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Qin Q, Yang M, Veazie P, Temkin-Greener H, Conwell Y, Cai S. Telemedicine Utilization Among Residents With Alzheimer Disease and Related Dementia: Association With Nursing Home Characteristics. J Am Med Dir Assoc 2024; 25:105152. [PMID: 39013475 DOI: 10.1016/j.jamda.2024.105152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To examine telemedicine use among nursing home (NH) residents with Alzheimer disease and related dementias (ADRD) and the associations with NH characteristics. DESIGN Observational study. SETTING AND PARTICIPANTS 2020-2021 Minimum Data Set 3.0, Medicare datasets, and Nursing Home Compare data were linked. A total of 10,810 NHs were identified. METHODS The outcome variable was the percentage of residents with ADRD who used telemedicine in an NH in a quarter. The main independent variables were NH racial and ethnic compositions (ie, percentages of Black and Hispanic residents) and NH rurality. A set of linear models with NH random effects were estimated. The analysis was stratified by COVID-19 pandemic stages, including the beginning of the pandemic [second quarter of 2020 (2020 Q2)], before and after the widespread of the COVID-19 vaccine (ie, 2020 Q3-2021 Q1 and 2021 Q2-2021 Q4). RESULTS The proportion of residents with ADRD in NHs who had telemedicine use declined from 35.0% in 2020 Q2 to 9.3% in 2021 Q4. After adjusting for other NH characteristics, NHs with a high proportion of Hispanic residents were 2.7 percentage points more likely to use telemedicine for residents with ADRD than those with a low proportion during 2021 Q2-2021 Q4 (P < .001), whereas NHs with a high proportion of Black residents were 1.5 percentage points less likely to use telemedicine than those with a low proportion (P < .01). Additionally, compared with metropolitan NHs, rural NHs were 6.4 percentage points less likely to use telemedicine in 2020 Q2 (P < .001), but 5.9 percentage points more likely to use telemedicine during 2021 Q2-2021 Q4 (P < .001). We also detected the relationship between telemedicine use and other NH characteristics, such as NH quality, staffing level, and Medicaid-pay days. CONCLUSIONS AND IMPLICATIONS The proportion of residents with ADRD in NHs who had telemedicine use decreased during the pandemic. Telemedicine could improve health care access for NHs with a high proportion of Hispanic residents and NHs in remote areas. Future studies should investigate how telemedicine use affects the health outcomes of NH residents with ADRD.
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Affiliation(s)
- Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Mingting Yang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Yeates Conwell
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Karmarkar AM, Roy I, Lane T, Shaibi S, Baldwin JA, Kumar A. Home health services for minorities in urban and rural areas with Alzheimer's and related dementia. Home Health Care Serv Q 2023; 42:265-281. [PMID: 37128943 DOI: 10.1080/01621424.2023.2206368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Timely access and continuum of care in older adults with Alzheimer's Disease and Related Dementia (ADRD) is critical. This is a retrospective study on Medicare fee-for-service beneficiaries with ADRD diagnosis discharged to home with home health care following an episode of acute hospitalization. Our sample included 262,525 patients. White patients in rural areas have significantly higher odds of delay (odds ratio [OR], 1.03; 95% CI, 1.01-1.06). Black patients in urban areas (OR, 1.15; 95% CI, 1.12-1.19) and Hispanic patients in urban areas also were more likely to have a delay (OR, 1.07; 95% CI, 1.03-1.11). Black and Hispanic patients residing in urban areas had a higher likelihood of delay in home healthcare initiation following hospitalization compared to Whites residing in urban areas.
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Affiliation(s)
- Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Research Department, Sheltering Arms Institute, Richmond, Virginia, USA
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Taylor Lane
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Stefany Shaibi
- Physical Therapy Department, Creighton University, Phoenix, Arizona, USA
| | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Amit Kumar
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
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Stewart JW, Hou H, Wang Y, Bonner SN, Hawkins RB, Pagani FD, Ailawadi G, Likosky DS, Thompson MP. Skilled Nursing Facility Quality Rating and Surgical Outcomes Following Coronary Artery Bypass Grafting. Semin Thorac Cardiovasc Surg 2022; 36:313-320. [PMID: 36402230 DOI: 10.1053/j.semtcvs.2022.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022]
Abstract
Centers for Medicare and Medicaid Services created a 5-star quality rating system to evaluate skilled nursing facilities (SNFs). Patient discharge to lower-star quality SNFs has been shown to adversely impact surgical outcomes. Recent data has shown that over 20% of patients are discharged to an SNF after CABG, but the link between SNF quality and CABG outcomes has not been established. The purpose of this study is to evaluate the impact of SNF quality ratings on postoperative outcomes after CABG. Retrospective cohort review of Medicare patients undergoing CABG and discharged to an SNF between the years 2016-2017. Patients were categorized into 3 groups according to the star rating of the SNF with receipt of care after discharge (ie, below average, average, above average). Risk-adjusted 30-day to 1-year outcomes of mortality, readmission, and SNF length of stay were calculated and compared using multivariable logistic regression and Poisson models across SNF quality categories. Of the 73,164 Medicare patients in our sample, 15,522 (21.2%) were discharged to an SNF. Patients in below average SNFs were more likely to be younger, Black, Medicare/Medicaid dual eligible, and have more comorbidities. Compared to above average SNFs, patients discharged to below average SNFs experienced higher risk-adjusted 30-day mortality (2.1% vs 1.6%, P<0.02), readmission (21.6% vs 19.3%, P<0.01) and SNF length of stay (17.3d vs 16.5d, P<0.0001). Within 90-days, below average SNFs experienced higher risk-adjusted readmission rates (31.7% vs 30.0%, P<0.004). Outcomes at 1-year were not statistically significant. Medicare beneficiaries discharged to lower quality SNFs experienced worse postoperative outcomes after CABG. Identifying best practices at high performing SNFs, to potentially implement at low performing facilities, may improve equitable care for patients.
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Affiliation(s)
- James W Stewart
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.; Department of Surgery, Yale School of Medicine, New Haven, Connecticut.; VA Healthcare System, Ann Arbor, Michigan..
| | - Hechuan Hou
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Yoyo Wang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael P Thompson
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
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Gozalo PL, Inrator O, Phibbs CS, Kinosian B, Allen SM. Successful Discharge of Short Stay Veterans from VA Community Living Centers. J Aging Soc Policy 2022; 34:690-706. [PMID: 35959862 DOI: 10.1080/08959420.2022.2111169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The Veterans Health Administration (VHA) long-term care rebalancing initiative encouraged VA Community Living Centers (CLCs) to shift from long-stay custodial-focused care to short-stay skilled and rehabilitative care. Using all VA CLC admissions during 2007-2010 categorized as needing short-stay rehabilitation or skilled nursing care, we assessed the patient and facility rates of successful discharge to the community (SDC) of these short-stay Veterans. We found large variation in inter- as well as intra- facility SDC rates across the rehabilitation and skilled nursing short-stay cohorts. We discuss how our results can help guide VHA policy directed at delivering high-quality short-stay CLC care for Veterans.
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Affiliation(s)
- Pedro L Gozalo
- Research Health Scientist, U.S. Department of Veterans Affairs Medical Center, Center of Innovation in Long-Term Services and Supports, Providence, Rhode Island, USA.,Professor, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Orna Inrator
- Professor, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Research Health Scientist, Geriatrics & Extended Care Data & Analysis Center (GEC DAC), Canandaigua VA Medical Center, Canandaigua, New York, USA
| | - Ciaran S Phibbs
- Research Health Scientist, Health Economics Resource Center, Palo Alto VA Health Care System, Palo Alto, California, USA.,Associate Professor, Center for Innovation to Implementation, Stanford University School of Medicine, Palo Alto, California, USA.,Research Health Scientist, Geriatrics and Extended Care Data and Analysis Center, Palo Alto VA Health Care System, Palo Alto, California, USA
| | - Bruce Kinosian
- Associate Professor, Division of Geriatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Research Health Scientist, Geriatrics & Extended Care Data & Analysis Center (GEC DAC), Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Susan M Allen
- Research Health Scientist, U.S. Department of Veterans Affairs Medical Center, Center of Innovation in Long-Term Services and Supports, Providence, Rhode Island, USA.,Professor, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
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Rivera-Hernandez M, Kumar A, Roy I, Fashaw-Walters S, Baldwin JA. Quality of Care and Outcomes Among a Diverse Group of Long-Term Care Residents With Alzheimer's Disease and Related Dementias. J Aging Health 2022; 34:283-296. [PMID: 34634973 PMCID: PMC8957613 DOI: 10.1177/08982643211043319] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ObjectivesThis article assessed whether disparities among ADRD Medicare beneficiaries existed in five different long-stay quality measures. Methods: We linked individual-level data and facility-level characteristics. The main quality outcomes included whether residents: 1) were assessed/appropriately given the seasonal influenza vaccine; 2) received an antipsychotic medication; 3) experienced one/more falls with major injury; 4) were physically restrained; and 5) lost too much weight. Results: In 2016, there were 1,005,781 Medicare Advantage and fee-for-service long-term residents. About 78% were White, 13% Black, 2% Asian/Pacific Islander (Asian/PI), 6% Hispanic, and 0.4% American Indian/Alaska Native (AI/AN). Whites reported higher use of antipsychotic medications along with Hispanics and AI/AN (28%, 28%, and 27%, respectively). Similarly, Whites and AIs/ANs reported having one/more falls compared to the other groups (9% and 8%, respectively). Discussion: Efforts to understand disparities in access and quality of care among American Indians/Alaska Natives are needed, especially post-pandemic.
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Affiliation(s)
- Maricruz Rivera-Hernandez
- Brown University School of Public Health, Providence, RI, USA
- Brown University School of Public Health, Providence, RI USA
| | - Amit Kumar
- Brown University School of Public Health, Providence, RI USA
- Northern Arizona University, Flagstaff, AZ, USA
- Northern Arizona University, Flagstaff, AZ, USA
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Mathuba W, Deer R, Downer B. Racial and ethnic differences in the improvement in daily activities during a nursing home stay. J Am Geriatr Soc 2021; 70:1244-1251. [PMID: 34882305 DOI: 10.1111/jgs.17600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Improving independence in daily activities is an important outcome of postacute nursing home care. We investigated racial and ethnic differences in the improvement in activities of daily living (ADL) during a skilled nursing facility (SNF) stay among Medicare fee-for-service beneficiaries with a hip fracture, joint replacement, or stroke. METHODS This was a retrospective study of Medicare beneficiaries admitted to a SNF between 01/01/2013 and 9/30/2015. The final sample included 428,788 beneficiaries admitted to a SNF within 3 days of hospital discharge for a hip fracture (n = 118,790), joint replacement (n = 245,845), or stroke (n = 64,153). Data from residents' first and last Minimum Data Set were used to calculate ADL total scores for self-performance in dressing, personal hygiene, toileting, locomotion on the unit, transferring, bed mobility, and eating. Residents were dichotomized according to having had any improvement in the ADL total score. Multivariable logistic regression models that included a random intercept for the facility were used to estimate the adjusted odds ratios for any improvement in ADL function among black and Hispanic residents compared to white residents. RESULTS A total of 299,931 residents (69.9%) had any improvement in ADL function. Black residents (OR:0.94; 95% CI: 0.91-0.98) but not Hispanic residents (OR: 0.98; 95% CI: 0.94-1.03) had significantly lower odds to have any improvement in ADL function. Analyses stratified by the reason for prior hospitalization indicated that black residents discharged for hip fracture (OR: 0.87; 95% CI: 0.80-0.93) and stroke (OR: 0.87; 95% CI: 0.83-0.93), but not joint replacement (OR: 1.02; 95% CI: 0.97-1.06) had significantly lower odds for any ADL improvement compared to white residents. CONCLUSIONS Our findings are evidence for racial disparities in the improvement in ADL function during a SNF stay. Future research should investigate systemic factors that may contribute to disparities in the improvement in ADL function during a SNF stay.
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Affiliation(s)
- Warona Mathuba
- University of Texas Medical Branch School of Medicine, Galveston, Texas, USA
| | - Rachel Deer
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas, USA.,University of Texas Medical Branch, Sealy Center on Aging, Galveston, Texas, USA
| | - Brian Downer
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas, USA.,University of Texas Medical Branch, Sealy Center on Aging, Galveston, Texas, USA
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