The effect of the Ambulatory Integration of the Medical and Social (AIMS) model on health risk and depression.

Social needs are factors for health risk and depression that may negatively impact health outcomes and costly services use. Care management addresses social needs that can reduce health risk and depression. An exploratory study of the 5-step Ambulatory Integration of the Medical and Social Model (AIMS) was conducted to examine the effect of steps completed as part of AIMS on patients' depression and health risk outcomes at 6-months.

Supporting free clinic patients' social needs with MSW interns: A pilot study.

Social needs, which are social risk factors including lack of access to stable housing, healthy food, or reliable transportation, are recognized as integral to health. Free clinics tend to serve patients with social needs, yet, few are screened or receive assistance. Lack of personnel, resources, and procedures to identify and assist patients are reasons few free clinics consider social needs.

Time Contribution of Social Workers in Care Management: Value for Older Adults.

Purpose Of The Study: The purpose of this study was to examine the time contribution of social workers in delivering AIMS (Ambulatory Integration of the Medical and Social), a care management protocol designed to address patients' nonmedical needs, and the association of time contribution with patients' depression outcomes.

Primary Practice Setting: The study was conducted in 6 primary care provider clinics housed in a large, urban academic medical center located in the Midwestern United States.

Methodology And Sample: A longitudinal, quasi-experimental study employing survey procedures and a retrospective review of patient records was conducted.

Predicting Risk Factors for 30-Day Readmissions Following Discharge From Post-Acute Care.

Purpose Of Study: The specific aims of this descriptive study were to (1) examine the relationships between individual-level determinants of health using standard care admission assessments of residents admitted to a skilled nursing facility (SNF) and those residents readmitted to the hospital within 30 days from discharge from the same SNF; (2) identify and describe the risk factors of the residents readmitted to the hospital within 30 days; and (3) use the findings to inform and refine current practice to target the mutable risk factors correlated with 30-day hospital readmission.

Primary Practice Setting: A 180-bed skilled nursing center in Northeastern Pennsylvania.

Methodology And Sample: A retrospective paper medical record review of patients discharged from an SNF to community living was conducted to examine the relationship between individual determinants of health behaviors and 30-day hospital readmissions.

The role of social workers in addressing nonmedical needs in primary health care.

Nonmedical needs are intricately linked to health. Unaddressed nonmedical needs often result in poorer health and increased healthcare costs. Although social workers are well positioned to address nonmedical needs, their role in healthcare environments to address nonmedical needs is limited.

The Ambulatory Integration of the Medical and Social (AIMS) model: A retrospective evaluation.

An exploratory, retrospective evaluation of Ambulatory Integration of the Medical and Social (AIMS), a care coordination model designed to integrate medical and non-medical needs of patients and delivered exclusively by social workers was conducted to examine mean utilization of costly health care services for older adult patients. Results reveal mean utilization of 30-day hospital readmissions, emergency department (ED) visits, and hospital admissions are significantly lower for the study sample compared to the larger patient population. Comparisons with national population statistics reveal significantly lower mean utilization of 30-day admissions and ED visits for the study sample.

Understanding Service Utilization in Cases of Elder Abuse to Inform Best Practices.

Elder abuse (EA) case resolution is contingent upon victims accepting and pursuing protective service interventions. Refusal/underutilization of services is a major problem. This study explored factors associated with extent of EA victim service utilization (SU).

A systematic evaluation of a multidisciplinary social work-lawyer elder mistreatment intervention model.

This study introduces a conceptually based, systematic evaluation process employing multivariate techniques to evaluate a multidisciplinary social work-lawyer intervention model (JASA-LEAP). Logistic regression analyses were used with a random sample of case records (n = 250) from three intervention sites. Client retention, program fidelity, and exposure to multidisciplinary services were significantly related to reduction in mistreatment risk at case closure.

Elder Abuse and Neglect Risk Alleviation in Protective Services.

Little is known about conditions associated with favorable elder mistreatment (EM) case outcomes. The fundamental goal of EM protective service programs is to alleviate risk associated with substantiated cases of elder abuse and neglect. Using the EM socio-cultural model, this study examined victim, perpetrator, victim-perpetrator relationship, social embeddedness, and socio-cultural factors predicting risk alleviation of EM cases.

The contribution of practice skills in a care management process for family caregivers.

Practice skills are believed to improve practice, yet, little is known about the extent to which skills affect outcomes. This exploratory study examined the extent to which 3 practice skills specific to a care management context for family caregivers, including communication skills, supportive skills, and linking skills, were associated with fidelity of a care management process. Twenty-one care managers who used a single process to serve 113 family caregivers were included in the study.

Understanding the impact of racial self-identification on perceptions of health-related quality of life: a multi-group analysis.

Purpose: Multiple group analysis is used to determine whether the health-related quality of life (HRQoL) model developed by Wilson and Cleary (1995) is equivalent across racial categories. Using data from the Centers for Disease Control's Behavioral Risk Factor Surveillance System, this study compares racial groups (African American vs. White; Hispanic vs.

The utility of the behavioral risk factor surveillance system (BRFSS) in testing quality of life theory: an evaluation using structural equation modeling.

Purpose: This study uses structural equation modeling to assess the utility of the behavioral risk factor surveillance system (BRFSS)--the Centers for Disease Control's premier surveillance tool for monitoring behavioral risk factors-in predicting health-related quality of life (HRQoL).

Methods: Using SPSS/AMOS (version 18), the study utilizes New York State data extracted from the 2007 BRFSS national dataset to test a well-known HRQoL model developed by Wilson and Cleary (J Am Med Assoc 59-65, 2). The analysis represents an exploratory study that seeks to identify new applications for this important epidemiological database as well as a theoretical evaluation that examines the robustness of our current understanding of HRQoL.

Use of the Stages of Change transtheoretical model in end-of-life planning conversations.

Reports in the end-of-life literature reveal that patients and health care professionals, including social workers, nurses, and physicians, avoid discussions about preparation for such care. End-of-life care discussion barriers include, but are not limited to, professionals feeling unprepared to have the discussions and patients' lack of readiness to discuss planning for this care. Another barrier is the lack of a structured framework to initiate these discussions, especially with clients with advanced illnesses who may not acknowledge that they are at high risk for needing end-of-life care in the future.

Effectiveness of care coordination and health counseling in advancing illness.

Objective: To evaluate the Advanced Illness Coordinated Care Program (hereafter AICCP) for effects on health delivery among patients and caregivers, quality of life, advance planning, and health service utilization.

Study Design: Prospective trial involving 532 patients and 185 caregivers. AICCP consisted of care coordination, health counseling, and education delivered in cooperation with physicians.

Perspectives on the roles and value of social work practice in neighborhood health centers and implications for the reimbursement of services.

In recent years, increasing attention has been paid to the delivery of primary care services to underserved populations. This paper presents a subset of data from a larger exploratory study that examined how three professional groups (social workers, physicians, and administrators) in neighborhood health centers perceived the type and extent of psychosocial problems in their patient populations and the roles of their staff in addressing these problems. We examined the perceptions of physicians, administrators, and social workers as to who handles various psychosocial problems and whose responsibility it is to perform a range of psychosocial functions, with a focus on the function of social work.

Social work support services for stroke patients: interventions and outcomes.

This study aims to better understand the influence of social work support services on the efficient use of rehabilitation services (LOS-EFF) and total hospital charges for individuals participating in an inpatient physical rehabilitation program following stroke. Although the effects of the social work support services on stroke outcomes were modest, the study found that these services influenced stroke outcomes. Most importantly, the study revealed that higher levels of informational social work support services were associated with lower total hospital charges.

Psychosocial problems among patients in neighborhood health centers: perspectives from health care providers.

Little is known about how health care professionals perceive and understand the psychosocial problems of individuals receiving services in neighborhood health centers (NHCs). We conducted interviews with health care professionals in NHCs in New York City. The respondents identified seven problems, including a lack of financial resources, unsafe housing, and emotional distress/depression as affecting large portions of their patient populations.

The impact of technology on the "older" nurse: findings of the study: part 2.

This article presents the results of a study identifying older nurses' response to using various technology in their practice. This study measured nurses working with wireless peripheral devices, such as blood pressure cuffs, pulse oximeters, scales, glucometers, and digital thermometers, and monitoring units that were placed in the patient's home. Findings have implications for both older and younger clinicians as these types of products and systems can affect productivity, visit time, and assessment accuracy.