Changes in hospitalization associated with introducing the Resident Assessment Instrument.

Objective: To compare the rates of hospitalization among cohorts of nursing home residents assembled before and after the implementation of the federally mandated Resident Assessment Instrument (RAI).

Sample: Subjects were nursing home residents chosen from 268 facilities in major Metropolitan Statistics Areas in 10 states and representing more than 1500 facilities and 60,000 residents. Two resident cohorts (1990 and 1993) were sampled (8 to 16 residents per facility, depending upon facility size) as part of an evaluation of the impact of implementing the RAI.

Effect of the National Resident Assessment Instrument on selected health conditions and problems.

Objective: To evaluate the effect of the implementation of the National Resident Assessment Instrument (RAI) system on selected conditions representing outcomes for nursing home residents.

Design: Quasi-experimental, pre-/post-design, with assessments at baseline and 6-month follow-up.

Sample: Two thousand one hundred twenty-eight residents from 268 nursing homes in 10 states before RAI implementation, and 2,088 from 254 of the same nursing homes after implementation.

Association of the Resident Assessment Instrument (RAI) with changes in function, cognition, and psychosocial status.

Objective: To evaluate the impact of the Resident Assessment Instrument (RAI) on changes in nursing home residents' functional status, cognitive status, and psychosocial well-being.

Design: A quasi-experiment involving the collection of longitudinal data on two cohorts of nursing home residents. One cohort was assessed before the implementation of the RAI, and the other was assessed after the implementation of the new assessment process.

The OBRA-87 nursing home regulations and implementation of the Resident Assessment Instrument: effects on process quality.

Objective: To characterize changes in key aspects of process quality received by nursing home residents before and after the implementation of the national nursing home Resident Assessment Instrument (RAI) and other aspects of the Omnibus Budget Reconciliation Act (OBRA) nursing home reforms.

Design: A quasi-experimental study using a complex, multistage probability-based sample design, with data collected before (1990) and after (1993) implementation of the RAI and other OBRA provisions.

Setting And Participants: Two independent cohorts (n > 2000) of residents in a random sample of 254 nursing facilities located in metropolitan statistical areas in 10 states.

Changes in advance care planning in nursing homes before and after the patient Self-Determination Act: report of a 10-state survey.

Objective: The Patient Self-Determination Act (PSDA) implemented in 1991 has focused national attention on the right of patients to be involved in decision-making and on the use of written advance directives. We report changes in advance care planning with the PSDA and other historical events in nursing homes in 10 states.

Design: Pre- and Post-observational cohort study.

Windows to their world: the effect of sensory impairments on social engagement and activity time in nursing home residents.

This study examined relationships between three sensory and communication abilities and two areas of nursing home resident behavior. Data from 18,873 nursing home residents include measures of hearing, visual, and communication abilities, and social engagement and time spent in activities. Increasing level of visual impairment is associated with low levels of social engagement and low time in activities.

Predicting discharge outcomes of VA nursing home residents.

This article's purpose was to identify predictors of discharge outcomes of VA nursing home stays. Using data tapes, diagnostic and assessment data were assembled on elderly individuals admitted to VA nursing homes nationwide during Fiscal Year 1987. Six-month outcomes for 3 groups were considered: all residents (n = 5,895), and those remaining in care after 6 (n = 2,815) and 12 months (n = 1,812), respectively.

Predicting patient scores between the functional independence measure and the minimum data set: development and performance of a FIM-MDS "crosswalk".

Objective: The functional status of rehabilitation patients is often measured using the Functional Independence Measure (FIM) in acute rehabilitation settings or the Minimum Data Set (MDS) in nursing homes. Because the relationship between the two instruments is unknown, preventing comparison of rehabilitation patients in different types of settings, a translation formula ("crosswalk") between items and subscales from the FIM and the MDS was developed and tested.

Design And Outcome Measures: Using definitions recommended by an expert panel, MDS items were chosen and rescaled (termed "Pseudo-FIM(E)" items) to correspond to FIM items.

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.

Health and economic implications of a work-site smoking-cessation program: a simulation analysis.

In this article, we examine the health and economic implications of a workplace smoking-cessation program by using a simulation model that includes, among its novel features, consideration of long-term as well as short-term implications and evaluation of the effects of employee turnover on benefits derived by both the firm and the broader community. As a result of employee turnover, approximately half of the program-generated benefits are realized by the community outside the firm. Still, smoking cessation is a very sound economic investment for the firm, and is particularly profitable when long-term benefits are included, with an eventual benefit-cost ratio of 8.

Karyotype instability in Cryptococcus neoformans infection.

The electrophoretic karyotypes of 32 clinical and 3 environmental Cryptococcus neoformans isolates from New York City were studied by contour clamped homogeneous electrophoresis. There was extensive variation among the electrophoretic karyotypes of isolates from different patients. Sequential C.

Patterns and determinants of health services use and mortality after VA nursing home care.

Risk factors for institutionalization and death for up to four years for a nationwide cohort (n = 6,488) of males discharged alive from Department of Veterans Affairs (DVA) nursing homes were identified through linked records of the DVA. Two-year cumulative probabilities of nursing home readmission, hospitalization, and death among nursing home dischargees were 0.30, 0.

Chemotactic response of human alveolar macrophages and blood monocytes elicited by exposure to sulfur dioxide.

An experimental study was undertaken to investigate the in vitro effect of sulfur dioxide on the chemotactic activity of alveolar macrophages (AM) and blood monocytes (BM). The cells were placed on a polycarbonate membrane and exposed to SO2 0.5, 1.

Factors associated with low body mass index and weight loss in nursing home residents.

Background: Undernutrition in nursing home residents is a significant and possibly modifiable public health problem. We evaluated the hypothesis that some potentially modifiable factors are associated with resident undernutrition.

Methods: This study is a cross-sectional, secondary data analysis of 6,832 community nursing home residents sampled from 202 nursing homes in 7 states.

Resource use on Alzheimer's special care units.

A multistate nursing home data base was used to compare resource use by residents on Alzheimer's Special Care Units (SCUs) and on other nursing home units. Overall, staff time expended per resident was less on SCUs. However, facilities with an SCU used considerably more staff time than facilities without.

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.

Activities of daily living and costs in nursing homes.

Functionality, as measured by activities of daily living (ADL), is the most important predictor of the cost of nursing home care. Data from a field-test version of the federally mandated Minimum Data Set (MDS) were examined using analysis of variance (ANOVA) and recursive partitioning methods to determine the relationships between ADL limitations and nursing cost (wage-weighted nursing time) among nursing home residents (n = 6,663). From this analysis, an index based on limitations in four ADLs was created.

Predictors of nursing home residents' participation in activity programs.

Nursing homes are mandated by the Omnibus Budget Reconciliation Act (OBRA) to provide activity programs (U.S. Congress, 1987).

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.

Applying RUG-III in Japanese long-term care facilities.

A U.S. nursing home case-mix system, Resource Utilization Group, Version III (RUG-III), was tested in a variety of Japanese long-term care facilities.

Refining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III).

A case-mix classification system for nursing home residents is developed, based on a sample of 7,658 residents in seven states. Data included a broad assessment of resident characteristics, corresponding to items of the Minimum Data Set, and detailed measurement of nursing staff care time over a 24-hour period and therapy staff time over a 1-week period. The Resource Utilization Groups, Version III (RUG-III) system, with 44 distinct groups, achieves 55.

MDS Cognitive Performance Scale.

Background: Chronic cognitive impairment is a major problem in U.S. nursing homes, yet traditional assessment systems in most facilities included only limited information on cognitive status.

Use of administrative records to describe longitudinal patterns of health services use among veterans.

Administrative records of the Department of Veterans Affairs (DVA) and the National Death Index were linked to create a four-year longitudinal database that describes the clinical status, hospital and nursing home use, and mortality for a nationwide cohort of persons admitted to DVA nursing homes (n = 23,039). Using Social Security Numbers as identifiers, the records of only 6% of these persons had logically inconsistent or implausible patterns. Nineteen percent of the remaining records had correctable logical errors.

[The chemotactic behavior of alveolar macrophages and blood monocytes after exposures to different NO2 concentrations].

The chemotaxis of alveolar macrophages (AM) and blood monocytes (BM) is important in the elimination of particles and microorganisms which have invaded the lung. The effect of nitrogen dioxide (NO2) on chemotaxis was tested on AM obtained by diagnostic bronchoscopy from five patients suspected of having bronchial carcinoma (four men, one woman; mean age 59 +/- 10 years). Blood monocytes were also studied with blood from seven healthy subjects (five men, two women; mean age 32 +/- 10 years).