Search PubMed⌕ Search

Biomedical subjects

B E Fries

Publications and source records attributed to B E Fries.

At least 55 records · Page 3Linked to original sources
PubMed1994

Activities of daily living and costs in nursing homes.

Functionality, as measured by activities of daily living (ADL), is the most important predictor of the cost of nursing home care. Data from a field-test version of the federally mandated Minimum Data Set (MDS) were examined using analysis of variance (ANOVA) and recursive partitioning methods to determine the relationships between ADL limitations and nursing cost (wage-weighted nursing time) among nursing home residents (n = 6,663). From this analysis, an index based on limitations in four ADLs was created. The developed ADL index is a readily determined measure of functional status useful in allocating nursing staff within nursing homes and in comparing the functional status of groups of residents, explaining 30 percent of variance in nursing costs among nursing home residents.

Activities of Daily Living↗
PubMed1993

Identifying elderly patients for early discharge after hospitalization for hip fracture.

BACKGROUND: Some elderly patients can be successfully treated in hospitals with lengths of stay (LOS) shorter than the norms developed by the diagnosis-related groups. This study was designed to test the hypothesis that elderly patients with short LOS after hip fracture have characteristics that can be identified shortly after hospital admission. METHODS: A retrospective chart review was performed of 216 patients over age 55 discharged alive from a university hospital after hip fracture. Demographic, medical, and functional data available within 48 hours of admission were used to develop an algorithm to identify patients eligible for early discharge. A prospective study of an additional 33 patients was undertaken to test this algorithm and to examine the predictive value of additional functional and psychosocial information not routinely recorded in the chart. RESULTS: Retrospective chart review identified 4 predictors of short LOS in multivariate analysis: age less than 75, admission from a nursing home, normality of admission laboratory results, and "no surgery or surgery by day three." These variables explain 25% of the total variation of LOS. In our prospective study the variable "day of surgery" had the greatest variance explanation (30.5%) in multivariate analysis. A model including day of surgery and the presence of dementia explained 42.5% of the variance of LOS. CONCLUSION: Short LOS can be predicted within 48 hours of admission utilizing data that measure severity of illness, functional status, and available support. The development of algorithms to identify patients eligible for early discharge would be beneficial to care managers.

Aged↗
PubMed1993

Mental dysfunction and resource use in nursing homes.

The role of dementia and other mental disorders in nursing home case-mix classification systems has been an area of controversy. The role of mental dysfunctions was considered in developing a new case-mix measurement system for facility payment in a national demonstration to understand staff time use in nursing homes. Nursing staff (nurses and aides) time and resident assessment data were collected for 6,663 nursing home residents in 6 states. Measures of signs and symptoms of cognitive impairment (dementia), depression, and delirium were created based on items from the new National Minimum Data Set. These measures then were used to determine whether mental dysfunctions were predictive of resource use (nursing staff times and costs) when controlling for other case-mix variables. Cognitive impairment was associated with slightly higher staff time only in less physically-impaired residents without serious medical conditions and not receiving heavy rehabilitation. Similarly, depression and delirium were associated with higher resource use only in selected types of residents. Based on these findings, the new Resource Utilization Groups Version III (RUG-III) contain a major category of residents who are cognitively impaired but not severely dependent in Activities of Daily Living. Depression is used to differentiate subgroups of residents with major medical conditions such as hemiplegia and aphasia. Delirium, when used together with other resident characteristics, was not found useful in explaining resource use. Case-mix groups defined by mental dysfunctions can foster improved care, but careful consideration must be given to appropriate incentives and documentation requirements for providers.

Aged↗
PubMed1993

How different are VA nursing home residents?

OBJECTIVE: To identify similarities and differences between VA nursing home residents and other nursing home residents. DESIGN: Comparison of cross-sectional data from three sources. PARTICIPANTS: Residents of VA nursing homes nationwide in early October 1986 (n = 10,117); participants in the 1985 National Nursing Home Survey (NNHS) (n = 5,243); residents assessed in New York State nursing homes in 1988 (n = 94,840). MEASURES: Age-stratified comparisons were made between the VA and the NNHS for gender, marital status, race, ethnicity, length of stay, activities of daily living (ADL) status, and selected diagnoses and conditions. Additionally, case-mix data were compared between the VA and the New York State populations. MAIN RESULTS: The population of VA nursing homes is overwhelmingly men (96.1% versus 28.4% in the NNHS), and 31.2% of the VA population is under 65 years of age compared with 11.6% in the NNHS. Young ( < 65) VA residents are considerably more impaired in ADL than young residents in the NNHS; differences are less pronounced in those over 65 years old. VA case mix is slightly higher than the overall New York State population though the distribution of residents into categories in the Resource Utilization Groups, Version II system is somewhat different. CONCLUSIONS: VA nursing homes contain a substantial distinctive population of seriously impaired residents under 65 years of age. Though differences exist, older VA residents have many similarities to residents of non-VA nursing homes and constitute a functionally impaired population that can provide insights into the status of nursing home residents generally.

Activities of Daily Living↗
PubMed1993

Length of stay in VA nursing homes. Comparative characteristics of brief-, medium-, and long-stay residents.

To examine the patterns and determinants of length of stay among residents of nursing homes of the Department of Veterans Affairs (VA), the authors conducted a retrospective follow-up study of all persons (n = 4,918) admitted to VA nursing homes between October 1986, and April 1987, using computerized records of the VA. Brief-stay (< 1 month; n = 1,139) residents had most often had previous admissions to VA nursing homes and were usually discharged alive from the nursing home. Medium-stay (1-6 months; n = 1,947) residents were the least functionally impaired and most likely to receive rehabilitative services. Long-stay residents (> 6 months; n = 1,832) were older and more functionally impaired than other residents. Medium- and long-stay residents of VA nursing homes most resembled "short-" and "long-stay" residents among non-VA nursing home residents, respectively. Brief-stay residents may be persons admitted for "respite" services or may be serial users of both VA and non-VA health services. Further study of this population may identify opportunities to decrease "revolving-door" use of nursing home services.

Activities of Daily Living↗
PubMed1993

Reducing the use of physical restraints in nursing homes: will it increase costs?

OBJECTIVES: Reducing the widespread use of physical restraints in nursing homes is a primary goal of the federal nursing home reforms enacted as part of the Omnibus Budget Reconciliation Act of 1987. However, some nursing home operators assert that reducing restraint use could be prohibitively expensive, costing payors perhaps as much as $1 billion annually. We investigated whether nursing home residents free from physical restraint require more care and resources than similar residents who are restrained. METHODS: We examined the major component of nursing home costs--staff time--and its allocation among residents who were physically restrained and those who were not restrained. The multivariate analysis used staff-time-study data on the care of 11,932 nursing home residents in 276 facilities in seven states. RESULTS: The analyses indicate that, when differences in impairment and care needs are controlled for, residents who are physically restrained require more nursing care than other residents. Higher levels of nursing-assistant time were consistently provided to restrained residents. CONCLUSIONS: Residents free of restraints are less costly to care for than restrained residents. The 1987 federal requirements concerning restraint use, which are aimed at improving quality of care and quality of life, can be implemented without engendering a major increase in care costs.

Aged↗
PubMed1993

A comprehensive payment model for short- and long-stay psychiatric patients.

In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated.

Acute Disease↗
PubMed1992

Predictors of the placement of cognitively impaired residents on special care units.

Nursing homes that have both special care units (SCUs) and traditional units were examined to determine the factors that cause homes to place cognitively impaired residents on the specialized units. Wandering, other problem behaviors, and Medicaid status were not significant predictors of placement. Logistic regression results indicated that functional status was the critical placement factor.

Activities of Daily Living↗
PubMed1992

The accuracy of the National Death Index when personal identifiers other than Social Security number are used.

This study analyzed the accuracy of the National Death Index when personal identifiers were used that included or excluded Social Security number. Computerized records of the Department of Veterans Affairs were used for comparison. Different combinations of identifiers other than Social Security number correctly identified from 83 to 92 percent of dead and 92 to 99 percent of living persons. These results should prove useful in ascertaining the mortality status of patient populations without information on Social Security numbers.

Databases, Factual↗
PubMed1992

Nursing home resident assessment and case-mix classification: cross-national perspectives.

Two broadly applied systems in the United States, the National Resident Assessment Instrument/Minimum Data Set and the Resource Utilization Groups, have provided new insight into the quality, delivery, and financing of nursing home care. In this article, the authors describe research efforts in eight other nations to translate, validate, and use one or both systems to understand their own long-term care systems. This consortium of studies, using common instruments, provides potential cross-national analyses that capitalize on differences in practice patterns and system designs to address critical policy issues.

Activities of Daily Living↗
PubMed1991

International comparison of long-term care: the need for resident-level classification.

Differences between long-term care facilities in Stockholm (1134 residents) and New York (95,000 residents statewide) were examined. The comparison employed a resident classification system, Resource Utilization Groups (RUG-II), which links individuals' characteristics to resource use. Distributions of Activity of Daily Living functionality and RUG-II categories demonstrated significant differences between these two populations, with the Stockholm facilities more akin to the heavier care skilled nursing facilities in New York. These differences may indicate different uses of long-term care beds in the United States and Sweden and demonstrate the need for resident-level classification systems in cross-national studies.

Activities of Daily Living↗
PubMed1990

Designing the national resident assessment instrument for nursing homes.

In response to the Omnibus Reconciliation Act of 1987 mandate for the development of a national resident assessment system for nursing facilities, a consortium of professionals developed the first major component of this system, the Minimum Data Set (MDS) for Resident Assessment and Care Screening. A two-state field trial tested the reliability of individual assessment items, the overall performance of the instrument, and the time involved in its application. The trial demonstrated reasonable reliability for 55% of the items and pinpointed redundancy of items and initial design of scales. On the basis of these analyses and clinical input, 40% of the original items were kept, 20% dropped, and 40% altered. The MDS provides a structure and language in which to understand long-term care, design care plans, evaluate quality, and describe the nursing facility population for planning and policy efforts.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1990

A classification system for long-staying psychiatric patients.

Data on a sample of 890 Veteran's Administration long-staying psychiatric patients were studied to develop a classification system that explains actual daily resource use. Disturbed patients with lengths of stay of less than three years and those with psychotic conditions who are not withdrawn represent the two groups found to use significantly more resources in their daily care. The Long-Stay Psychiatric Patient Classification (LPPC) System, with six categories, explains 11.4% of the variability in per diem resource use and can be used for case-mix adjustment of payments for psychiatric care.

Data Interpretation, Statistical↗
PubMed1990

Comparing case-mix systems for nursing home payment.

Case-mix systems for nursing homes use resident characteristics to predict the relative use of resources. Seven systems are compared in structure, accuracy in explaining resource use, group homogeneity, and ability to identify residents receiving heavy care. Resource utilization groups, version II (RUG-II), was almost uniformly the best system, although management minutes and the Minnesota case-mix system were also highly effective. Relative weights for case-mix groups were sensitive to cost differences and should be recomputed for new applications. Multiple criteria should be used in choosing a case-mix system, including consideration of inherent incentives and how residents' characteristics are defined.

Diagnosis-Related Groups↗
PubMed1989

A psychiatric patient classification system. An alternative to diagnosis-related groups.

It is generally accepted that diagnosis-related groups (DRGs) for alcohol, drug, and mental disorders are inappropriate for inpatient prospective payment. To address this issue, the Veterans Administration (VA) supported a project to construct alternative classes that are more clinically meaningful, more homogeneous in their resource use, and that account for more variation in resource use among psychiatric and substance use cases than existing DRGs. This paper reports on this project. Using a data set containing universally available discharge data plus behavioral, social, and functional information obtained by a survey of 116,191 discharges from VA psychiatric beds, and with AUTOGRP as the classifying algorithm, a classification system was formed. Twelve psychiatric diagnostic groupings (PDGs) were identified, analogous to major diagnostic groups in the DRG system. Within each PDG, from 4 to 9 terminal groups of Psychiatric Patient Classes (PPCs) were formed and validated. The 12 substance abuse PPCs explain greater than 31% of the variation in length of stay; for the mental disorder PPCs the variance explanation is greater than 11%, a substantial improvement over DRGs that, for the same data set, explain less than 2 and 3%, respectively. With the addition of only 5 variables beyond those presently included in discharge data sets, greater precision for payment purposes can be achieved. Implications for adoption of this classification system are discussed.

Algorithms↗
PubMed1989

Case-mix classification of Medicare residents in skilled nursing facilities: resource utilization groups (RUG-T18).

Medicare residents in Skilled Nursing Facilities (SNFs) represent a small but unique population about which little is known. Data collected in a national sample of 2,564 Medicare residents in 38 SNFs were used to derive a resident classification system appropriate for use in a payment system. The classification system, Resource Utilization Groups-Medicare (RUG-T18) explains 55.5% of the per-diem resource cost differences of Medicare SNF residents. No classification system could be derived to provide significant explanation of per-episode costs. Although Medicare residents are admitted to SNFs immediately following an acute stay that is paid according to their diagnosis-related groups, the DRGs were ineffective in explaining SNF resource costs.

California↗
PubMed1988

Case mix for nursing home payment: resource utilization groups, version II.

A study of 3,427 nursing home residents in New York State, measuring both resources used and resident characteristics, was used to develop a resident classification system for payment purposes. The system balances clinical, statistical, and administrative criteria, making it useful both for the New York State Medicaid payment system and for quality of care and facility management.

Activities of Daily Living↗