August 6, 2019

Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials

Peikes D, Chen A, Schore J, Brown R. Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries. JAMA. 2009;301(6). Http://jama.jamanetwork.com/article.aspx?articleid=183370 Accessed 7/9/14. Medicare expenditures of patients with chronic illnesses might be reduced through improvements in care, patient adherence, and communication.
Peikes D, Chen A, Schore J, Brown R. Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries. JAMA. 2009;301(6). Http://jama.jamanetwork.com/article.aspx?articleid=183370 Accessed 7/9/14. Medicare expenditures of patients with chronic illnesses might be reduced through improvements in care, patient adherence, and communication.
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http://jama.jamanetwork.com/article.aspx?articleid=183370

August 6, 2019

Kaiser Family Foundation: Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long-Term Care Facilities—A Potential for Achieving Medicare Savings and Improving the Quality of Care

We find that beneficiaries living in long-term care facilities account for a disproportionate share of Medicare spending, with relatively high rates of hospitalizations, emergency room visits, skilled nursing facility admissions and other Medicare-covered services. The relatively high Medicare spending is incurred not only by long-term care residents who die within […]
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We find that beneficiaries living in long-term care facilities account for a disproportionate share of Medicare spending, with relatively high rates of hospitalizations, emergency room visits, skilled nursing facility admissions and other Medicare-covered services. The relatively high Medicare spending is incurred not only by long-term care residents who die within the year, or those who transition from another setting into a long-term care facility, but also by beneficiaries living in a facility throughout the calendar year. Studies indicate that 30 to 67 percent of hospitalizations among facility residents could be prevented with well-targeted interventions.3 Others have identified factors that contribute to preventable hospitalizations, including liability concerns, limited staff capacity, financial incentives, and physician preferences.4 This analysis illustrates how successful efforts to reduce the rate of preventable hospitalizations could yield savings to Medicare. Such efforts, if carefully implemented, could also help to improve the quality of patient care for Medicare’s oldest and most frail beneficiaries.
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http://www.kff.org/medicare/upload/Presentation-Slides-Jacobson.pdf

August 6, 2019

GAO Report: Care Coordination Programs Used in Demonstration Show Promise, but Wider Use of Payment Approach May be Limited

United States Government Accountability Office Report. GAO Report: Care Coordination Programs Used in Demonstration Show Promise, but Wider Use of Payment Approach May be Limited.http://www.gao.gov/new.items/d0865.pdf. Published February 2008. Accessed December 11, 2014. All 10 participating physician groups implemented care coordination programs to generate cost savings for patients with certain conditions, […]
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United States Government Accountability Office Report. GAO Report: Care Coordination Programs Used in Demonstration Show Promise, but Wider Use of Payment Approach May be Limited.http://www.gao.gov/new.items/d0865.pdf. Published February 2008. Accessed December 11, 2014. All 10 participating physician groups implemented care coordination programs to generate cost savings for patients with certain conditions, such as congestive heart failure, and initiated processes to better identify and manage diabetes patients in PY1. However, only 2 of the 10 participants earned a bonus payment in PY1 for achieving cost savings and meeting diabetes quality-of-care targets. The remaining 8 participants met most of the quality targets, but did not achieve the required level of cost savings to earn a bonus. Many of the participants’ care coordination programs were not in place for all of PY1
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http://www.gao.gov/new.items/d0865.pdf

August 6, 2019

Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification

Coleman EA, Min SJ, Chomiak A, et al. Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification. Health Serv Res. 2004;39(5):1423-1440. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361078/ . Accessed August 7, 2014. Principle Findings: 46 distinct types of care patterns were observed during the 30 days following hospital discharge. Among these patterns, 444 episodes (61.2 percent) […]
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Coleman EA, Min SJ, Chomiak A, et al. Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification. Health Serv Res. 2004;39(5):1423-1440. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361078/ . Accessed August 7, 2014. Principle Findings: 46 distinct types of care patterns were observed during the 30 days following hospital discharge. Among these patterns, 444 episodes (61.2 percent) were limited to a single transfer, 130 episodes (17.9 percent) included two transfers, 62 episodes (8.5 percent) involved three transfers, and 31 episodes (4.3 percent) involved four or more transfers. 59 episodes (8.1 percent) resulted in death. Between 13.4 percent and 25.0 percent of post-hospital care patterns in the 1998 sample were classified as complicated. The area under the receiver operating curve was 0.771 for a predictive index that utilized administrative data and 0.833 for an index that used a combination of administrative and self-reported data. Conclusions: Post-hospital care transitions are common among Medicare beneficiaries and patterns of care vary greatly. A significant number of beneficiaries experienced complicated care transitions – a finding that has important implications for both patient safety and cost containment efforts. Patients at-risk for complicated care patterns can be identified using data available at the time of hospital discharge.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361078/

August 6, 2019

National Transitions of Care Coalition

National Transitions of Care Coalition (NTOCC). [Web site]. Http://www.ntocc.org/Home.aspx . Updated 2014. Accessed July 29, 2014. The National Transitions of Care Coalition is a 501©(4) organization dedicated to addressing a serious U.S. health care issue: filling the gaps that occur when patients leave one care setting and move to another […]
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National Transitions of Care Coalition (NTOCC). [Web site]. Http://www.ntocc.org/Home.aspx . Updated 2014. Accessed July 29, 2014. The National Transitions of Care Coalition is a 501©(4) organization dedicated to addressing a serious U.S. health care issue: filling the gaps that occur when patients leave one care setting and move to another care setting. These transitions include patients moving from primary care to specialty physicians; moving or transferring patients from the emergency department to intensive care or surgery; and when patients are discharged from the hospital to home, assisted living arrangements, or skilled nursing facilities. The U.S. health care system often fails to meet the needs of patients during these transitions because care is rushed and responsibility is fragmented, with little communication across care settings and multiple providers. Since 2006, NTOCC’s Advisors Council of over 30 organizations has shared a common goal of improving the quality of Transitions of Care. Working in conjunction with 450 Associate Member organizations and over 3,000 individual professional subscribers, NTOCC has developed tools and resources made available to everyone in the health care industry including providers, payers, patients and consumers. NTOCC’s mission is supported by the Partners Council made up of innovative companies leading critical change in health care coordination.
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Http://www.ntocc.org/Home.aspx

August 6, 2019

Variations in Service Use in the Program of All-Inclusive Care for the Elderly (PACE): Is More Better?

Temkin-Greener H, Bajorska A, Mukamel DB. Gerontol A Biol Sci Med Sci.2008;63(7): 731-738. http://biomedgerontology.oxfordjournals.org/content/63/7/731.abstract?sid=565d77dd-7d89-4ba5-a8b6-7df5bc49e08a. Accessed July 24, 2014. Background: To date, there has been little empirical evidence about the relationship between service use and risk-adjusted functional outcomes among the frail, chronically ill elderly population. The Program of All-Inclusive Care for the […]
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Temkin-Greener H, Bajorska A, Mukamel DB. Gerontol A Biol Sci Med Sci.2008;63(7): 731-738. http://biomedgerontology.oxfordjournals.org/content/63/7/731.abstract?sid=565d77dd-7d89-4ba5-a8b6-7df5bc49e08a. Accessed July 24, 2014. Background: To date, there has been little empirical evidence about the relationship between service use and risk-adjusted functional outcomes among the frail, chronically ill elderly population. The Program of All-Inclusive Care for the Elderly (PACE) offers a unique model within which to investigate this relationship. We examine variation in the risk-adjusted utilization of acute, rehabilitative, and supportive services in PACE, and assess whether use of these services is associated with risk-adjusted functional outcomes.
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http://biomedgerontology.oxfordjournals.org/content/63/7/731.abstract?sid=565d77dd-7d89-4ba5-a8b6-7df5bc49e08a

August 6, 2019

From Hospital to Home: Assessing the Transitional Care Needs of Vulnerable Seniors

Graham C, Ivey S, Neuhauser L. From Hospital to Home: Assessing the Transitional Care Needs of Vulnerable Seniors. The Gerontologist. 2009;49 (1): 23-33. http://gerontologist.oxfordjournals.org/content/49/1/23. Accessed July 30, 2014. Purpose: This qualitative study assessed the needs of patients and caregivers during the transition from hospital to home. We specifically identified unmet needs […]
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Graham C, Ivey S, Neuhauser L. From Hospital to Home: Assessing the Transitional Care Needs of Vulnerable Seniors. The Gerontologist. 2009;49 (1): 23-33. http://gerontologist.oxfordjournals.org/content/49/1/23. Accessed July 30, 2014. Purpose: This qualitative study assessed the needs of patients and caregivers during the transition from hospital to home. We specifically identified unmet needs of ethnic minorities, recent immigrants, and seniors with limited English proficiency (LEP). Findings are translated into recommendations for improving services to these groups during health care transitions. Design and Methods: This needs assessment included extensive analysis of qualitative data collected from 20 language-, culture-, and ethnic-specific focus groups with caregivers who recently assisted a senior after a hospital discharge. Findings from these focus groups were supplemented by 5 in-depth, longitudinal case studies of recently hospitalized seniors and their caregivers. Results: Inadequate information and training at discharge were themes that spanned all groups, despite ethnicity or language. Additional unmet needs were identified for ethnic minorities, those with LEP, and recent immigrants, including lower levels of social support than might be expected, lack of linguistically appropriate information and services, and cultural and financial barriers to using long-term care services. Implications: As ethnic diversity increases among older Americans, it will become increasingly important to design health care services to meet the needs of diverse groups. Recommendations include assessments of informal care, bilingual information and services, partnerships with community agencies providing culturally competent services, and expansion of home- and community-based services to near-poor seniors.
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http://gerontologist.oxfordjournals.org/content/49/1/23

August 6, 2019

Defining and disseminating the hospital-at-home model

Leff B. Defining and disseminating the hospital-at-home model. CMAJ.2009;180(2):156-157.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621275/. Accessed 7/9/14.The hospital, which is the “gold standard” for the delivery of acute medical care, is not an ideal care environment for many patients.1 Iatrogenic events such as nosocomial infections, pressure sores, falls and delirium are common.2 New functional impairment commonly […]
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Leff B. Defining and disseminating the hospital-at-home model. CMAJ.2009;180(2):156-157.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621275/. Accessed 7/9/14.The hospital, which is the "gold standard" for the delivery of acute medical care, is not an ideal care environment for many patients.1 Iatrogenic events such as nosocomial infections, pressure sores, falls and delirium are common.2 New functional impairment commonly occurs during hospital stay. Suboptimal transitions in care at the time of hospital discharge also occur, contributing, ironically, to readmission to hospital.3 Furthermore, hospital care is very expensive. In this issue, Shepperd and colleagues4 present a meta-analysis of the effectiveness of "hospital-at-home programs."
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621275/

August 7, 2019

Guided Care: Care for the Whole Person, For Those Who Need It Most

Guided Care is a new solution to the growing challenge of caring for older adults with chronic conditions and complex health needs. A Guided Care Nurse, based in a primary care office, works with patients and their families to improve their quality of life and make more efficient use of […]
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Guided Care is a new solution to the growing challenge of caring for older adults with chronic conditions and complex health needs. A Guided Care Nurse, based in a primary care office, works with patients and their families to improve their quality of life and make more efficient use of health services. The nurse assesses patient needs, monitors conditions, educates and empowers the patient, and works with community agencies to ensure that the patient’s healthcare goals are met. The Lipitz Center recently conducted a cluster-randomized controlled trial of Guided Care at eight community-based primary care practices in the Baltimore-Washington D.C. area that included over 900 patients, 300 caregivers, and 48 primary care physicians. Preliminary data indicate that Guided Care improves the quality of patients' care, reduces family caregiver strain, improves physicians' satisfaction with chronic care, and may reduce the use and cost of expensive services, especially in well-managed systems. Click here for a summary of preliminary data from the trial.
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http://www.guidedcare.org/

August 7, 2019

The effects of guided care on the perceived quality of health care for multi-morbid older persons: 18-month outcomes from a cluster-randomized controlled trial

J Gen Intern Med, 25;3:235-42 Authors: Boyd, C. M., Reider, L., Frey, K., Scharfstein, D., Leff, B. Wolff, J., Groves, C., Karm, L., Wegener, S., Marsteller, J., Boult, C. BACKGROUND: The quality of health care for older Americans with chronic conditions is suboptimal. OBJECTIVE: To evaluate the effects of “”Guided […]
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J Gen Intern Med, 25;3:235-42 Authors: Boyd, C. M., Reider, L., Frey, K., Scharfstein, D., Leff, B. Wolff, J., Groves, C., Karm, L., Wegener, S., Marsteller, J., Boult, C. BACKGROUND: The quality of health care for older Americans with chronic conditions is suboptimal. OBJECTIVE: To evaluate the effects of ""Guided Care"" on patient-reported quality of chronic illness care. DESIGN: Cluster-randomized controlled trial of Guided Care in 14 primary care teams. PARTICIPANTS: Older patients of these teams were eligible to participate if, based on analysis of their recent insurance claims, they were at risk for incurring high health-care costs during the coming year. Small teams of physicians and their at-risk older patients were randomized to receive either Guided Care (GC) or usual care (UC). INTERVENTION: ""Guided Care"" is designed to enhance the quality of health care by integrating a registered nurse, trained in chronic care, into a primary care practice to work with 2-5 physicians in providing comprehensive chronic care to 50-60 multi-morbid older patients. MEASUREMENTS: Eighteen months after baseline, interviewers blinded to group assignment administered the Patient Assessment of Chronic Illness Care (PACIC) survey by telephone. Logistic and linear regression was used to evaluate the effect of the intervention on patient-reported quality of chronic illness care. RESULTS: Of the 13,534 older patients screened, 2,391 (17.7%) were eligible to participate in the study, of which 904 (37.8%) gave informed consent and were cluster-randomized. After 18 months, 95.3% and 92.2% of the GC and UC recipients who remained alive and eligible completed interviews. Compared to UC recipients, GC recipients had twice greater odds of rating their chronic care highly (aOR = 2.13, 95% CI = 1.30-3.50, p = 0.003). CONCLUSION: Guided Care improves self-reported quality of chronic health care for multi-morbid older persons.
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http://www.springerlink.com/content/1602g85371r24623/