The Metrics Matter: Improving Comparisons of COVID-19 Outbreaks in Nursing Homes.

Objectives: In the United States, nursing facility residents comprise fewer than 1% of the population but more than 40% of deaths due to Coronavirus Disease 2019 (COVID-19). Mitigating the enormous risk of COVID-19 to nursing home residents requires adequate data. The widely used Centers for Medicare & Medicaid Services (CMS) COVID-19 Nursing Home Dataset contains 2 derived statistics: Total Resident Confirmed COVID-19 Cases per 1000 Residents and Total Resident COVID-19 Deaths per 1000 Residents.

Factors Associated With Racial Differences in Deaths Among Nursing Home Residents With COVID-19 Infection in the US.

Importance: It is important to understand differences in coronavirus disease 2019 (COVID-19) deaths by nursing home racial composition and the potential reasons for these differences so that limited resources can be distributed equitably.

Objective: To describe differences in the number of COVID-19 deaths by nursing home racial composition and examine the factors associated with these differences.

Design, Setting, And Participants: This cross-sectional study of 13 312 nursing homes in the US used the Nursing Home COVID-19 Public File from the Centers for Medicare and Medicaid Services, which contains COVID-19 cases and deaths among nursing home residents as self-reported by nursing homes beginning between January 1, 2020, and May 24, 2020, and ending on September 13, 2020.

Outcomes of Medicaid home- and community-based long-term services relative to nursing home care among dual eligibles.

Objective: To provide the first plausibly causal national estimates of health outcomes for older dual-eligible recipients of Medicaid HCBS relative to nursing home care and to explore possible mechanisms for the effect.

Data Sources: We use 2005 and 2012 Medicaid Analytic eXtract (MAX), a national compilation of Medicaid claims, merged with Medicare claims to identify hospital admissions, our main outcome variable.

Study Design: We model the effects of HCBS using a longitudinal instrumental variables framework.

Staffing Levels and COVID-19 Cases and Outbreaks in U.S. Nursing Homes.

Background/objectives: Nursing homes have experienced a disproportionate share of COVID-19 cases and deaths. Early analyses indicated that baseline quality was not predictive of nursing home cases, but a more nuanced study of the role of nurse staffing is needed to target resources and better respond to future outbreaks. We sought to understand whether baseline nurse staffing is associated with the presence of COVID-19 in nursing homes and whether staffing impacts outbreak severity.

A National Examination Of Long-Term Care Setting, Outcomes, And Disparities Among Elderly Dual Eligibles.

The benefits of expanding funding for Medicaid long-term care home and community-based services (HCBS) relative to institutional care are often taken as self-evident. However, little is known about the outcomes of these services, especially for racial and ethnic minority groups, whose members tend to use the services more than whites do, and for people with dementia who may need high-intensity care. Using national Medicaid claims data on older adults enrolled in both Medicare and Medicaid, we found that overall hospitalization rates were similar for HCBS and nursing facility users, although nursing facility users were generally sicker as reflected in their claims history.

Association Between Groundwater Lithium and the Diagnosis of Bipolar Disorder and Dementia in the United States.

This study examines the association between groundwater lithium and diagnoses of bipolar disorder and dementia in the United States, adjusting for local health care resources and demographics.

Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care.

Objective: To create and test three prospective, increasingly restrictive definitions of serious illness.

Data Sources: Health and Retirement Study, 2000-2012.

Study Design: We evaluated subjects' 1-year outcomes from the interview date when they first met each definition: (A) one or more severe medical conditions (Condition) and/or receiving assistance with activities of daily living (Functional Limitation); (B) Condition and/or Functional Limitation and hospital admission in the last 12 months and/or residing in a nursing home (Utilization); and (C) Condition and Functional Limitation and Utilization.

Predictors of Mortality Up to 1 Year After Emergency Major Abdominal Surgery in Older Adults.

Objectives: To identify factors associated with mortality in older adults 30, 180, and 365 days after emergency major abdominal surgery.

Design: A retrospective study linked to Medicare claims from 2000 to 2010.

Setting: Health and Retirement Study (HRS).