The opportunity for collaborative care provision: the presence of nursing home/hospice collaborations in the U.S. states.

This study estimated the proportion of U.S. nursing homes (NHs) collaborating with Medicare hospices and identified state-level factors associated with this collaboration.

Hospice and palliative care in nursing homes.

This article reviews the challenges inherent in providing high-quality palliative care to dying nursing home residents and summarizes the efforts to address these challenges. It is suggested that a stronger physician presence and oversight of physicians knowledgeable in palliative care in nursing homes are needed to improve the quality of end-of-life care in nursing homes.

Nursing home characteristics and potentially preventable hospitalizations of long-stay residents.

Objectives: To examine the association between having a nurse practitioner/physician assistant (NP/PA) on staff, other nursing home (NH) characteristics, and the rate of potentially preventable/avoidable hospitalizations of long-stay residents, as defined using a list of ambulatory care-sensitive (ACS) diagnoses.

Design: Cross-sectional prospective study using Minimum Data Set (MDS) assessments, Centers for Medicare and Medicaid Services inpatient claims and eligibility records, On-line Survey Certification Automated Records, (OSCAR) and Area Resource File (ARP).

Setting: Freestanding urban NHs in Maine, Kansas, New York, and South Dakota.

Which organizational characteristics are associated with increased management of depression using antidepressants in US nursing homes?

Background: There is universal agreement that organizational characteristics of nursing facilities can and do influence the quality of care and resident outcomes.

Objective: This study evaluated the relation between organizational characteristics and management of depression using antidepressants.

Research Design: This was a cross-sectional study of Medicare/Medicaid certified nursing homes in 6 states in 2000.

Nursing intervention and older adults who have cancer: specific science and evidence based practice.

This review of a small and heterogeneous body of literature suggests intriguing and useful approaches to nursing interventions with older adults who have cancer and areas that clearly deserve greater attention in future research. Research such as that done by McCorkle and Goodwin,while disparate in design, clearly demonstrate the ability of interventions to achieve better continuity of care and appropriate treatment for physically and socially vulnerable older adults with cancer. Comparison across settings and studies that investigate similar clinical phenomena would illuminate further how to achieve more effective intervention with elders who have cancer.

Perspectives on behavioral and social science research on cancer screening.

The first section in the current article offered several themes that characterize behavioral and social science cancer screening research to date and are likely to be relevant for studying the adoption and utilization of future screening technologies. The themes discussed included the link between epidemiologic surveillance and the priorities of intervention, the "at-risk" perspective that often guides research on screening and initiatives to redress disparities, the need to monitor the diversification of personal screening histories, the range of intervention groups and study designs that can be tested, the importance of including key questions in population-level surveys and national health objectives, and the desirability of clarifying the characteristics of cancer screening that make it an attractive field of study in its own right. The second section commented on emerging areas in which more research will allow additional lessons to be learned.

Hospice care in nursing homes: is site of care associated with visit volume?

Objectives: To determine factors associated with hospice visit volume and to examine whether visit volume differs by nursing home (NH) versus non-NH setting.

Design: Retrospective cohort study.

Setting: Twenty-one hospices across seven states under the ownership of one parent provider.

Government expenditures at the end of life for short- and long-stay nursing home residents: differences by hospice enrollment status.

Objectives: To examine end-of-life government expenditures for short- and long-stay Medicare- and Medicaid-eligible (dual-eligible) nursing home (NH) hospice and nonhospice residents.

Design: A retrospective cohort study.

Setting: Six hundred fifty-seven Florida NHs.

Prevalence and correlates of repeat mammography among women aged 55-79 in the Year 2000 National Health Interview Survey.

Background: Utilization of mammography has increased steadily since the early 1990s. It is now important to expand the attention given to obtaining repeat examination. This study examines the prevalence and cross-sectional correlates of repeat mammography, among women aged 55-79, using a 12-month (N = 3,502) and a 24-month interval (N = 3,491).

A comprehensive clinical assessment tool to inform policy and practice: applications of the minimum data set.

The Minimum Data Set (MDS) for nursing home (NH) resident assessment, designed to assess elders functional status and care needs, exemplifies how the information needs of clinical practice are congruent with those of research. Building on a review of the published literature, this article describes the development of the MDS, its reliability and validity testing, as well as the variety of different policy and research uses to which it has been applied. Interrater reliability of items and internal consistency of MDS summary scales is generally good to excellent.

Effect of state Medicaid reimbursement rates on hospitalizations from nursing homes.

Objectives: To estimate the effect of state Medicaid nursing home reimbursement rates on hospitalizations of nursing home residents.

Design: Cross-sectional sample of nongovernment-owned nursing homes with 25 beds or more in one Metropolitan Statistical Area in each of 10 states in 1993, with 6 months follow-up on mortality and hospitalizations.

Setting: Two hundred fifty-three nursing homes.

An evaluation of the impact of the prospective payment system on antidepressant use in nursing home residents.

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.

Methods: We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs).

Family perspectives on end-of-life care at the last place of care.

Context: Over the past century, nursing homes and hospitals increasingly have become the site of death, yet no national studies have examined the adequacy or quality of end-of-life care in institutional settings compared with deaths at home.

Objective: To evaluate the US dying experience at home and in institutional settings.

Design, Setting, And Participants: Mortality follow-back survey of family members or other knowledgeable informants representing 1578 decedents, with a 2-stage probability sample used to estimate end-of-life care outcomes for 1.

The cancer screening project for women: experiences of women who partner with women and women who partner with men.

The Cancer Screening Project for Women is a study about the experiences of legally unmarried women with breast, cervical, and colorectal cancer screening. During the initial phase of the study, we conducted focus groups to explore factors that influence unmarried women's decisions about cancer screenings. Women were invited to attend one of four group discussions: (1) never married women who either partner with women (WPW) or with both women and men (WPWM), (2) previously married women who now partner either with women (WPW) or with both women and men (WPWM), (3) never married women who partner with men (WPM), and (4) previously married women who partner with men (WPM).

Using clinical outcomes to explore the theory of expert practice in physical therapy.

Background And Purpose: Theoretical models of physical therapist expertise have been developed through research on physical therapists sampled solely on the basis of years of experience or reputation. Expert clinicians, selected on the basis of their patients' outcomes, have not been previously studied, nor have the patient outcomes of peer-nominated experts been analyzed. The purpose of our study was to describe characteristics of therapists who were classified as expert or average therapists based on the outcomes of their patients.

Factors associated with the high prevalence of short hospice stays.

This study's goal was to gain an understanding of the factors associated with hospice stays of 7 days or less (i.e., short hospice stays), and to test the hypothesis that independent of changes in sociodemographics, diagnoses, and site-of-care, the likelihood of a short hospice stay increased over time.

Inter-rater reliability of nursing home quality indicators in the U.S.

Background: In the US, Quality Indicators (QI's) profiling and comparing the performance of hospitals, health plans, nursing homes and physicians are routinely published for consumer review. We report the results of the largest study of inter-rater reliability done on nursing home assessments which generate the data used to derive publicly reported nursing home quality indicators.

Methods: We sampled nursing homes in 6 states, selecting up to 30 residents per facility who were observed and assessed by research nurses on 100 clinical assessment elements contained in the Minimum Data Set (MDS) and compared these with the most recent assessment in the record done by facility nurses.

Using clinical outcomes to identify expert physical therapists.

Background And Purpose: Previous studies of expert physical therapists have sampled therapists based on years of clinical experience or reputation, not on their patients' clinical outcomes. The purposes of this study were to identify expert physical therapists by using patient self-reported outcomes and to describe the characteristics of clinicians whose patients with lumbar spine syndromes reported higher health-related quality of life (HRQL) following rehabilitation.

Methods: Retrospective data were analyzed on 24276 patients (mean age=47.

Racial disparities in receipt of secondary stroke prevention agents among US nursing home residents.

Background And Purpose: Although medications can significantly reduce the risk of recurrent stroke, little is known about the extent to which such therapies are given to nursing home residents. We sought to evaluate the extent to which people of color were less likely to receive pharmacological agents in the treatment of recurrent stroke while living in US nursing homes.

Methods: We identified 19 051 residents with a recent hospitalization and primary discharge diagnosis of 434 or 436 in 5 states from 1992 to 1996; of these, 7053 had concomitant conditions indicating anticoagulant therapy.

Hospice enrollment and pain assessment and management in nursing homes.

This study compared pain assessment and management in the last 48 hours of life for hospice and nonhospice nursing home residents. Included were 209 hospice and 172 nonhospice residents in 28 nursing homes in six geographic areas. Hospice patients were considered short-stay (seven days or less) (n=51), or longer-stay (over seven days) (n=158).

Guide to outcomes measurement for patients with low back pain syndromes.

The Guide for Physical Therapist Practice states that the physical therapist determines the expected outcomes for each intervention and engages in outcomes data collection and analysis. Outcomes tracking provides a systematic way for therapists to monitor treatment effectiveness and efficiency. A familiarity with outcome measures for the patient with low back pain is indispensable for therapists in the outpatient orthopaedic setting, where patients with lumbar pain often comprise the majority of the caseload.

How does the timing of hospice referral influence hospice care in the last days of life?

Objectives: To determine factors associated with the type of hospice care received in the last days of life and, in particular, how the timing of referral influences the use of continuous hospice home care and inpatient hospice care.

Design: Retrospective cohort study.

Setting: Twenty-one hospice programs across seven states under the ownership of one hospice parent provider.

Oversight of nursing homes: pruning the tree or just spotting bad apples?

Purpose: This study investigated whether higher rates of nursing home quality citations are associated with increased risk of voluntary and involuntary facility terminations from the Medicare/Medicaid certification process.

Design And Methods: We examined nationwide Online Survey Certification and Reporting (OSCAR) data from 1992 through 2000 and used a multinomial logistic regression model with time-varying covariates to estimate the relationship between nursing home deficiencies and terminations.

Results: In the study period, 8.

Linkages in the rural continuum: the balanced budget act and beyond.

Purpose: This study examined how rural hospitals altered their postacute and long-term care strategies after the Balanced Budget Act of 1997 (BBA97).

Design And Methods: A nationally representative sample of 540 rural hospital discharge planners were interviewed in 1997. In the year 2000, 513 of 540 discharge planners were reinterviewed.