Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study.

Background: The change in the reimbursement policy of erythropoietin administration to patients receiving peritoneal dialysis by the Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs when maintaining the hematocrit (Hct) level below or above 30%.

Objective: The aim of this study was to analyze the impact of loosening the erythropoietin payment criteria for peritoneal dialysis patients on their cardiovascular outcomes.

Methods: Two cohorts of incident peritoneal dialysis patients were identified according to the time before and after relaxation of the NHI's erythropoietin payment criteria, designated cohort 1 (n=1759) and cohort 2 (n=2981), respectively.

The Challenges of Developing a Participatory Arts Intervention for Caregivers of Persons with Dementia.

We describe the development and challenges in implementing a web-based participatory art intervention specifically designed for caregivers of persons with dementia to use at home with their loved one.   Method: An interprofessional team, including an experienced national panel of artists, developed a participatory arts toolkit consisting of seven web-based modules involving a combination of music, singing, dancing, poetry, and painting. Participants completed a survey of demographics, caregiver needs, and caregiver burden.

Thailand's universal coverage scheme and its impact on health-seeking behavior.

Background: Thailand's Universal Coverage Scheme (UCS) has improved healthcare access and utilization since its initial introduction in 2002. However, a substantial proportion of beneficiaries has utilized care outside the UCS boundaries. Because low utilization may be an indication of a policy gap between people's health needs and the services available to them, we investigated the patterns of health-seeking behavior and their social/contextual determinants among UCS beneficiaries in the year 2013.

Contextual, Ecological and Organizational Variations in Risk-Adjusted COPD and Asthma Hospitalization Rates of Rural Medicare Beneficiaries.

The purpose of this study is to examine what factors contributing to the variability in chronic obstructive pulmonary disorder (COPD) and asthma hospitalization rates when the influence of patient characteristics is being simultaneously considered by applying a risk adjustment method. A longitudinal analysis of COPD and asthma hospitalization of rural Medicare beneficiaries in 427 rural health clinics (RHCs) was conducted utilizing administrative data and inpatient and outpatient claims from Region 4. The repeated measures of risk-adjusted COPD and asthma admission rate were analyzed by growth curve modeling.

A cost analysis of remote monitoring in a heart failure program.

In this study, we examine the cost per outcomes of remote monitoring services in home health care. The methodology followed case matched design via retrospective chart reviews. Results of the chi-square test suggest that there were no significant associations between the intervention and hospital readmissions, χ = (1, n = 210, p-value = .

Estimating the Net Career Income of a Geriatrician and a Nurse Practitioner: Still Want to Be a Doctor?

Objectives: With a continual shortage of geriatricians, adult-gerontology primary care nurse practitioners have assumed a greater role in the delivery of outpatient care for older adults. Given the long duration of physician training, the high cost of medical school, and the lower salaries compared with subspecialists, the financial advantage of a career as a geriatrician as opposed to a nurse practitioner is uncertain. This study compares the estimated career earnings of a geriatrician and an adult-gerontology primary care nurse practitioner.

A remote monitoring program evaluation: a retrospective study.

Objective: Using an integrated model, the Donabedian Quality and Logic Model, we examined a remote monitoring heart failure disease management program.

Method: This quantitative research used post-test only case matched design. The sample consisted of 210 participants from 23 home health care agencies.

Application of the WHOQOL-HIV-BREF Questionnaire in HIV-Infected Thai Patients: Reliability and Validity of the Instrument.

Given the prolonged survival of HIV-infected individuals as a result of widespread availability of treatment, health-related quality of life (HRQOL) becomes a relevant endpoint for assessing the impacts of HIV interventions. We examined the reliability and validity of the World Health Organization Quality of Life in HIV-infected Persons instrument (WHOQOL-HIV-BREF) using data from 329 HIV-infected Thai patients who received outpatient care at seven public hospitals. Our findings revealed acceptable reliability, construct validity, and convergent validity of the WHOQOL-HIV-BREF.

The moderating effect of leadership on the relationship between personality and performance.

Aim: To examine how personality and leadership influence efficiency in the nursing service environment.

Background: Leadership and personality contribute to the success and failure of a unit. However, how they interact to influence performance is still understudied.

Identifying the readiness of patients in implementing telemedicine in northern Louisiana for an oncology practice.

This study identified the readiness factors that may create challenges in the use of telemedicine among patients in northern Louisiana with cancer. To identify these readiness factors, the team of investigators developed 19 survey questions that were provided to the patients or to their caregivers. The team collected responses from 147 respondents from rural and urban residential backgrounds.

Contextual, organizational and ecological effects on the variations in hospital readmissions of rural Medicare beneficiaries in eight southeastern states.

The enactment of the Patient Protection and Affordable Care Act (ACA) has been expected to improve the coverage of health insurance, particularly as related to the coordination of seamless care and the continuity of elder care among Medicare beneficiaries. The analysis of longitudinal data (2007 through 2013) in rural areas offers a unique opportunity to examine trends and patterns of rural disparities in hospital readmissions within 30 days of discharge among Medicare beneficiaries served by rural health clinics (RHCs) in the eight southeastern states of the Department of Health & Human Services (DHHS) Region 4. The purpose of this study is twofold: first, to examine rural trends and patterns of hospital readmission rates by state and year (before and after the ACA enactment); and second, to investigate how contextual (county characteristic), organizational (clinic characteristic) and ecological (aggregate patient characteristic) factors may influence the variations in repeat hospitalizations.

The Impact of State Nursing Home Staffing Standards on Nurse Staffing Levels.

This study investigated the impact of state nursing home staffing standards on nurse staffing levels for the year 2011. Specifically, the study attempted to measure state staffing standards at facility level (i.e.

Variations in Colorectal Cancer Screening of Medicare Beneficiaries Served by Rural Health Clinics.

This study aims (1) to examine the trends and patterns of colorectal cancer screening (CCS) of Medicare beneficiaries in rural areas by state and year (before and after Affordable Care Act [ACA] enactment) and (2) to investigate the contextual, organizational, and aggregated patient characteristics influencing variations in care received by patients of rural health clinics (RHCs). The following 2 hypotheses were formulated: (1) CCS rates are higher in the post-ACA period than in the pre-ACA period, irrespective of the factors rurality, poverty, dually eligible status, and the organizational characteristics of RHCs and (2) the contextual and organizational factors of RHCs exert more influence on the variation in CCS rates of RHC patients than do aggregated personal factors. We used administrative data on CCS rates (2007 through 2012) for rural Medicare beneficiaries.

A TRANSDISCIPLINARY APPROACH TO HEALTH POLICY RESEARCH AND EVALUATION.

An integrated perspective consists of macro- and micro-level approaches to health policy research and evaluation is presented. Analytical strategies are suggested for policy analysis, targeting on health disparities at individual and population levels. This systems approach enables investigators to view how scientific public policy analysis can be implemented to assess policy impacts.

INFRASTRUCTURAL MECHANISMS LEADING TOWARD PRO-ACCOUNTABLE CARE ORGANISATION ORIENTATION: A SURVEY OF HOSPITAL MANAGERS.

Organisations across the country are transforming the way they deliver care, in ways similar to the accountable care organisation (ACO) model supported by Medicare. ACOs modalities are varying in size, type, and financing structure. Little is known about how specific infrastructural mechanisms influence hospital managers' pro-ACO orientation.

Gaps in nurse staffng and nursing home resident needs.

Trends in nurse staffing levels in nursing homes from 1997 to 2011 varied across the category of nurse and the type of nursing home. The gaps found in this study are important to consider because nurses may become overworked and this may negatively affect the quality of services and jeopardize resident safety. Nursing home administrators should consider improving staffing strategically.

Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem.

Introduction: The issues of medical errors and medical malpractice have stimulated significant interest in establishing transparency in health care, in other words, ensuring that medical professionals formally report medical errors and disclose related outcomes to patients and families. However, research has amply shown that transparency is not a universal practice among physicians.

Methods: A review of the literature was carried out using the search terms "transparency," "patient safety," "disclosure," "medical error," "error reporting," "medical malpractice," "doctor-patient relationship," and "physician" to find articles describing physician barriers to transparency.

Willingness to participate in accountable care organizations: health care managers' perspective.

This study examines how health care managers responded to the accountable care organization (ACO). The effect of perceived benefits and barriers of the commitment to develop a strategic plan for ACOs and willingness to participate in ACOs is analyzed, using organizational social capital, health information technology uses, health systems integration and size of the health networks, geographic factors, and knowledge about ACOs as predictors. Propensity score matching and analysis are used to adjust the state and regional variations.

Transitional care: looking for the right shoes to fit older adult patients.

Potentially avoidable hospitalizations are associated with high costs and an increased risk for iatrogenic conditions in older adult patients. Although care managers may be aware of the common potential pitfalls that may arise in the transfer of patients to and from the hospital defining best practice models has been difficult. Many current models of geriatric care have had little or no impact on lowering the rates of hospitalizations and rehospitalizations when formally studied.

Organizational and Environmental Correlates to Preventive Quality of Care in US Rural Health Clinics.

Purpose: To identify organizational and environmental correlates to rural health clinics' preventive quality of care in the United States.

Design: A retrospective observational cohort study design was applied under Donabedian's Structure-Process-Outcome framework. Three structure measures of care (proportion of nonphysicians, absence of physicians, and provider affiliation) and three measures of process (total clinical visits, prevention use for congestive heart failure and diabetes) were used as explanatory variables.

Nursing home research in Jinan, China: a focus group approach.

This qualitative research using the focus group approach has gathered pertinent perceptions from the stakeholders in Chinese elderly care environment, including community-based and institutionalised elderly, medical providers, administrators and governmental officials. The study found that the elderly are willing to live in nursing homes when they are not in good physical condition and are dependent on others for their activities of daily living. The utilisation of nursing home care has gained acceptance in the community as more elders recognise its advantages.

The impact of health literacy on a patient's decision to adopt a personal health record.

Health literacy is a concept that describes a patient's ability to understand materials provided by physicians or other providers. Several factors, including education level, income, and age, can influence health literacy. Research conducted at one medical practice in Florida indicated that in spite of the patients' relatively low education level, the majority indicated a broad acceptance of personal health record (PHR) technology.

Predicting quality of life after breast cancer surgery using ANN-based models: performance comparison with MR.

Purpose: The goal was to develop models for predicting long-term quality of life (QOL) after breast cancer surgery.

Methods: Data were obtained from 203 breast cancer patients who completed the SF-36 health survey before and 2 years after surgery. Two of the models used to predict QOL after surgery were artificial neural networks (ANNs), which included one multilayer perceptron (MLP) network and one radial basis function (RBF) network.

Trends in rural health Clinics and needs during U.S. health care reform.

Aim: Rural Health Clinics (RHCs) are primary care clinics certified through Medicare and Medicaid to provide health care to the medically underserved in rural areas of the United States. The purpose of this paper is to describe how the characteristics of RHCs have either changed or remained stable over a 10-year period in the past: from the late 1990s to 2007. In addition, it is also to describe some of the outstanding needs of RHCs as they navigate the transitions of U.