Search PubMed⌕ Search

Biomedical subjects

V L Greene

Publications and source records attributed to V L Greene.

At least 19 recordsLinked to original sources
PubMed1998

Can home care services achieve cost savings in long-term care for older people?

OBJECTIVE: To determine whether efficient allocation of home care services can produce net long-term care cost savings. METHODS: Hazard function analysis and nonlinear mathematical programming. RESULTS: Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. DISCUSSION: Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

Aged↗
PubMed1995

Reducing nursing home use through community long-term care: an optimization analysis.

Can community services be made more effective in reducing nursing home use through better management of their mix and allocation? To test this idea, we used data from the National Long-Term Care Channeling Demonstration to estimate logistic regression models relating the use of various types of community services to nursing home use. We then used these estimates to form an objective function for a mathematical optimization procedure which minimizes total expected population nursing home use as a function of community service use, subject to a total expenditure constraint. We find through this simulated reallocation that, in theory, significant reductions in nursing home use can be produced without increasing total community expenditures.

Aged↗
PubMed1993

The cost-effectiveness of community services in a frail elderly population.

We use an integrated model incorporating simple principles of decision analysis and marginal cost analysis to discuss cost-effectiveness of community long-term care services as a substitute for nursing home care. By taking individuals as the unit of analysis and analyzing different types of community services separately, the model defines the targeting issue precisely and permits key policy parameters to be estimated empirically. When applied to data from the National Long Term Care Channeling Demonstration, 41% of those screened into the control group were found to have some potential for net long-term care cost reduction through program services.

Aged↗
PubMed1992

Caregiver support groups: factors affecting use of services.

Use of time-limited psychoeducational support groups by family caregivers to help frail elderly people in the community reflects a mixture of predisposing, enabling, and need factors. Using multivariate regression methods that control for dependent-variable censoring, the authors found that attendance in support groups by primary caregivers was greater for those who were older, who had a secondary informal caregiver involved in providing care, or who had significant health problems. Attendance was greater also for those caring for Alzheimer's victims and for those experiencing higher levels of burden in their caregiving role. In English-language groups, Mexican American caregivers showed markedly lower attendance than Anglo American caregivers, but in Spanish-language groups attendance by Mexican American caregivers was essentially the same as that of the Anglo Americans in English-language groups. Data for this study are from a federally funded support group demonstration project conducted in a southwestern metropolitan area.

Age Factors↗
PubMed1990

Risk factors for nursing home admissions and exits: a discrete-time hazard function approach.

Discrete-time hazard functions were estimated to determine factors associated with the probability of admission to a nursing home from the community, and the probability of discharge to the community from nursing home care, for 3,332 individuals enrolled in The National Long Term Care Channelling Demonstration. This was a relatively frail elderly population assessed to be at high risk for nursing home use. In predicting admissions, major factors were found to be ethnicity (Blacks and Hispanics were at much lower risk), homeownership, advancing age, living alone, exhibiting higher cognitive and functional impairment levels, physician use, and living in an area with a larger nursing home bed supply. The probability of being discharged alive was predicted by several factors, including ethnicity (Blacks being less likely to be discharged), homeownership, being of younger age, better (self-rated) health, functional and cognitive capacities, and medical acuity.

Activities of Daily Living↗
PubMed1989

The effect of a support and education program on stress and burden among family caregivers to frail elderly persons.

An eight-week professionally guided caregiver support group program was found to produce statistically significant reductions in anxiety, depression, and sense of burden among family caregivers to frail elderly persons living in the community. Effects were weaker four months after the intervention ended than immediately after, but reductions in anxiety and depression were still evident.

Adult↗
PubMed1987

Nursing home admission risk and the cost-effectiveness of community-based long-term care: a framework for analysis.

The relationship of prior risk of nursing home entry among applicants for community-based long-term care (CB/LTC) services to cost-effective admission decisions is investigated using decision analytic techniques. It is shown that using such evaluation criteria as have predominated in the major CB/LTC demonstrations, the necessary minimum level of prior risk is well above that typical of those actually enrolled. It is further shown that the remedy usually proposed, increasing the rigor and accuracy of enrollment screening, is unlikely to be of much practical effect. A case can be made, however, for defining the benefits of CB/LTC more broadly, in which case it may become cost-effective to enroll lower-risk applicants.

Aged↗
PubMed1984

Comparative utilization of community based long term care services by Hispanic and Anglo elderly in a case management system.

Utilization of formal and informal supports by Hispanic and Anglo (white, non-Hispanic) elderly enrollees in a comprehensive case management system was compared. It was found that Hispanic elderly, on the average, used significantly fewer agency services than did Anglo elderly, despite a tendency to exhibit higher levels of impairment. Hispanic elderly utilized significantly higher levels of informal support, however, and this may be a mediating factor in their lower use of agency services. Policy implications of these findings are discussed.

Activities of Daily Living↗
PubMed1983

Substitution between formally and informally provided care for the impaired elderly in the community.

This article assesses the extent to which formally provided comprehensive community care tends to substitute for informal care provided by family and friends to impaired elderly persons living in the community. Using simultaneous equations causal modeling techniques to control for selective targeting and other intervening factors, results, indicate a substantial tendency for formally provided care to be substituted for informal care. Other results indicate that unmet need appears to be the major variable predicting both informal and formal support levels, with informal care providers appearing to be somewhat more precise in conditioning support levels on need than formal care providers. Policy implications of these findings are discussed.

Activities of Daily Living↗
PubMed1981

Inconsistency in level of care assignment decisions in skilled nursing facilities.

In Arizona, a non-Medicaid state, we investigated the extent to which unregulated level of care assignments in Skilled Nursing Facilities consistently reflect level and nature of patient impairment. Using Multiple Discriminant Analysis (MDA) to develop optimal prediction functions, approximately 70 per cent of patients could be correctly classified. Factors identified by MDA as discriminating among patients at different levels of care are an Activities of Daily Living (ADL) impairment factor, and a factor defined by confusion, transitory contact with the social environment, and propensity to wander. Results are compared with those of studies using MDA to replicate Multidisciplinary Review Team (MRT) or other expert level of care assignments intended to develop patient classification functions for clinical use. MRT assignments appear to reflect patient impairment characteristics only slightly better than do unregulated institutional assignments, suggesting that such utilization review efforts may result in minimal net gains in appropriateness of placement.

Arizona↗