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Biomedical subjects

V Mor

Publications and source records attributed to V Mor.

At least 181 records · Page 10Linked to original sources
PubMed1985

An examination of the relationship of reimbursement and organizational structure to the use of hospice volunteers.

This article examines the use of volunteers in hospice based on a national study of hospice programs. The data collected as part of the study make it possible to address several questions related to the prevalence and role of volunteers. Does the prevalence of volunteers decrease with the availability of reimbursement for hospice services? Is reimbursement related to a shift in the types of activities performed by volunteers? Is the level of volunteer involvement and the mix of volunteer activities related to type of hospice organization? Although it was hypothesized that volunteer activities would shift to non-patient-related tasks with the availability of reimbursement, this was not found to be the case. The availability of Medicare reimbursement for hospice services was not related to a decrease in the ratio of volunteers to paid staff. Freestanding hospices utilized volunteers to a greater degree than institution-affiliated hospices.

Data Collection↗
PubMed1985

Staff burnout in a hospice setting.

Burnout is a job-related state characterized by emotional and physical exhaustion which can be caused by intense involvement over an extended period of time with people who are experiencing psychological and/or physical problems. People working in the health care professions have been identified as being particularly at risk for experiencing burnout. Based on hospice staff survey data collected as a part of the National Hospice Study (NHS), this paper describes multivariate analyses of selected demographic, occupational, and organizational predictors of burnout. Findings indicated that younger, better-educated staff are more prone to burnout, as are staff who work on a full-time basis in direct contact with patients. None of the hospice organizational factors tested were significantly related to burnout. Further research is necessary to determine whether or not such factors as staff support systems are effective in mitigating burnout among staff in the health care field.

Adolescent↗
PubMed1985

The cost of residential care homes serving elderly adults.

Given increasing expenditures for long-term nursing home care costs, the residential care home (RCH) provides a viable alternative for elderly Americans requiring daily supervision but not extensive care. Purposive and random sampling procedures were used to select 181 RCHs serving the elderly in five states in order to analyze their expenditures. Home operator interviews yielded facility and patient descriptors as well as expenditure data. Analyses of these data revealed total expenditures per resident month to be $330 in 1980 dollars. Based on multivariate analyses, measures of resident case mix were significantly related to food costs but not to staffing costs. Findings suggest that small homes commit more resources to resident care since operator labor is not an expenditure.

Aged↗
PubMed1985

Patient predictors of hospice choice. Hospital versus home care programs.

Research findings indicate cost savings associated with home care hospices, while hospital-based hospices can be as expensive as conventional care. Based on National Hospice Study data, this article identifies the characteristics of patients admitted to hospital-based and home care hospices in those areas of the country where a choice of hospice model was possible. Multivariate logistic regression indicates that the significant discriminating factors between the two patient populations relate to the availability of supportive care at home and the severity of nursing care problems at the time of hospice entry. Reinforcing selected pre-existing differences, an examination of prehospice had longer episodes of care than was the case for home care hospice patients.

Activities of Daily Living↗
PubMed1985

Relationship between age at diagnosis and treatments received by cancer patients.

Increases in cancer incidence and mortality reflect the larger numbers of elderly in the population. Using a mortality sample of 1891 biopsy-confirmed cancer patients, analyses reveal older breast, prostate, and cervical-uterine cancer victims were more likely to be diagnosed with metastases. Logistic regression analyses of subsamples of breast (N = 224), lung (N = 513), and colorectal (N = 299) cancer patients indicate that age is significantly inversely related to receipt of both subsequent chemotherapy and radiation therapy, controlling for stage of disease and presence of co-morbid disease. Exceptions to this relationship are the use of radiation therapy among nonmetastatic lung cancer patients and all breast cancer patients. The implications of these findings for current cancer control programs are discussed.

Adult↗
PubMed1985

Terminally ill patients' and families' responses to participation in a research study.

Evaluations of the effect of interventions on the terminally ill focus on outcomes such as patient satisfaction and quality of life. Due to the theoretical nature of these measures, researchers must rely on patients and family members as primary data sources. Family members of terminally ill patients wee queried concerning their motives for participation in the National Hospice Study and their reactions to an intensive interview schedule. Of those contacted, 94% agreed to the interview. The most frequently cited reasons for participating in the study were the desire to help other families facing a serious illness and the desire to help the hospice movement. Responses indicated a real enthusiasm for study participation in spite of the stressful nature of the terminally ill patient's situation.

Family↗
PubMed1985

An examination of the effect of reimbursement and organizational structure on the allocation of hospice staff time.

The unique needs of the terminally ill patient may require more planning and service coordination than those of the non-terminal patient. The hospice interdisciplinary team was a response to these additional needs. This paper examines the pattern of patient care and administrative activities of paid hospice staff by hospice organizational type and demonstration status in the National Hospice Study. Data gathered over a one year period revealed that demonstration hospices, in which all allowable costs were Medicare reimbursed, spent significantly more time in general and patient related administrative activities than non-demonstration hospices, which operated within existing Medicare cost limits. Staff in demonstration home care-based hospices reported significantly longer home visits than staff in non-demonstration hospices. In both groups, home care-based hospice visits were of longer duration than those home visits conducted by staff of hospital-based hospices.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1985

Cost savings in hospice: final results of the National Hospice Study.

Medicare inpatient and home care costs over the last year of life of terminal cancer patients served in two types of hospices and in conventional care (CC) were compared as a part of the National Hospice Study (NHS). Both home care (HC) and hospital-based (HB) hospice patients had lower costs in the last month of life than did CC patients. HC patients substituted home care for inpatient care, yielding cost savings for lengths of hospice stay of up to 1 year. Although HB patients added home care to relatively high levels of inpatient care, their ancillary costs per inpatient day were significantly lower than those of CC patients. Thus, HB costs over the last year of life were also somewhat less than those of CC. The size of the savings associated with hospice care is sensitive to the type of hospice and the length of stay distribution of patients served; patients served longer have significantly higher costs in the last year of life.

Aged↗
PubMed1984

The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting.

The Karnofsky Performance Status Scale (KPS) is widely used to quantify the functional status of cancer patients. However, limited data exist documenting its reliability and validity. The KPS is used in the National Hospice Study (NHS) as both a study eligibility criterion and an outcome measure. As part of intensive training, interviewers were instructed in and tested on guidelines for determining the KPS levels of patients. After 4 months of field experience, interviewers were again tested based on narrative patient descriptions. The interrator reliability of 47 NHS interviewers was found to be 0.97. The construct validity of the KPS was analyzed, and the KPS was found to be strongly related (P less than 0.001) to two other independent measures of patient functioning. Finally, the relationship of the KPS to longevity (r = 0.30) in a population of terminal cancer patients documents its predictive validity. These findings suggest the utility of the KPS as a valuable research tool when employed by trained observers.

Activities of Daily Living↗
PubMed1984

Burnout among hospice staff.

Is burnout common among health care personnel dealing with situations of great emotional intensity? This study surveyed personnel in 40 hospices to examine the components of burnout among those who work with the terminally ill. Although the overall burnout among staff was found to be relatively low, a higher than average measure of burnout was recorded among employees with high educational levels, long tenure, and full-time status.

Adult↗
PubMed1984

Psychiatric history as a barrier to residential care.

Bias against individuals with a history of psychiatric hospitalization can block their access to residential care homes and thus impede deinstitutionalization efforts. After surveying home operators in nine residential care programs in five states, the authors found that providers tend to accept a physically impaired client over one with behavioral problems or a history of psychiatric hospitalization. The authors also point out that actual admission practices may not reflect facility policies. For example, more than 30 percent of the operators said they admitted persons with behavioral problems or psychiatric histories, yet no such persons resided in their homes. The authors suggest strategies such as provider education and financial incentives to combat the operator's bias against former mental patients.

Aged↗
PubMed1984

Utilization and charges for terminal cancer patients in Rhode Island.

A population-based sample of 2,104 terminal cancer patients who died in Rhode Island during 1980-1981 was created by merging death certificates, the claims of Medicare and non-Medicare health insurance beneficiaries served by Blue Cross and Blue Shield of Rhode Island, and records of the state's only hospice. The data collected included utilization and charges for services rendered by hospitals, nursing homes, home health agencies, physicians, and outpatient clinics. Regression analysis of charges during the last month and six months revealed significant differences for age and hospice: Six-month charges were found to be inversely related to age (+151 for each year of age), and the charges for the last month of care for decedents who received hospice care were 43.5% lower than the charges for conventional care.

Aged↗
PubMed1983

National hospice study analysis plan.

Since the founding of the first hospice in the United States in 1974, the number of health care organizations providing hospice services has grown rapidly. In 1978, the U.S. General Accounting Office identified 59 operational hospices [1]. A survey undertaken by the National Hospice Organization (NHO) in 1980 found 235 operational programs and many more actively planning to deliver services. By the summer of 1981, the Joint Commission on the Accreditation of Hospitals (JCAH), in studying the feasibility of a voluntary hospice accreditation program, had 650 responses to a national survey [2]. Finally, the 1981 NHO directory identifies 464 operational "provider programs" as well as 33 functioning state-level hospice organizations with an additional 353 programs in various stages of establishing hospice programs of care [3]. The growth of the movement and the public recognition it has received have catalyzed advocacy of Federal support for hospice services. In 1979, the Congress responded by mandating a study to delineate the implications of inclusion of hospice services in the Medicare program. The Health Care Financing Administration (HCFA) then selected 26 hospices (from an applicant pool of 233) to participate in a two-year experimental program. These demonstration sites receive reimbursement for services provided Medicare beneficiaries not otherwise available under current regulations. The special reimbursement provisions went into effect on October 1, 1980. (See Appendix A: Description of the Hospice Reimbursement Program.) In the spring of 1980, the Robert Wood Johnson Foundation and the John A. Hartford Foundation joined with the Health Care Financing Administration (HCFA) to solicit proposals for a national evaluation of hospice care as a basis for future Federal fiscal policy and legislation. Brown University was selected as the evaluation center by competitive process and the grant was awarded on September 30, 1980. The evaluation employs a quasi-experimental design in which the impact of hospice care (with and without reimbursement) on quality of life and costs are compared to non-hospice (conventional) terminal care. Eight hundred patients and families in 24 comparison sites located in three regional areas (Southern New England, Northern Midwest and Southern California) are expected to participate. Primary data collection began on August 1, 1981. Analyses of differential outcome are performed using standard linear multiple regression and logistic multiple regression with separate models for each comparison group. Effects are tested by separately estimating the specific response variable for the prototype (average) hospice patient for each model.

Costs and Cost Analysis↗
PubMed1983

Roles ascribed to volunteers. An examination of different types of hospice organizations.

Volunteers have been the hallmark of the hospice movement since its U.S. inception in 1973. As part of the National Hospice Study, volunteer hours and activities were reported monthly in forth participating hospices nationwide. Most volunteers were white females with at least a high school education. The attitude of paid staff toward volunteers was overwhelmingly positive. Overall, the level of volunteer involvement is approximately 1.5 hours per patient each day he or she spends in the hospice program. This breaks down to nearly .80 hours of direct patient care and .70 hours devoted to other activities. While the most prevalent use of volunteers is in the provision of direct patient care in freestanding hospices, volunteers also spend a large proportion of their time in the performance of administrative activities.

Analysis of Variance↗