Publications by authors named "Madeline Sterling"
Objectives: Our study investigates unionization trends among direct care workers (DCWs) in the United States and examines the association between unionization and their wealth outcomes.
Design: This is a cross-sectional study using data from the Current Population Survey and Annual Social and Economic Supplement from 2009 to 2023.
Setting And Participants: Our study is based on US representative household surveys.
To reduce morbidity and mortality rates of cardiovascular disease, an urgent need exists to improve cardiovascular health among US adults. In 2022, the American Heart Association issued Life's Essential 8, which identifies and defines 8 health behaviors and factors that, when optimized through a combination of primary prevention, risk factor management, and effective treatments, can promote ideal cardiovascular health. Because of its central role in patient care across the life span, primary care is in a strategic position to promote Life's Essential 8 and improve cardiovascular health in the United States.
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- Fewer than 20% of heart failure patients with reduced ejection fraction receive all recommended treatments, highlighting the need to investigate disparities based on race, sex, and social factors for effective care.
- A study analyzed data from the American Heart Association's registry to evaluate how these disparities affect the optimization of quadruple therapy in heart failure patients between July 2021 and September 2023.
- Results showed that while Black and Hispanic patients had slightly higher therapy scores compared to non-Hispanic Whites, females performed better than males, and those without private insurance faced significantly lower optimization scores.
Article Synopsis
- The study focuses on improving care transitions for heart failure patients by implementing an intervention called I-TRANSFER-HF, which combines early home health care (HHC) nurse visits with outpatient medical follow-up to reduce hospital readmissions.
- It employs a Hybrid Type 1, stepped wedge randomized trial design, involving multiple hospital and home health agency (HHA) pairs across the US, to measure the effectiveness of the intervention on readmission rates and patient outcomes.
- Additionally, the study aims to understand the factors affecting the implementation of I-TRANSFER-HF through qualitative interviews with key stakeholders, using the Consolidated Framework for Implementation Research 2.0 to guide the analysis.
Objectives: To meet a growing demand for direct care workers (DCWs) in the United States, structural, organizational, and policy-related solutions are needed. Unionization of the workforce may be one such mechanism; however, its impact on outcomes remains poorly understood. To examine the impact of unionization on DCWs' financial well-being and employment attitudes, as well as patient outcomes.
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- - Cognitive impairment is prevalent in adults with heart failure (HF) and can lead to worse health outcomes, but the specific pattern of cognitive decline following a first HF hospitalization had not been thoroughly studied.
- - In a study involving nearly 24,000 participants aged 45 and older, those who experienced HF hospitalization showed a more rapid decline in overall cognitive function (measured by the Six-Item Screener) over five years compared to those without HF hospitalization, even after accounting for other factors.
- - However, this faster cognitive decline was not observed in specific memory tasks (Word List Learning and Delayed Recall), suggesting that while general cognitive health is affected by HF hospitalization, certain cognitive domains may remain relatively stable.
Objectives: This study examines the perspectives of key stakeholders in home health toward Medicare's Home Health Value Based Purchasing (HHVBP) program, piloted among home health agencies (HHAs) in 9 states from 2016 to 2021, and based on initial performance, was expanded to the remaining 41 (nonpilot) states in January 2023.
Design: We conducted semistructured interviews wherein we inquired participants' views toward and experiences with HHVBP. We used convenience and purposive sampling to obtain diversity in HHA size, geography, and quality.
Background: Self-care for adults with hypertension includes adherence to lifestyle behaviors and medication. For unpaid caregivers with hypertension, the burden of family caregiving may adversely impact self-care. We examined the association between caregiver strain and hypertension self-care among caregivers with hypertension.
View Article and Find Full Text PDFImportance: Home health aides and attendants (HHAs) provide essential care to older adults and those with chronic conditions in the home. However, some HHAs struggle with poor mood and stress, which may have been exacerbated by the COVID-19 pandemic.
Objective: To elicit HHAs' perspectives toward mental health and well-being, including how their job influences both and how to better support the workforce in the future.
Background: Although family caregivers play a critical role in care delivery, research has shown that they face significant physical, emotional, and informational challenges. One promising avenue to address some of caregivers' unmet needs is via the design of digital technologies that support caregivers' complex portfolio of responsibilities. Augmented reality (AR) applications, specifically, offer new affordances to aid caregivers as they perform care tasks in the home.
View Article and Find Full Text PDFBackground: Home health care (HHC) has been increasingly used to improve care transitions and avoid poor outcomes, but there is limited data on its use and efficacy following coronary artery bypass grafting. The purpose of this study was to describe HHC use and its association with outcomes among Medicare beneficiaries undergoing coronary artery bypass grafting.
Methods: Retrospective analysis of 100% of Medicare fee-for-service files identified 77 331 beneficiaries undergoing coronary artery bypass grafting and discharged to home between July 2016 and December 2018.
Heart failure (HF) affects six million people in the U.S., is associated with high morbidity, mortality, and healthcare utilization.
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- There’s no standardized method to screen for social risk factors in adults, so this study aimed to create mortality risk prediction models using social determinants of health (SDoH) for better clinical risk assessment.
- The research utilized data from a national cohort (REGARDS) of over 20,000 adults aged 45 and older to analyze how individual, area-level, and business-level SDoH relate to all-cause mortality.
- The findings indicated that while individual-level SDoH improved mortality predictions compared to basic demographic data, adding area and business-level SDoH provided minimal benefits, highlighting the importance of SDoH in identifying high-risk individuals for further intervention.
Guideline-directed medical therapies and guideline-directed nonpharmacological therapies improve quality of life and survival in patients with heart failure (HF), but eligible patients, particularly women and individuals from underrepresented racial and ethnic groups, are often not treated with these therapies. Implementation science uses evidence-based theories and frameworks to identify strategies that facilitate uptake of evidence to improve health. In this scientific statement, we provide an overview of implementation trials in HF, assess their use of conceptual frameworks and health equity principles, and provide pragmatic guidance for equity in HF.
View Article and Find Full Text PDFObjectives: To identify factors associated with high and low "voice"-or level of input in patient care decisions-among home care workers (HCWs), an often marginalized workforce that provides care in the home to older adults and those with chronic conditions.
Design: We conducted a secondary analysis of data from a cross-sectional survey assessing experiences of HCWs in caring for adults with heart failure. The survey measured HCWs' voice using a validated, 5-item instrument.
Background: Over 20% of patients are discharged to a skilled nursing facility (SNF) after coronary artery bypass graft surgery, but little is known about specific drivers for postdischarge SNF use. The purpose of this study was to evaluate hospital variation in SNF use and its association with postoperative outcomes after coronary artery bypass graft.
Methods And Results: A retrospective study design utilizing Medicare Provider Analysis and Review files was used to evaluate SNF use among 70 509 beneficiaries undergoing coronary artery bypass graft, with or without valve procedures, between 2016 and 2018.
Background: Although many Medicare beneficiaries with heart failure (HF) are discharged with home health services, little is known about mortality rates and hospice use in this group.
Objectives: To identify risk factors for 6-month mortality and hospice use among patients hospitalized due to HF who receive home health care, which could inform efforts to improve palliative and hospice use for these patients.
Methods: A retrospective cohort analysis was conducted in a 100% national sample of Medicare fee-for-service beneficiaries with HF who were discharged to home health care between 2017 and 2018.
Importance: Use of race-specific risk prediction in clinical medicine is being questioned. Yet, the most commonly used prediction tool for atherosclerotic cardiovascular disease (ASCVD)-pooled cohort risk equations (PCEs)-uses race stratification.
Objective: To quantify the incremental value of race-specific PCEs and determine whether adding social determinants of health (SDOH) instead of race improves model performance.
Importance: Involvement of a cardiologist in the care of adults during a hospitalization for heart failure (HF) is associated with reduced rates of in-hospital mortality and hospital readmission. However, not all patients see a cardiologist when they are hospitalized for HF.
Objective: To determine whether social determinants of health (SDOH) are associated with cardiologist involvement in the management of adults hospitalized for HF.
Objective: To examine associations between myocardial infarction (MI) and multiple physical function metrics.
Methods: Among participants aged ≥45 years in the REasons for Geographic And Racial Differences in Stroke prospective cohort study, instrumental activities of daily living (IADL), activities of daily living (ADL), gait speed, chair stands, and Short Form-12 physical component summary (PCS) were assessed after approximately 10 years of follow-up. We examined associations between MI and physical function (no MI [n = 9,472], adjudicated MI during follow-up [n = 288, median 4.