Improving care for nursing home-acquired pneumonia in a managed care environment.

Objective: To characterize care of nursing home residents who became ill with nursing home-acquired pneumonia (NHAP) in a group-model, nonprofit HMO, and to pilot-test a strategy to implement evidence-based NHAP care guidelines.

Study Design: Medical record review and intervention pilot test.

Methods: Nursing home medical records of 78 patients who developed NHAP in 6 homes where the HMO contracts for Medicare services were reviewed for demographics, functional status, comorbidity, NHAP severity, care processes, and guideline compliance.

Associations among processes and outcomes of care for Medicare nursing home residents with acute heart failure.

Objective: To characterize Medicare skilled nursing facility (SNF) residents who become acutely ill with heart failure (HF) and assess the association between the outcomes of rehospitalization and mortality, and severity of the acute exacerbation, comorbidity, and processes of care.

Design: SNF medical record review of Medicare patients who developed an acute exacerbation of heart failure (HF) during the 90 days following nursing home admission.

Setting: A total of 58 SNFs in 5 states during 1994 and 1997.

Precipitants of emergency room visits and acute hospitalization in short-stay medicare nursing home residents.

Objectives: To determine what precipitates rehospitalization for residents who become acutely ill in the first 90 days of a nursing home (NH) admission.

Design: NH medical record review comparing acutely ill Medicare admissions transferred back to hospital with those not transferred.

Setting: Sixty skilled nursing facilities in five states during 1994.

Prospective payment for nursing homes increased therapy provision without improving community discharge rates.

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities (SNFs) on therapy use and community discharge rates.

Design: Quasi-experimental study examining the predemonstration (1994) to demonstration (1997) change in amount of therapy provided, and in community discharge rates at PPS participating and nonparticipating facilities.

Setting: Eighteen PPS participating and 17 nonparticipating SNFs in five states.

CLCN5 mutation Ser244Leu is associated with X-linked renal failure without X-linked recessive hypophosphatemic rickets.

This study demonstrates that a missense mutation in the voltage gated chloride channel, CLCN5, can cause X-linked renal failure without X-linked recessive hypophosphatemic rickets. A large kindred (Family A), initially evaluated in 1974 with an inherited syndrome characterized by hypercalciuria, nephrocalcinosis, low molecular weight proteinuria, renal tubular acidosis, and renal failure, was clinically re-evaluated and genetically characterized. Medical histories, physical examinations, blood chemistries, and 24-hour urine collections were obtained from 48 family members.