Biomedical subjects

Kathleen K Brody

Publications and source records attributed to Kathleen K Brody.

6 recordsLinked to original sources

PubMed2006

Advanced illness index: Predictive modeling to stratify elders using self-report data.

OBJECTIVES: Develop a prediction model to identify persons who have an increased risk of dying within the next 36 months, in order to focus additional resources and assessment in areas related to advanced care planning. DESIGN: Retrospective study with a 3-year observation period. SETTING: Integrated, not-for-profit managed care organization. PARTICIPANTS: Beneficiaries aged 65-105 responding to an annual survey (n = 4888). MEASUREMENTS: Survey instrument includes physical function, geriatric syndromes, health care utilization, special equipment use, self-care deficits, caregiving responsibilities, and general health problems. RESULTS: An 11-variable model changed the baseline chi2 from 315.71 (df = 1) to 742.511 (df = 11). The percent of subjects correctly classified was 74.3% and the negative predictive value was 92.2%. CONCLUSION: Advanced Illness Index (AII) model is stable. Characteristic variables used are not easily reversed: the 1997 cohort classified as at-risk consistently remained at risk or died in the subsequent years (1998, 92%; and 1999, 96%) and 92% of those not at-risk survived the next 36 months. Persons at high risk should at a minimum be made aware of the types of integrated home and community-based services available to them should it be needed. They also should be targeted for elicitation of treatment preferences, values, designation of health care proxy, planning, and advanced care directives.

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PubMed2005

Usefulness of a single item in a mail survey to identify persons with possible dementia: a new strategy for finding high-risk elders.

The objective of this study was to examine the characteristics of elderly persons who responded positively to a question about "severe memory problems" on a mailed health questionnaire yet were missed by the existing health risk algorithm to identify vulnerable elderly persons. A total of 324,471 respondents aged 65 and older completed a primary care health status questionnaire that gathered clinical information to quickly identify members with functional impairment, multiple chronic diseases, and higher medical care needs. The respondents were part of a large, integrated, not-for-profit managed care organization that implemented a model of care for elders using a uniform risk identification method across eight regions. Respondents with severe memory problems were compared to general respondents by morbidity, geriatric syndromes, functional impairments, service utilization, sensory impairments, sociodemographic characteristics, and activities of daily living. Of the respondents, 13,902 persons (4.3%) reported severe memory problems; the existing health risk algorithm missed 47.1% of these. When severe memory problems were included in the risk algorithm, identification increased from 11% to 13%, and risk prevalence by age groups ranged from 4.4% to 40.5%; one third had severe memory problems, a finding that was fairly consistent within age groups (28.4% to 36.5%). A question about severe memory problems should be incorporated into population risk-identification techniques. While false-negative rates are unknown, the false-positive rate of a self-report mail survey appears to be minimal. Persons reporting severe memory problems clearly have multiple comorbidities, higher prevalence of geriatric syndromes, and greater functional and sensory impairments.

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PubMed2003

Community-based care and risk of nursing home placement.

OBJECTIVE: To test the substitution hypothesis, that community-based care reduces the probability of institutional placement for at-risk elderly. RESEARCH DESIGN: The closure of the Social Health Maintenance Organization (Social HMO) at HealthPartners (HP) in Minnesota in 1994 and the continuation of the Social HMO at Kaiser Permanente Northwest (KPNW) in Oregon/Washington comprised a "natural experiment." Using multinomial logistic regression analyses, we followed cohorts of Social HMO enrollees for up to 5 years, 1995 to 1999. To adjust for site effects and secular trends, we also followed age- and gender-matched Medicare-Tax Equity and Fiscal Responsibility Act (TEFRA) cohorts, enrolled in the same HMOs but not in the Social HMOs. SUBJECTS: All enrollees in the Social HMO for at least 4 months in 1993 and an age-gender matched sample of Medicare-TEFRA enrollees. To be included, individuals had to be alive and have a period out of an institution after January 1, 1995 (total n = 18,143). MEASURES: The primary data sources were the electronic databases at HP and KPNW. The main outcomes were long-term nursing home placement (90+ days) or mortality. Covariates were age, gender, a comorbidity index, and geographic site effect. RESULTS: Adjusting for variations in the 2 sites, we found no difference in probability of mortality between the 2 cohorts, but approximately a 40% increase in long-term institutional placement associated with the termination of the Social HMO at HealthPartners (odds ratio, 1.43; 95% confidence interval, 1.15-1.79). CONCLUSIONS: The Social HMO appears to help at-risk elderly postpone long-term nursing home placement.

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PubMed2003

Integrating prenatal-postnatal smoking interventions into usual care in a health maintenance organization.

Consistent with the increasing national emphasis on providing health promotion in clinical care settings, Stop Smoking for OuR Kids (STORK), a research-derived, prenatal-postnatal smoking cessation intervention, was implemented throughout prenatal clinics, inpatient postpartum services, and pediatric clinics of Kaiser Permanente Northwest. Process data collected during the project rollout and maintenance to monitor the clinical practices of clinicians and staff members, patient responses to the intervention, and penetration of the intervention into the health maintenance organization priority population of prenatal smokers high-lighted barriers to intervention delivery. These barriers fell into three categories related to the smoking intervention design, clinicians and staff members, and the organization. By monitoring the intervention implementation process, such problems were identified early. This allowed for implementing strategies to overcome many of these barriers and to assess their effectiveness. Keys to implementation success included simplifying the intervention activities, considering stakeholder needs, and providing tangible organizational resources and goals.

Continuity of Patient Care↗

PubMed2002

A comparison of two methods for identifying frail Medicare-aged persons.

This article compares the efficacy of two screening methods to identify frail Medicare-aged persons using self-report questionnaire data: a clinical judgment method developed by nurse and social worker professionals in a community-based long-term care department and an empirical research method previously developed by the Center for Health Research using computer formulas and stepwise logistic regression coefficients. A sub-aim was to see whether the empirical method proved robust over time by measuring aggregate utilization and mortality in frail and nonfrail cohorts, which would increase the interest of physicians, managed care organizations, and other agencies providing service to Medicare beneficiaries.

Activities of Daily Living↗

PubMedDate not supplied

Depression, functional status, treatment for psychiatric problems, and the health-related practices of elderly HMO members.

PURPOSE: To study relationships between depression, functional limitations, psychiatric treatment, and the health-related practices of elderly individuals. DESIGN: Cross-sectional, observational study based on survey data (response rate = 90%) analyzed using multiple linear and logistic regression models. SETTING: Kaiser Permanente Northwest, a large nonprofit HMO. SUBJECTS: Medicare members (4615) aged 65-103 years who responded to a health status survey. MEASURES: Depression, health and functional status, frequency of alcohol consumption, smoking status, advance medical directive completion, influenza or pneumonia vaccinations, mammograms, recent psychiatric treatment, and attempts to lose weight or increase exercise. RESULTS: Self-reported depression was related to a greater risk of smoking (odds ratio [OR] = 1.54). Health-related functional limitations were related to fewer attempts to change health behaviors and less preventive service use (significant ORs ranged from 0.84 to 0.94). Minority group membership and Supplemental Security Income were negatively associated with better health practices and with completing advance medical directives (ORs 0.41 and 0.79, respectively). Falls in the prior year, more prescription medications, and psychiatric treatment were positively associated with better health practices (significant ORs ranged from 1.12 to 1.88). CONCLUSIONS: Depression and smoking are associated among elderly individuals, as are psychiatric treatment and attempts to lose weight. Those with functional limitations, minority status, or Supplemental Security Income use fewer preventive services; the latter two groups are less likely to complete advance medical directives. Older adults with these characteristics might need assistance in improving health-related practices.

Adaptation, Psychological↗