NCT03978130) is a multicenter randomized clinical trial that is enrolling patients age ≥65 with ischemic heart disease in a 3:1 ratio to either intervention (mHealth-CR) or control (usual care), with a target sample size of 400 participants. mHealth-CR consists of a commercially available mHealth software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcomes is change in functional mobility (6 minute walk distance) which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand characteristics that determine different patterns of utilization (e.g. persistent high engagement, declining engagement). Discussion: The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains, as well as characteristics that determine sustained utilization of mHealth-CR. These findings will help in designing future precision medicine approaches to mHealth implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic which has shifted much of healthcare to the virtual setting.

Type 1 Diabetes Management With Technology: Patterns of Utilization and Effects on Glucose Control Using Real-World Evidence

<b>Key Points</b> <p>· About one-third of patients with type 1 diabetes were found to use continuous glucose monitoring (CGM) and/or continuous subcutaneous insulin infusion (CSII) in routine clinical care.</p> <p>· Disparities exist in CGM and CSII adoption, with device use more common in patients of higher socioeconomic status.</p> <p>· Mining clinical narratives with natural language processing techniques can be applied successfully for medical device surveillance and cohort identification for observational studies.</p> <p>· CGM use in conjunction with CSII after type 1 diabetes diagnosis is more effective than other therapy regimens and may translate to improved long-term glycemic control. </p>

Type 1 Diabetes Management With Technology: Patterns of Utilization and Effects on Glucose Control Using Real-World Evidence

<b>Key Points</b> <p>· About one-third of patients with type 1 diabetes were found to use continuous glucose monitoring (CGM) and/or continuous subcutaneous insulin infusion (CSII) in routine clinical care.</p> <p>· Disparities exist in CGM and CSII adoption, with device use more common in patients of higher socioeconomic status.</p> <p>· Mining clinical narratives with natural language processing techniques can be applied successfully for medical device surveillance and cohort identification for observational studies.</p> <p>· CGM use in conjunction with CSII after type 1 diabetes diagnosis is more effective than other therapy regimens and may translate to improved long-term glycemic control. </p>