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Biomedical subjects

J H Swan

Publications and source records attributed to J H Swan.

At least 37 records · Page 2Linked to original sources
PubMed1993

Trends in Medicaid nursing home reimbursement: 1978-89.

Medicaid nursing home reimbursement is of concern because of implications for nursing home expenditures. This article presents data on State Medicaid nursing home reimbursement methods, ratesetting methods, and average per diem rates, refining earlier data and updating through 1989. A trend in the early 1980s toward adopting prospective systems played out by the end of the decade. There were trends, however, toward casemix methods, which may increase access for high-need patients, and toward cost-center limits on nursing, which may provide incentives to lower quality care. Analysis supports previous findings that prospective systems allow greater control over increases in rates.

Data Collection↗
PubMed1992

Reduction of glutamate release and protection against ischemic brain damage by BW 1003C87.

BW 1003C87, 5-(2,3,5-trichlorophenyl)-2,4-diaminopyrimidine ethane sulphonic acid, has been tested for its in vitro and in vivo effects on glutamate release in rat brain tissue, and for its cerebro-protective action in two rodent models of cerebral ischemia. In rat brain slices the release of glutamate evoked by veratrine is inhibited by BW 1003C87 (IC50 = 1.6 microM). In anaesthetised rats with microdialysis probes implanted in the dorsal hippocampus the increase in extracellular glutamate evoked by veratrine is markedly reduced by co-infusion of BW 1003C87, 100 microM. In anaesthetised rats with microdialysis probes implanted in the cortex and the caudate nucleus ipsilateral to a middle cerebral artery (MCA) occlusion the increase in dialysate glutamate concentration seen in the first 2 h following MCA occlusion is markedly attenuated by the prior administration of BW 1003C87, 20 mg/kg i.v. In rats subjected to 10 min of bilateral common carotid artery occlusion the loss of CA1 pyramidal neurons (assessed 7 days later) is reduced by administration of BW 1003C87 (20 mg/kg i.v., at the time of ischemia and 4 h later). The volume of cortex showing infarction 72 h after unilateral MCA occlusion is reduced by treatment with BW 1003C87 (20 mg/kg, i.v., beginning 5 min after occlusion). Inhibition of glutamate release may provide a therapeutic approach in cerebral ischemia as well as in epilepsy.

Animals↗
PubMed1992

Skilled nursing facility care for persons with AIDS: comparison with other patients.

We compared average daily hours of care for patients with and without acquired immunodeficiency syndrome (AIDS) in a hospital-based skilled nursing facility. Patients with AIDS averaged over an hour more direct nursing care per patient day (6.5 vs 5.4 hours). These findings support other reports of greater nursing time and higher costs of caring for nursing home patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Running as fast as they can: organizational changes in home health care.

During the 1980s, as the health care industry experienced what observers have dubbed a revolution, the home health industry also experienced its own transformation. Utilizing three organizational theories (neoinstitutional, resource dependency and population ecology), the authors report on a study of a probability sample of 163 home health agencies (HHAs) that were interviewed in 1986 and again in 1987 on the effects of Medicare policy changes including prospective payment (DRGs). This study tests hypotheses concerning the influence of environmental factors (e.g., state policy and characteristics of the local market) and organizational characteristics of the HHA (e.g., tax status and Medicare reliance) in explaining the propensity of HHAs to be (or become) parts of chains and/or multi-facility systems; and to develop particular types of interorganizational relations. The paper discusses the results in the context of public policy changes and the implications for future research and practice.

Data Collection↗
PubMed1991

In-home physician visits and large medical groups.

In-home care has grown rapidly in the past decade and has become increasingly complex. Accompanying these changes has been a resurgence of what was once thought to be an endangered if not extinct species, the physician house call. This paper is concerned with the involvement in the provision of physician home visits by large medical groups, and with how this involvement is related to the characteristics of the medical group. In December 1989, telephone interviews were conducted with 174 large medical groups (those with more than 50 physician members), representing a response rate of 73 percent of the universe of (239) groups found to fit study criteria. Of responding groups, 52 percent indicated that they provided physician home visits. Groups in states with higher proportions of population aged 85 years and over and groups that report accepting physician house calls are more likely to provide house calls. It is concluded that the provision of house calls by large medical groups is likely to increase with the greater complexity of in-home care, the shift of acute care into the home, and the rapid growth of the very old population.

Aged↗
PubMed1990

Protection by NMDA antagonists against selective cell loss following transient ischaemia.

We have administered antagonists acting competitively or noncompetitively at the N-methyl-D-aspartate receptor after a short period of incomplete ischaemia and evaluated selective neuronal loss in the CA1 region of the rat hippocampus. The competitive antagonists D-(-)-2-amino-7-phosphonoheptanoate (2APH); 100 or 330 mg/kg; 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonate (CPP); 3.3 or 10 mg/kg; and CGS 19755 (cis-4-phosphonomethyl-2-piperidine carboxylate) 3.3 or 10 mg/kg; and the noncompetitive antagonists MK801 [+)5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate), 0.3, 1, or 3 mg/kg, and dextrorphan, 2, 6, 18, or 54 mg/kg, were administered intraperitoneally 15 min and 5 h after a 10-min incomplete ischaemia period; additionally MK801 (1 or 3 mg/kg) and CGS 19755 (10 or 30 mg/kg) were administered 5 and 10 h postischaemia. Seven days after ischaemia, the brains were fixed by perfusion. CA1 pyramidal cell counts were performed on Nissl-stained sections using an ocular grid piece. Ventilated (no ischaemia) control animals had a mean of 406 +/- 13 CA1 neurones/3 grid lengths. Ischaemia reduced this mean to 157 +/- 23. A significant protective effect against this cell loss was seen after two injections (at 15 min and 5 h postischaemia) of 2APH, CPP (10 mg/kg), CGS 19755 (10 mg/kg), MK801 (1 mg/kg), and dextrophan (54 mg/kg). Delayed injection (5 and 10 h postischaemia) of CGS 19755 (10 and 30 mg/kg) and MK801 (1 and 3 mg/kg) did not provide any protection against pyramidal cell loss.

2-Amino-5-phosphonovalerate↗
PubMed1990

Ripple effects of PPS on nursing homes: swimming or drowning in the funding stream?

In a sample of 189 nursing homes, 83% reported that Medicare's hospital Prospective Payment System (PPS) impacts patient needs, 53% said it impacts both patients and services provided, and 25% said it impacts referrals to hospitals. The PPS effects were found to depend on the facility factors of size, Medicare certification, and tax status, and on the local market area factors of prevalence of PPS-nonexcluded hospital psychiatric units, competition, and levels of hospital discharges.

Aged↗
PubMed1990

Changes in aged populations served by home health agencies.

This article examines changes in clients served by home health agencies, and how changes are related to recent health care trends and local market structure. Two types of explanatory factors are examined: organizational measures and market factors. A theoretical model of isomorphism is tested, considering the effects of privatization within the context of the growth of chains and multifacility systems. Findings show that (a) system members are more likely than nonmembers to show increases in clients of all ages; (b) for-profits that are not system members are more likely to have increases in total clientele and in clients age 65-74, whereas for-profits' changes in clientele age 85 or over depends on their system membership--increasing among nonmembers, decreasing among members; and (c) agencies in states with home health "certificate of need" (CON) are more likely to have increases in clients age 65-74 and 85 and over. The results for total clientele and those age 65-74 support an isomorphism hypothesis.

Aged↗
PubMed1990

The share of Medicaid for nursing home care.

Over one-third of Medicaid dollars go to nursing homes, a share that is decreasing but that varies widely among the states. This paper examines demand, supply, and policy factors explaining interstate variation over time in the nursing home share of state Medicaid dollars. Nursing home bed stock shows strong effects; Medicaid expenditures for acute hospital and for ICF-MR care are important; and various demand factors also explain nursing home share. In this model, residual nursing home share of Medicaid declines over time, which is interpreted to reflect omitted state policy factors explaining state ability to constrain Medicaid nursing home utilization and expenditures.

Health Expenditures↗
PubMed1990

State Medicaid ICF-MR utilization and expenditures in the 1980-1984 period.

State Medicaid ICF-MR expenditures have shown a dramatic increase during the 1980-1984 period. The ICF-MR bed capacity declined slightly relative to the total state population, whereas the number of ICF-MR Medicaid recipients increased somewhat during the period. Regression analysis showed a strong positive relation with higher ICF-MR utilization and expenditures. Higher Medicaid reimbursement rates and greater proportions of employees who were unionized were also associated with higher state expenditures. Some states may be using limits on ICF-MR bed supply and reimbursement rates to constrain their overall Medicaid ICF-MR program costs.

Health Expenditures↗
PubMed1990

Medicare home health utilization as a function of nursing home market factors.

Rapid increases in the size and costs of the home health market, unknown impacts of Medicare's DRG hospital reimbursement on the posthospital market, and general lack of knowledge about factors that explain interstate variation in home health utilization all suggest the importance of developing and testing models of Medicare home health use. This article proposes and tests a model of state home health utilization as a function of the nursing home market. This model proposes that home health utilization is a function of nursing home bed capacity, of the utilization of nursing home beds by Medicaid patients, of other demand factors, and of supply factors. This model is supported by the data. Specifically, Medicare home health use in the 1978-1984 period was found to be negatively related to nursing home bed stock, positively related to Medicaid nursing home utilization, and related to several other supply and demand factors, as hypothesized by the model. The further model assumption that home health utilization does not affect the nursing home market could not be tested in this analysis, but will be addressed in future research by the authors.

Aged↗
PubMed1989

Geriatric services: community mental health center boon or bane?

The fragmented and uncoordinated development of federal and state mental health policy for the aged, the lifting of federal mandates for CMHC service emphases on the aged, and the underutilization of CMHC services by the aged all raise the issue of the implications of CMHCs emphasis on services to elderly clients. We hypothesized that CMHCs with increases in aged clientele would fare worse in terms of budgets, services, and staffing than those that did not report increases in elderly clientele. The findings are more complex in that, compared to centers with no change in aged clientele, CMHCs fared better when they either had decreases in aged clientele (as expected) or increases in such clientele (in contradiction to the hypothesis), although the former relationship was stronger. These findings are interpreted in terms of the need for CMHCs to specialize either on the aged or on other client populations. Such specialization, and the stronger effect for de-emphasis on the aged, suggest greater barriers to access of the aged to community mental health care.

Aged↗
PubMed1989

State Medicaid reimbursement for ICF-MR facilities in the 1978-1986 period.

Medicaid policies for Intermediate Care Facilities for the Mentally Retarded (ICF-MR) are important because of rapid expenditure growth. Our study of 1978-1986 state Medicaid ICF-MR reimbursement policies showed massive shifts from traditional retrospective reimbursement methods, paralleling changes in reimbursing skilled nursing facility and ICF care. Meanwhile, Medicaid per diem ICF-MR reimbursement rates increased about 67%. Regression analysis showed that personal income, population percentage in poverty, unionization, and percentage of ICF-MR beds in government facilities influenced rates positively, whereas prospective class and combination reimbursement methods negatively affected rates. Thus, within the context of economic factors, government involvement in care and the reimbursement methodology are policies found to affect rates.

Humans↗
PubMed1988

Long-term development of selective neuronal loss and the mechanism of protection by 2-amino-7-phosphonoheptanoate in a rat model of incomplete forebrain ischaemia.

Excitatory neurotransmission at the N-methyl-D-aspartate (NMDA) receptor is selectively blocked by 2-amino-7-phosphonoheptanoate acid (2-APH). Acute focal microinjection of 2-APH into the rat hippocampus partially protects against cytopathology developing in selectively vulnerable neurons after 30 min of ischaemia and 2 h of reperfusion. We show that this protective action of 2-APH does not involve alterations in local cerebral blood flow (CBF). Intermediate cytopathology and long-term neuronal survival has been assessed in rats receiving focal injections of (+/-) 2-APH, 20 micrograms in 1 microliter, into one dorsal hippocampus prior to and 4 and 10 h after a 10-min period of forebrain ischaemia. Cytopathology assessed 4 or 24 h after ischaemia shows no difference between the buffer and 2-APH-injected hippocampi. Assessment after 7 days survival shows a significant protection against neuronal loss in the CA1 zone of the 2-APH-injected hippocampus compared with the contralateral, buffer-injected hippocampus. Systemic injection of D(-)2-APH (675 mg/kg i.v. at 0 h, 4 h, and 10 h) affords significant protection to CA1 hippocampal neurones (as assessed after 7 days). These results suggest that maintained blockade of neurotransmission at the NMDA receptor in the postischaemic period can protect against delayed cell loss. The mechanism may be through antagonism of the excitotoxic action of an endogenous neurotransmitter acting in the postischaemic period.

2-Amino-5-phosphonovalerate↗
PubMed1988

State Medicaid reimbursement for nursing homes, 1978-86.

State Medicaid reimbursement methods and rates are reported for the period 1978-86 for skilled nursing and intermediate care facilities. A cross-sectional time series regression analysis of Medicaid reimbursement rates on methods showed that States using prospective class reimbursement had significantly lower rates for the period 1982-86. States using prospective facility-specific reimbursement methods had lower rates than retrospective methods in 1983-84.

Data Collection↗
PubMed1988

Nursing home bed capacity in the States, 1978-86.

Trends in nursing home bed supply in the States show large variations in beds per population and a gradual decline in supply per aged population. A cross-sectional time-series regression analysis was used to examine some factors associated with nursing home bed supply. Variation was accounted for by economic factors, supply of alternative services, and climate. State Medicaid reimbursement rates had negative coefficients, with supply suggesting States may be increasing rates to improve access where supply is limited. Medicaid waiver policy was not found to be significant.

Data Collection↗
PubMed1987

An adenosine analogue, 2-chloroadenosine, protects against long term development of ischaemic cell loss in the rat hippocampus.

Delayed ischaemic damage was assessed by light microscopy following 10 min of incomplete forebrain ischaemia and 7 days of reperfusion. Iterative focal injections of 2-chloroadenosine, a stable analogue of adenosine, protect against selective hippocampal CA1 loss (P less than 0.01), when given either immediately before ischaemia and after 4 and 10 h of reperfusion or after 1 min, 4 h and 10 h of reperfusion. Delayed focal injection of 2-chloroadenosine after 10 and 24 h of reperfusion fails to protect against CA1 cell loss. The mechanism of cerebroprotection may involve attenuation of excitatory neurotransmission.

2-Chloroadenosine↗