Patient and Caregiver Perceptions of Nursing Home Physicians: Insight from Yelp Reviews, 2009-2018

Association between Timing of Clinical Evaluation by a Physician or Advanced Practitioner and Risk of Rehospitalization in Older Adults Admitted to a Skilled Nursing Facility Following Hospitalization: A Cohort Study

OBJECTIVES

How transitional care services are provided to patients receiving post-acute care in skilled nursing facilities (SNFs) is not well understood. We aimed to determine the association of timing of physician or advanced practice provider (APP) visit after SNF admission with rehospitalization risk in a national cohort of older adults.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

2,482,616 Medicare fee-for-service beneficiaries aged ≥66 years who entered an SNF for post-acute care following hospitalization.

METHODS

We measured the relative risk of being rehospitalized within 14 days of SNF admission as a function of time to the first PAP visit, using time to follow-up as a time-dependent covariate, adjusted for patient demographics and clinical characteristics. We also evaluated whether findings extended across groups with different SNF prognosis on admission.

RESULTS

Patients seen sooner after admission to an SNF (0-1 days) were less likely to be rehospitalized compared to patients seen later (≥2 days). The relative difference was similar across different risk groups.

CONCLUSIONS AND IMPLICATIONS

Timely evaluation by a physician or APP after SNF admission may protect against rehospitalization. Investment in the workforce such as training programs, practice innovations, and equitable reimbursement for SNF visits after hospital discharge may mitigate labor shortages that were exacerbated by the COVID pandemic.

A sentiment analysis driven method based on public and personal preferences with correlated attributes to select online doctors

This paper proposes a method to assist patients in finding the most appropriate doctor for online medical consultation. To do that, it constructs an online doctor selection decision-making method that considers the correlation attributes, in which the measure of attribute correlation is derived from the history real decision data. To combine public and personal preference with correlated attributes, it proposes a Choquet integral based comprehensive online doctor ranking method. In detail, a two stage classification model based on BERT (Bidirectional Encoder Representations from Transformers) is used to extract service features from unstructured text reviews. Then, 2-additive fuzzy measure is adopted to represent the patient public group aggregated attribute preference. Next, a novel optimization model is proposed to combine the public preference and personal preference. Finally, a case study of dxy.com is carried out to illustrate the procedure of the method. The comparison result between proposed method and other traditional MADM (multi-attribute decision-making) methods prove its rationality.

US Generalist Physicians and Groups That Focused Practice in a Single Care Setting: 2014-2017

BACKGROUND

Some generalist physicians whose training prepared them for primary care practice increasingly practice in a facility (eg, hospitals, nursing homes); however, whether this trend was accompanied by a complimentary rise in generalist physicians who focused their practice on office-based care is unknown.

OBJECTIVES

Our objective in this study was to examine trends in the prevalence of generalist physicians and physician groups that practice in a single setting.

RESEARCH DESIGN

This was a retrospective cross-sectional study of generalist physicians trained in family medicine, internal medicine, or geriatrics. We used 2014-2017 billing data for Medicare fee-for-service beneficiaries to measure the proportion of all patient visits made by physicians in the following care settings: office, outpatient hospital department, inpatient hospital, and other sites.

RESULTS

From 2014 to 2017, the proportion of generalist physicians who narrowed their practice to a single setting increased by 6.69% (from 62.80% to 67.00%, p for trend <0.001). In 2017, 4.63% of physician groups included more than 1 type of setting-based physicians.

CONCLUSIONS

Generalist physicians treating older adults increasingly narrowed their practice focus to a single type of health care setting. This trend was not accompanied by growth among physician groups that included different types of setting-based physicians. Further evaluation of the consequences of these trends on the fragmentation of primary care delivery across different health care settings and primary care outcomes is needed.

Characterizing Physician Practice in Nursing Homes Using Claims-Based Measures: Correlation With Nursing Home Administrators' Perceptions

Heterogeneity in physician practice within nursing homes (NHs) may explain variations in quality. However, data on physician practice organization in NHs are hard to obtain. We characterized NH physician practice using two claims-based measures: (a) concentration of NH care among physicians (measured by Herfindahl-Hirschman index of visits); and (b) physician NH practice specialization (measured by the proportion of a physician's visits to NHs). We examined the relationship between the measures and NH administrator perceptions of physician practice reported in the Shaping Long-Term Care in America (SLTCA) Survey. All 2011 Part B claims from 13,718 physicians who treated Medicare fee-for-service patients in 2,095 NHs in the SLTCA survey were analyzed. The median Herfindahl-Hirschman index was 0.44 (interquartile range [IQR] 0.28-0.70), and the median specialization was 38.1% (IQR 19.9% to 60.9%). NHs with higher physician specialization reported more frequent physician participation in care coordination activities. Claims-based measures could inform the study of NH physician practice.