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Biomedical subjects

V Mor

Publications and source records attributed to V Mor.

At least 73 records · Page 4Linked to original sources
PubMed1997

A commitment to change: revision of HCFA's RAI.

OBJECTIVE: To describe the reliability of new assessment items and their clinical utility as judged by experienced nurse assessors, based on the results from the field test of Version 2.0 of the Resident Assessment Instrument (RAI). DESIGN: Independent dual assessment of residents of nursing facilities by staff nurses using a draft of Version 2.0 of the minimum data set (MDS). SETTING AND PARTICIPANTS: A total of 187 randomly selected residents from 21 nursing homes in seven states volunteered to test Version 2.0 of the MDS. MEASUREMENT: The full array of MDS assessment items included measures in the following areas: Background information, cognitive patterns, communication/hearing, vision, mood and behavior, psychosocial well-being, physical functioning and structural problems, continence, disease diagnoses, health condition, oral/nutritional status, dental status, skin condition, activity pursuit patterns, medications, special treatments and procedures, and discharge potential and overall status. RESULTS: Evaluative data address issues of MDS item utility and reliability. For new items, almost all achieved a reasonably high-weighted Kappa interrater reliability; revised items also surpassed earlier items, and with the updated training materials, even the non-changed items had higher average reliability levels. Based on the success of the field test and the positive response of the industry, Version 2.0 of the RAI has been adopted, and HCFA has initiated a more long-range process to update further the RAI when necessary. CONCLUSION: Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.

Activities of Daily Living↗
PubMed1997

Inappropriate drug prescriptions for elderly residents of board and care facilities.

OBJECTIVES: Using 1993 data, this study examines the prevalence of presumptively inappropriate prescriptions among residents, aged 65 and older, of board and care homes. METHODS: Inappropriate drug prescriptions were identified through the use of established criteria developed for application to older nursing home residents and to community-dwelling elderly. This research used a sample of 2054 elderly residents from 410 facilities in 10 states. Weighted analyses were performed with SUDAAN, which accounted for the complex, multistage sampling design. RESULTS: Depending on the criterion applied, between 20% and 25% of residents had at least one inappropriate prescription. Propoxyphene, long-acting benzodiazepines, dipyridamole, and amitriptyline were prescribed most frequently. Residents with inappropriate drug prescriptions had more complex drug regimens prescribed on a routine basis. CONCLUSIONS: The results are a conservative estimate of the extent of inappropriate drug prescribing and utilization in board and care facilities. Increased involvement by pharmacists and physicians in systematic drug utilization review is warranted.

Aged↗
PubMed1997

Quality improvement in nursing homes.

Regulation, competition, and cost containment have focused attention on quality improvement in nursing homes. Definition, measurement, and monitoring of quality are essential components of any program designed for quality assurance or continuous quality improvement.

Economic Competition↗
PubMed1997

Specialization and diversification in the nursing home industry.

Recent increases in the types of services offered by nursing facilities and in the formation of specialized care units have resulted in the emergence of two distinct but broadly defined types of services: subacute and long-term care. The authors examine the market, regulatory, and structural incentives behind diversification and specialization and speculate how these trends will affect the future of the nursing home industry.

Economic Competition↗
PubMed1996

Differences in patient demographics and expenditures among Medicare hospice providers.

This study compares differences in demographics and Medicare expenditures for beneficiaries in 4 different types of hospice programs: hospital based, skilled nursing facility (SNF) based, home health agency based, and freestanding across the years 1987-1990. Enrollment and expenditures in hospital based hospices is increasing faster than for other types of hospices; at the same time, both hospital and SNF based programs are attracting greater proportions of non-white and female beneficiaries but fewer beneficiaries with non-cancer diagnoses. These results indicate that expansion of the hospice benefit has increased institutionalized use of hospice and that this institutionalized form of hospice may benefit demographic groups that previously underutilized the hospice benefit.

Aged↗
PubMed1996

Functional and residential status transitions among nursing home residents.

BACKGROUND: The present study examines transitions in the functional status and discharge destination of new nursing home admissions who remain at least 100 days, and ascertains baseline covariates associated with transition patterns. METHODS: Using a fully observed, continuous-time Markov chain model for maximum likelihood estimation of probability intensities, transition processes are characterized. The long-stay cohort (n = 9,541) was derived from a sample of elders newly admitted to 48 National Health Corporation (NHC) nursing homes between 1983 and 1987. Assessment of functional status, using a modified Katz ADL scale, occurred during the first, second, and third months, and the second, third, and fourth quarters after admission. Four types of residential changes (e.g., mortality) were examined for the latter three quarters. RESULTS: While stability was the predominant pattern during the first 90 days in the nursing home, 51.5% of residents experienced a change in function. The probability of change was higher for modest (one level) rather than substantial change, and for such change to represent improvement rather than decline. Over 25% of this long-stay sample exited in the second quarter, 37% of them returning home. The rates for returns to home and for mortality were strongly related to functional level. Several sociodemography variables (e.g., age, source of payment), diagnostic indicators (e.g., cancer), and orientation status were consistently associated with transition rates within functionally homogeneous groups. CONCLUSIONS: Overall, findings underscore the heterogeneity and complexity of transition patterns for a subgroup historically treated as likely to decline or remain stable, and viewed as "permanent" residents. The model was useful in describing the volatile transition process among older long-stayers.

Activities of Daily Living↗
PubMed1996

Regulatory environment and psychotropic use in board-and-care facilities: results of a 10-state study.

BACKGROUND: Largely unsupervised administration of drugs and the potential for overuse of psychotropic agents in residential care facilities have emerged as major public policy concerns. In a large multistate study, we examined patterns of psychotropic prescription and use by facility licensure status and the extensiveness of state regulations. METHODS: Descriptive analyses were based on a sample of 2,949 residents from 493 board-and-care facilities in 10 states, drawn via a complex, multistage sampling design. States were purposively selected based on the stringency of their board-and-care regulatory system, and samples of facilities were drawn, stratified by licensure status and home size. Residents were randomly selected within the sampled facilities. Weighted analyses were performed with Software for Survey Data Analysis (SUDAAN), accounting for the complex sampling design. RESULTS: Approximately 43% of the residents were prescribed and 41% used at least one psychotropic agent, primarily on a routinely scheduled basis. Antipsychotics were prescribed to 22% and used by 21%; antidepressants were prescribed to 17% and taken by 16%; antimanic agents were prescribed to and used by 4%; and anxiolytics, sedatives, or hypnotics were prescribed to 17% and used by 14%. Among psychotropic users, over 50% had not had mental health services in the prior year; 25% had no psychiatric history. Among licensed facilities, prescription and use of psychotropics, particularly antipsychotics, was significantly higher among residents of homes located in states with limited regulatory systems. CONCLUSIONS: Results revealed high rates of psychotropic prescription and use, and not inconsequential levels of polypharmacy - within and across therapeutic classes - among board-and-care facility residents. Frequently, psychotropics were not used as an adjunct to alternative treatments, and were not associated with a psychiatric history. Extent of psychotropic use was related to the regulatory environment, suggesting that more extensive regulations and monitoring may reduce psychoactive drug use in board-and-care facilities, and more adequately ensure the appropriateness of such treatment.

Adolescent↗
PubMed1996

Facility and area variation affecting the use of physical restraints in nursing homes.

OBJECTIVES: Various individual characteristics increase a nursing home resident's likelihood of being mechanically restrained. However, there is not good information on the role played by facility characteristics and geographic area in determining the likelihood of physical restraint use. This study investigates the importance of individual, facility, and area indicators in determining the likelihood of restraint use. METHODS: This research uses data on 2,000 nursing home residents receiving care in more than 250 nursing homes in 10 different areas. Resident-level data were collected in 1990 by research nurses using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening. Facility-level data were gathered by telephone interviews with facility staff. The relations among the variables were investigated using contingency tables and multivariate logistic regression models. RESULTS: Controlling for residents' physical and cognitive function, facility characteristics and location had a significant impact on restraint practices. Those facilities with low nurse staffing were more likely to restrain residents. Furthermore, controlling for these factors, restraint practices varied significantly across the geographic areas in the study. CONCLUSIONS: Like hospitals, nursing homes exhibit significant interfacility and regional variation in their clinical practices. Future analyses of nursing home care might benefit from considering both factors in much finer detail.

Activities of Daily Living↗
PubMed1996

The impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective.

OBJECTIVE: Using resource dependency theory as a conceptual framework, this study investigates both the organizational and environmental factors associated with an emerging health care service delivery innovation, the provision of specialty care in designated units in nursing care facilities. We consider two types of specialty units, Alzheimer's Disease and subacute care. DATA SOURCES: The Medicare/Medicaid Automated Certification Survey (MMACS) data file was merged with local market area data obtained from the 1992 Area Resource File and with state level regulatory data. STUDY DESIGN: The likelihood of providing Alzheimer's Disease or subacute care in dedicated units was estimated by separate logistic regressions. PRINCIPAL FINDINGS: Results indicate that facilities with fewer Medicare patients are more likely to operate a dedicated Alzheimer's care unit, while facilities located in markets with a large HMO population and greater hospital supply are more likely to operate a subacute care unit. While competition among nursing homes, for the most part, is an incentive to innovate, greater regulatory stringency appears to constrain the development of specialty care units of both types. Finally, organizational characteristics (e.g., size and proprietary status) appear to be important enabling factors influencing the propensity to provide specialty care in dedicated units. CONCLUSIONS: Nursing care facilities are moving toward providing specialty care units partly as a response to a growing demand by resource providers and to maintain a competitive edge in tighter markets. Loosening regulation directed at cost containment would further encourage the development of specialty care but should be preceded by some evaluation of population needs for specialty care and the effectiveness of specialty care units.

Alzheimer Disease↗
PubMed1996

Effect of the Medicare Catastrophic Coverage Act on payer source changes among nursing home residents.

The Medicare Catastrophic Coverage Act (MCCA) of 1989 was designed to expand Medicare's post-acute care benefits, reduce copayments, and raise the asset limit for Medicaid eligibility. This analysis uses a semi-Markov transition model to estimate the effect of the MCCA on changes to Medicare coverage and the spend-down rate among 5,551 new nursing home admissions followed for an average of 2.5 years. We found that Medicare use increased in 1989 and the risk of transiting from Medicare to self-pay decreased compared to 1988. Spend-down from self-pay to Medicaid was 60% more likely in 1990. The MCCA clearly increased access to Medicare coverage of nursing home care among individuals previously paying privately.

Aged↗
PubMed1995

The structure of social engagement among nursing home residents.

This research tests the reliability and construct validity of social engagement, a new quality of life measure embedded in the federally mandated Resident Assessment Instrument (RAI) for the nursing home population. The sample consisted of 1,848 residents from 268 homes in 10 states with data collected by trained research nurses. Three resident groups were formed based on residents' cognitive and ADL functioning. Social engagement was significantly related to average time spent in activities across all three groups. We hypothesized a four-factor model with social engagement distinct from mood problems, conflicted relationships, and behavior problems. LISREL confirmatory factor analysis found the data to be consistent with this hypothesis (Fit Index > .98). Intercorrelations between factors showed that for high-functioning residents, engagement was negatively related to conflict but was positively related to conflict among the most impaired. The validity of the social engagement measure and its stability across types of residents suggest its potential utility as a marker of nursing home quality.

Activities of Daily Living↗
PubMed1995

Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS).

The MDS is a core set of items, definitions, and response categories used to assess all of the nation's 1.5 million nursing home residents who reside in facilities participating in the Medicare or Medicaid programs. Further, the Health Care Financing Administration (HCFA) has proposed a rule that would require facilities to computerize MDS data and submit it to state and federal agencies, paving the way for a national database. This article describes the process of testing the reliability of the MDS items in 13 nursing homes in five states. The results demonstrate that MDS data gathered in a research effort attain reliabilities that make such data useful. MDS items met a standard for excellent reliability (i.e., intraclass correlation of .7 or higher) in key areas of functional status, such as cognition, ADLs, continence, and diagnoses. Sixty-three percent of the items achieved reliability coefficients of .6 or higher. Eighty-nine percent of the items in the MDS achieved .4 or higher.

Activities of Daily Living↗
PubMed1995

Organizing for nursing home quality.

This article explores the relationship between job, work group, and organizational design and the quality of nursing home care. Contingency theorists contend that effective organizations develop structures that support the nature of their production processes and complement their environment. Within the same facility, units with differing care requirements should be structured differently to achieve quality outcomes. Efforts to improve quality can be integrated through the practice of total quality management and facilitated by using the Health Care Financing Administration Minimum Data Set.

Efficiency, Organizational↗
PubMed1995

Psychotropic use among older residents of board and care facilities.

OBJECTIVE: To describe patterns of psychotropic use as well as clinically relevant and concurrent nonpsychotropic use among older residents of board and care facilities in 10 states. METHODS: Weighted use rates were based on data from a sample of 2054 residents aged 65 and older from 410 facilities in 10 states, drawn via a complex, multistage sampling design. Data, including drug name, use frequency, and PRN use, were collected on all drugs taken by the resident during a 7-day period. During face-to-face interviews with residents and/or proxies, data were also collected on resident characteristics. SUBJECTS: The majority of subjects were female, white, and widowed. Average age was 82 years. Approximately 25% had a current mental or emotional condition, and 8% had been hospitalized for a psychiatric condition during the year before admission. More than half needed help with at least one activity of daily living. Forty percent had moderate or severe cognitive impairment, and 18% had received mental health care during the previous year. ANALYSES: Weighted descriptive analyses were performed with Software for Survey Data Analysis (SUDAAN), which accounts for the complex, multistage sampling design. RESULTS: Approximately 35% of the older residents used at least one psychoactive agent, with 30% of psychotropic users receiving two to four different psychotropic medications. Use rates decline with age, for psychotropics overall and for therapeutic classes. Results revealed potentially problematic polypharmacy in relation to drug duplication within therapeutic classes, use of multiple psychotropics across classes, and concurrent nonpsychotropic use. CONCLUSIONS: Compared with community-dwelling older adults, this study revealed high psychotropic use rates among older board and care facility residents. Overall, our results suggest that serious consideration be given to the apparent need for systematic drug utilization review, a potentially useful program that is mandated in other settings.

Aged↗