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Ahmed S, Cayea D, Tackett S, Bellantoni M, Massare J, Ward H, Schoenborn N, Oh ES. Knowledge and attitudes of patient safety attendants in managing hospitalized older adults with delirium and dementia. J Am Geriatr Soc 2024; 72:616-619. [PMID: 37850722 PMCID: PMC10922417 DOI: 10.1111/jgs.18635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/31/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Shaista Ahmed
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Danelle Cayea
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sean Tackett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michele Bellantoni
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacqueline Massare
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hannah Ward
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nancy Schoenborn
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Esther S. Oh
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Neuropathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Hsiao YL, Bass EB, Wu AW, Kelly D, Sylvester C, Berkowitz SA, Bellantoni M. Preventing Avoidable Rehospitalizations through Standardizing Management of Chronic Conditions in Skilled Nursing Facilities. J Am Med Dir Assoc 2023; 24:1910-1917.e3. [PMID: 37690461 DOI: 10.1016/j.jamda.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES This study evaluated the impact of standardized care protocols, as a part of a quality improvement initiative (J10ohns Hopkins Community Health Partnership, J-CHiP), on hospital readmission rates for patients with a diagnosis of congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD) after being discharged to skilled nursing facilities (SNFs). DESIGN A retrospective study comparing 30-day hospital readmission rates the year before and 2 years following the implementation of the care protocol interventions. SETTINGS AND PARTICIPANTS Patients discharged from Johns Hopkins Hospital or Johns Hopkins Bayview Medical Center to the participating SNFs diagnosed with CHF and/or COPD. METHODS The standardized protocols included medical provider or nurse assessments on SNF admission, multidisciplinary care planning, and medication management to avoid unplanned readmissions to the hospital. Descriptive analyses were conducted to illustrate the 30-day readmission rates before and after protocol implementation. RESULTS There were 1128 patients in the pre-J-CHiP cohort and 2297 patients in the J-CHiP cohort. About half of the patients with a recorded diagnosis of CHF without COPD had the standardized protocol initiated, whereas 47% of the patients with a recorded diagnosis of COPD without CHF had the standardized protocol initiated. Of patients with recorded diagnoses of COPD and CHF, 49% had both protocols initiated. A reduction in the readmission rate was observed for patients with COPD protocols, from 23.5% in 2011 to 12.1% in 2015. However, fluctuations in the readmission rates were observed for patients who initiated the CHF protocols. CONCLUSIONS AND IMPLICATIONS There were improvements in the readmission rates in this study, especially for patients who had initiated standardized care protocols in the SNFs. Our findings demonstrate great value in standardizing care management and strengthening collaboration with chronic care settings to facilitate a smooth transition of medically complex patients discharged from large health care systems. Future interventions could consider assessing nonclinical factors that may impact preventable hospital readmissions.
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Affiliation(s)
- Ya Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Denise Kelly
- Division of Geriatric Medicine and Gerontology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Carol Sylvester
- Office of Population Health, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Scott A Berkowitz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michele Bellantoni
- Division of Geriatric Medicine and Gerontology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
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Waters L, Berish D, Rhodes A, Bellantoni M. AGE-FRIENDLY CARE: A FRAMEWORK TO ADDRESS HEALTH DISPARITIES IN NURSING HOMES. Innov Aging 2022. [PMCID: PMC9770299 DOI: 10.1093/geroni/igac059.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Three Geriatrics Workforce Enhancement Programs (Johns Hopkins, Penn State and Virginia Commonwealth) within Health and Human Services Region-3, implemented a project providing tailored educational content designed to meet the regional needs of nursing home staff, residents, and carepartners within the context of the COVID-19 pandemic. Semi-Structured, recorded focus groups were conducted with direct care workers, and family and resident counsels. All groups were interviewed about familiarity and comfort with the 3Ds (Dementia, Delirium, and Depression) as well as what mattered most to them as workers, residents and care partners. The overall goal was to enhance development of the nursing home workforce thus creating a meaningful clinical improvement in care. We aim to go beyond the improvement of routine clinical care and address the long-standing behavioral and mental health disparities observed in this resident population. Policy implications around education, engagement of workforce, resident, and carepartner voices will be discussed.
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Affiliation(s)
- Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Diane Berish
- Pennsylvania State University, University Park, Pennsylvania, United States
| | - Annie Rhodes
- Virginia Commonwealth University, Richmond, Virginia, United States
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Hamilton C, Hamilton C, Robertson M, Arbaje A, Sheikh F, Bellantoni M. "What Is a Care Plan?": A Qualitative Assessment of Nursing Home Resident's Perspectives. J Am Med Dir Assoc 2021; 22:B18-B19. [PMID: 34287162 DOI: 10.1016/j.jamda.2021.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVES To assess the association of geriatric syndrome risk factors with postacute utilization among hospitalized Medicare patients (both Medicare Advantage [MA] and fee-for-service [FFS] cohorts) and to examine patterns of postacute care for MA and FFS cohorts with high geriatric syndrome risk. STUDY DESIGN Secondary data analysis using encounter-level data from the State Inpatient Databases (SID) of the Healthcare Cost and Utilization Project. METHODS The sample included 3.1 million Medicare hospitalizations from the Florida SID (2010 to 2014). We used multivariate linear regression to examine the impact of a geriatric syndrome risk measure, assessed as high risk, moderate risk, or nonrisk, on outcomes in MA and FFS cohorts. Outcome measures included postacute destination and inpatient utilization. We then examined if this risk measure was associated with differences in outcomes between MA and FFS cohorts. RESULTS Patients with high geriatric syndrome risk (in both MA and FFS cohorts) are less likely to be discharged to home or to home health care. They also have longer inpatient lengths of stay and higher inpatient costs. This risk measure also explains differences in postacute skilled nursing destination between MA and FFS cohorts. CONCLUSIONS Geriatric syndrome risk factors not only play a role in postacute care and inpatient utilization in MA and FFS cohorts but also explain different utilizations between MA and FFS cohorts. This study's results can be applied to guide discharge planning among a group of high-risk patients and evaluate alternative delivery models for this high-cost, high-need cohort.
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Affiliation(s)
- Shannon S Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 428, Baltimore, MD 21205.
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Sheikh F, Gathecha E, Bellantoni M, Christmas C, Lafreniere JP, Arbaje AI. A Call to Bridge Across Silos during Care Transitions. Jt Comm J Qual Patient Saf 2019; 44:270-278. [PMID: 29759260 DOI: 10.1016/j.jcjq.2017.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/27/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Older adults with complex medical conditions are vulnerable during care transitions. Poor care transitions can lead to poor patient outcomes and frequent readmissions to the hospital. FACTORS CONTRIBUTING TO SUBOPTIMAL CARE TRANSITIONS Key factors related to ineffective care transitions, which can lead to suboptimal patient outcomes, include poor cross-site communication and collaboration; lack of awareness of patient wishes, abilities, and goals of care; and incomplete medication reconciliation. Fundamental elements for effective care transitions put forth by The Joint Commission for effective care transitions include interdisciplinary coordination and collaboration of patient care in care transitions, shared accountability by all clinicians involved in care transitions, and provision of appropriate support and follow-up after discharge. REVIEW OF FOUR EXISTING MODELS OF CARE TRANSITIONS Consideration of four existing care transitions models representing different health care settings-Care Transitions Intervention® Guided Care, Interventions to Reduce Acute Care Transfers (INTERACT®), Home Health Model of Care Transitions-revealed that they are important but limited in their impact on transitions across health care settings. PROPOSAL OF THE INTEGRATED CARE TRANSITIONS APPROACH An innovative approach, Integrated Care Transitions Approach (ICTA), is proposed that incorporates the best practices of the four models discussed in this article and factors identified as essential for an effective care transition while addressing limitations of existing transitional care models. ICTA's four key characteristics and seven key elements are unique and stem from factors that help achieve effective care transitions.
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Conway SJ, Parekh AK, Hughes AH, Sylvester C, Himmelrich S, Hebert LC, Doyle D, Bellantoni M, Berkowitz SA. Postacute Care Transitions: Developing a Skilled Nursing Facility Collaborative within an Academic Health System. J Hosp Med 2019; 14:174-177. [PMID: 30811325 DOI: 10.12788/jhm.3117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/27/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Sarah J Conway
- The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Anand K Parekh
- The Johns Hopkins School of Medicine, Baltimore, Maryland
- Bipartisan Policy Center, Washington, DC
| | - Andrew H Hughes
- The Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | | | | | - Lindsay C Hebert
- Johns Hopkins HealthCare LLC, Glen Burnie, Maryland; On behalf of the Johns Hopkins Medicine Skilled Nursing Facility Collaborative
| | - Damien Doyle
- Johns Hopkins HealthCare LLC, Glen Burnie, Maryland; On behalf of the Johns Hopkins Medicine Skilled Nursing Facility Collaborative
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Nahm ES, Zhu S, Bellantoni M, Keldsen L, Russomanno V, Rietschel M, Majid T, Son H, Smith L. The Effects of a Theory-Based Patient Portal e-Learning Program for Older Adults with Chronic Illnesses. Telemed J E Health 2018; 25:940-951. [PMID: 30431393 DOI: 10.1089/tmj.2018.0184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction: The high prevalence of chronic illnesses is a serious public health problem in the United States, and more than 70 million older adults have at least one chronic illness. Patient portals (PPs) have an excellent potential to assist older adults in managing chronic illnesses; however, older adults' PP adoption rates have been low. Lack of support for older adults using PPs remains a critical gap in most implementation processes. The main aim of this study was to assess the impact of an older adult friendly Theory-based Patient portal e-Learning Program (T-PeP) on PP knowledge, selected health outcomes (health decision-making self-efficacy [SE] and health communication), PP SE and use, and e-health literacy in older adults. Materials and Methods: A two-arm randomized controlled trial was conducted with older adults (N = 272) who had chronic conditions. Participants were recruited online, and data were collected at baseline, 3 weeks, and 4 months. The main intervention effects were tested using linear mixed models. Results: The average age of participants was 70.0 ± 8.5 years, and 78.3% (n = 213) were white. At 3 weeks, the intervention group showed significantly greater improvement than the control group in all outcomes except PP use. At 4 months, the intervention effects decreased, but PP SE remained significant (p = 0.015), and the intervention group showed higher frequency of PP use than the control group (p = 0.029). Conclusion: The study findings showed that the T-PeP was effective in improving selected health and PP usage outcomes. Further studies are needed to test the long-term effects of T-PeP using more diverse samples.
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Affiliation(s)
- Eun-Shim Nahm
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Shijun Zhu
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Michele Bellantoni
- Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Linda Keldsen
- Veterans Health Education, Nursing Affiliations & My HealtheVet, VA Maryland Health Care System, Baltimore, Maryland
| | - Vince Russomanno
- eHealth Initiatives, University of Maryland Medical System, Baltimore, Maryland
| | - Matt Rietschel
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | | | - HyoJin Son
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
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Berkowitz SA, Parashuram S, Rowan K, Andon L, Bass EB, Bellantoni M, Brotman DJ, Deutschendorf A, Dunbar L, Durso SC, Everett A, Giuriceo KD, Hebert L, Hickman D, Hough DE, Howell EE, Huang X, Lepley D, Leung C, Lu Y, Lyketsos CG, Murphy SME, Novak T, Purnell L, Sylvester C, Wu AW, Zollinger R, Koenig K, Ahn R, Rothman PB, Brown PMC. Association of a Care Coordination Model With Health Care Costs and Utilization: The Johns Hopkins Community Health Partnership (J-CHiP). JAMA Netw Open 2018; 1:e184273. [PMID: 30646347 PMCID: PMC6324376 DOI: 10.1001/jamanetworkopen.2018.4273] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The Johns Hopkins Community Health Partnership was created to improve care coordination across the continuum in East Baltimore, Maryland. OBJECTIVE To determine whether the Johns Hopkins Community Health Partnership (J-CHiP) was associated with improved outcomes and lower spending. DESIGN, SETTING, AND PARTICIPANTS Nonrandomized acute care intervention (ACI) and community intervention (CI) Medicare and Medicaid participants were analyzed in a quality improvement study using difference-in-differences designs with propensity score-weighted and matched comparison groups. The study spanned 2012 to 2016 and took place in acute care hospitals, primary care clinics, skilled nursing facilities, and community-based organizations. The ACI analysis compared outcomes of participants in Medicare and Medicaid during their 90-day postacute episode with those of a propensity score-weighted preintervention group at Johns Hopkins Community Health Partnership hospitals and a concurrent comparison group drawn from similar Maryland hospitals. The CI analysis compared changes in outcomes of Medicare and Medicaid participants with those of a propensity score-matched comparison group of local residents. INTERVENTIONS The ACI bundle aimed to improve transition planning following discharge. The CI included enhanced care coordination and integrated behavioral support from local primary care sites in collaboration with community-based organizations. MAIN OUTCOMES AND MEASURES Utilization measures of hospital admissions, 30-day readmissions, and emergency department visits; quality of care measures of potentially avoidable hospitalizations, practitioner follow-up visits; and total cost of care (TCOC) for Medicare and Medicaid participants. RESULTS The CI group had 2154 Medicare beneficiaries (1320 [61.3%] female; mean age, 69.3 years) and 2532 Medicaid beneficiaries (1483 [67.3%] female; mean age, 55.1 years). For the CI group's Medicaid participants, aggregate TCOC reduction was $24.4 million, and reductions of hospitalizations, emergency department visits, 30-day readmissions, and avoidable hospitalizations were 33, 51, 36, and 7 per 1000 beneficiaries, respectively. The ACI group had 26 144 beneficiary-episodes for Medicare (13 726 [52.5%] female patients; mean patient age, 68.4 years) and 13 921 beneficiary-episodes for Medicaid (7392 [53.1%] female patients; mean patient age, 52.2 years). For the ACI group's Medicare participants, there was a significant reduction in aggregate TCOC of $29.2 million with increases in 90-day hospitalizations and 30-day readmissions of 11 and 14 per 1000 beneficiary-episodes, respectively, and reduction in practitioner follow-up visits of 41 and 29 per 1000 beneficiary-episodes for 7-day and 30-day visits, respectively. For the ACI group's Medicaid participants, there was a significant reduction in aggregate TCOC of $59.8 million and the 90-day emergency department visit rate decreased by 133 per 1000 episodes, but hospitalizations increased by 49 per 1000 episodes and practitioner follow-up visits decreased by 70 and 182 per 1000 episodes for 7-day and 30-day visits, respectively. In total, the CI and ACI were associated with $113.3 million in cost savings. CONCLUSIONS AND RELEVANCE A care coordination model consisting of complementary bundled interventions in an urban academic environment was associated with lower spending and improved health outcomes.
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Affiliation(s)
- Scott A. Berkowitz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kathy Rowan
- NORC at the University of Chicago, Bethesda, Maryland
| | | | - Eric B. Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michele Bellantoni
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel J. Brotman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Samuel C. Durso
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anita Everett
- Substance Abuse Mental Health Services Administration, Department of Health and Human Services, Washington, DC
| | | | | | | | - Douglas E. Hough
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric E. Howell
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xuan Huang
- Johns Hopkins HealthCare, Glen Burnie, Maryland
| | - Diane Lepley
- Johns Hopkins Health System, Baltimore, Maryland
| | - Curtis Leung
- Johns Hopkins Health System, Baltimore, Maryland
| | - Yanyan Lu
- Johns Hopkins HealthCare, Glen Burnie, Maryland
| | | | | | - Tracy Novak
- Johns Hopkins Health System, Baltimore, Maryland
| | | | | | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ray Zollinger
- Johns Hopkins Community Physicians, Baltimore, Maryland
| | - Kevin Koenig
- NORC at the University of Chicago, Bethesda, Maryland
| | - Roy Ahn
- NORC at the University of Chicago, Bethesda, Maryland
| | - Paul B. Rothman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Nahm E, Zhu S, Bellantoni M, Rietschel M, Russomanno V, Son H, La I. THE EFFECTS OF A THEORY-BASED PATIENT PORTAL ELEARNING PROGRAM FOR OLDER ADULTS WITH CHRONIC ILLNESSES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Nahm
- University of Maryland School of Nursing
| | - S Zhu
- University of Maryland Baltimore
| | | | | | | | - H Son
- University of Maryland Baltimore, School of Nursing
| | - I La
- University of Maryland School of Nursing
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Magidson P, Malabanan D, Goodhew G, Bellantoni M, Chanmugam A, Awan K. 163 Preliminary Findings and Acceptability of a Clinician-Driven Emergency Department Geriatric Consult Service. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hsiao YL, Bass EB, Wu AW, Richardson MB, Deutschendorf A, Brotman DJ, Bellantoni M, Howell EE, Everett A, Hickman D, Purnell L, Zollinger R, Sylvester C, Lyketsos CG, Dunbar L, Berkowitz SA. Implementation of a comprehensive program to improve coordination of care in an urban academic health care system. J Health Organ Manag 2018; 32:638-657. [PMID: 30175678 DOI: 10.1108/jhom-09-2017-0228] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose Academic healthcare systems face great challenges in coordinating services across a continuum of care that spans hospital, community providers, home and chronic care facilities. The Johns Hopkins Community Health Partnership (J-CHiP) was created to improve coordination of acute, sub-acute and ambulatory care for patients, and improve the health of high-risk patients in surrounding neighborhoods. The paper aims to discuss this issue. Design/methodology/approach J-CHiP targeted adults admitted to the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, patients discharged to participating skilled nursing facilities (SNFs), and high-risk Medicare and Medicaid patients receiving primary care in eight nearby outpatient sites. The primary drivers of the program were redesigned acute care delivery, seamless transitions of care and deployment of community care teams. Findings Acute care interventions included risk screening, multidisciplinary care planning, pharmacist-driven medication management, patient/family education, communication with next provider and care coordination protocols for common conditions. Transition interventions included post-discharge health plans, hand-offs and follow-up with primary care providers, Transition Guides, a patient access line and collaboration with SNFs. Community interventions involved forming multidisciplinary care coordination teams, integrated behavioral care and new partnerships with community-based organizations. Originality/value This paper offers a detailed description of the design and implementation of a complex program to improve care coordination for high-risk patients in an urban setting. The case studies feature findings from each intervention that promoted patient engagement, strengthened collaboration with community-based organizations and improved coordination of care.
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Affiliation(s)
- Ya Luan Hsiao
- Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Albert W Wu
- Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | | | | | - Daniel J Brotman
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | | | - Eric E Howell
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Anita Everett
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Debra Hickman
- Sisters Together and Reaching, Baltimore, Maryland, USA
| | - Leon Purnell
- Men and Families Center, Baltimore, Maryland, USA
| | | | | | | | - Linda Dunbar
- Johns Hopkins HealthCare LLC, Baltimore, Maryland, USA
| | - Scott A Berkowitz
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
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Nahm ES, Zhu S, Bellantoni M, Keldsen L, Charters K, Russomanno V, Rietschel M, Son H, Smith L. Patient Portal Use Among Older Adults: What Is Really Happening Nationwide? J Appl Gerontol 2018; 39:442-450. [PMID: 29779422 DOI: 10.1177/0733464818776125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patient portals (PPs), secure websites that allow patients to access their electronic health records and other health tools, can benefit older adults managing chronic conditions. However, studies have shown a lack of PP use in older adults. Little is known about the way they use PPs in community settings and specific challenges they encounter. The aim of this study was to examine the current state of PP use in older adults, employing baseline data (quantitative and qualitative) from an ongoing nationwide online trial. The dataset includes 272 older adults (mean age, 70.0 years [50-92]) with chronic conditions. Findings showed that the majority of participants (71.3%) were using one or more PPs, but in limited ways. Their comments revealed practical difficulties with managing PPs, perceived benefits, and suggestions for improvement. Further studies with different older adult groups (e.g., clinic patients) will help develop and disseminate more usable PPs for these individuals.
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Affiliation(s)
- Eun-Shim Nahm
- University of Maryland School of Nursing, Baltimore, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
| | | | | | | | | | - Matt Rietschel
- University of Maryland School of Nursing, Baltimore, USA
| | - HyoJin Son
- University of Maryland School of Nursing, Baltimore, USA
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Hasan M, Hasan M, McNabney M, Bellantoni M, Oh E, Sheikh F. High BMI and Functional Dependence in Nursing Facilities: What We Need to Know. J Am Med Dir Assoc 2018. [DOI: 10.1016/j.jamda.2017.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Leng S, Bellantoni M, McNabney M, Finucane T, Greeenough W, Fried L, Durso S. INTERNATIONAL COLLABORATION FOR GERIATRICS AND HOME CARE MODEL DEVELOPMENT IN CHINA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
| | - M. Bellantoni
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
| | - M. McNabney
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
| | - T. Finucane
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
| | - W. Greeenough
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
| | - L.P. Fried
- Mailman School of Public Health, Columbia University, New York, New York
| | - S. Durso
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
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Yang M, Vleck K, Bellantoni M, Sood G. Telephone Survey of Infection-Control and Antibiotic Stewardship Practices in Long-Term Care Facilities in Maryland. J Am Med Dir Assoc 2016; 17:491-4. [DOI: 10.1016/j.jamda.2015.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/28/2022]
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Nahm ES, Resnick B, Brown C, Zhu S, Magaziner J, Bellantoni M, Brennan PF, Charters K, Brown J, Rietschel M, An M, Park BK. The Effects of an Online Theory-Based Bone Health Program for Older Adults. J Appl Gerontol 2015; 36:1117-1144. [PMID: 26675352 DOI: 10.1177/0733464815617284] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An estimated 10 million Americans age 50 and older have osteoporosis, and many experience associated fractures. Although several interventions have been shown to be effective in preventing osteoporosis, their impact on bone health among older adults was limited. The aim of this study was, therefore, to examine the effects of a theory-based online bone health program (Bone Power program) for a large number of older adults. The 8-week program included learning modules, discussion boards, and other resources. Participants ( N = 866; M age = 62.5 years) were recruited online and randomized into a Bone Power or control group. At the end of the intervention, the Bone Power group showed significantly greater improvement over the control group in osteoporosis knowledge, self-efficacy/outcome expectations for calcium intake and exercise, and calcium intake and exercise behaviors. This study's findings suggest that online health programs can be effective in improving older adults' knowledge, beliefs, and health behaviors.
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Affiliation(s)
| | | | | | - Shijun Zhu
- 1 University of Maryland, Baltimore, USA
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Greenough WB, Ahmed M, Finucane T, Galiatsatos P, Weiss C, Bellantoni M. Where do we go from here? A small scale observation of transfer results from chronic to skilled ventilator facilities. J Crit Care 2015; 30:1400-2. [PMID: 26404958 DOI: 10.1016/j.jcrc.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Skilled nursing facility ventilator units (SNF) are a recent attempt to reduce the costs of an increasing number of patients who are in acute intensive care units and are not able to be liberated from ventilators. Transfers of such patients from long-term care chronic vent units (LTCVs) to SNFs in Maryland began in 2006. The safety of these transfers needs to be assessed. METHODS We retrospectively followed up all patients designated as eligible by their insurance for transfer from our LTCV units to SNF from July 1, 2008 through June 30, 2010 looking only at survival. Those patients who refused transfer and appealed and remained in our LTCV were compared to those who were transferred to SNF ventilator units. The analysis was by Kaplan-Meier statistics. RESULTS There was an increased mortality (P=.025) of those transferred to SNF ventilator facilities as compared to those remaining in the LTCV. CONCLUSION We recognize that bias may occur in patients choosing to remain in our LTCV compared to those accepting transfers, the magnitude of the difference in mortality indicates the need for more comprehensive well designed analysis investigating the outcome of all transfers occurring to and from LTCVs.
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Affiliation(s)
- William B Greenough
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Maaz Ahmed
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas Finucane
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Panagis Galiatsatos
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carlos Weiss
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michele Bellantoni
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Nahm ES, Resnick B, Bellantoni M, Zhu S, Brown C, Brennan PF, Charters K, Brown J, Rietschel M, Pinna J, An M, Park BK, Plummer L. Dissemination of a theory-based online bone health program: Two intervention approaches. Health Informatics J 2015; 21:120-36. [DOI: 10.1177/1460458213505573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the increasing nationwide emphasis on eHealth, there has been a rapid growth in the use of the Internet to deliver health promotion interventions. Although there has been a great deal of research in this field, little information is available regarding the methodologies to develop and implement effective online interventions. This article describes two social cognitive theory–based online health behavior interventions used in a large-scale dissemination study (N = 866), their implementation processes, and the lessons learned during the implementation processes. The two interventions were a short-term (8-week) intensive online Bone Power program and a longer term (12-month) Bone Power Plus program, including the Bone Power program followed by a 10-month online booster intervention (biweekly eHealth newsletters). This study used a small-group approach (32 intervention groups), and to effectively manage those groups, an eLearning management program was used as an upper layer of the Web intervention. Both interventions were implemented successfully with high retention rates (80.7% at 18 months). The theory-based approaches and the online infrastructure used in this study showed a promising potential as an effective platform for online behavior studies. Further replication studies with different samples and settings are needed to validate the utility of this intervention structure.
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Affiliation(s)
| | | | | | - Shijun Zhu
- University of Maryland School of Nursing, USA
| | | | | | | | | | | | | | - Minjeong An
- University of Maryland School of Nursing, USA
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Yokoi Y, Misal M, Oh E, Bellantoni M, Rosenberg PB. Benzodiazepine discontinuation and patient outcome in a chronic geriatric medical/psychiatric unit: A retrospective chart review. Geriatr Gerontol Int 2013; 14:388-94. [DOI: 10.1111/ggi.12113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Yuma Yokoi
- Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Meenal Misal
- University of Arizona College of Medicine; Tucson Arizona USA
| | - Esther Oh
- Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | | | - Paul B Rosenberg
- Johns Hopkins University School of Medicine; Baltimore Maryland USA
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Finucane TE, Bellantoni M, Ouslander JG. Strangers in Strange Lands: The Serial Transfer of Individuals with Severe Dementia. J Am Geriatr Soc 2013; 61:1804-5. [DOI: 10.1111/jgs.12483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bantis C, Heering P, Kouri NM, Siekierka-Harreis M, Stangou M, Schwandt C, Efstratiadis G, Rump LC, Ivens K, Haddiya I, Houssaini Squalli T, Laouad I, Ramdani B, Bayahia R, Dimas GG, Tegos TJ, Spiroglou SG, Pitsalidis CG, Sioulis AS, Karamouzis IM, Savopoulos CG, Karamouzis MI, Orologas AG, Hatzitolios AI, Grekas DM, Maixnerova D, Jancova E, Rychlik I, Rysava R, Merta M, Reiterova J, Kolsky A, Honsova E, Skibova J, Tesar V, Kendi Celebi Z, Calayoglu R, Keven K, Kurultak I, Mescigil P, Erbay B, Karatan O, Duman N, Erturk S, Nergizoglu G, Kutlay S, Sengul S, Ates K, Marino F, Martorano C, Bellantoni M, Tripepi R, Zoccali C, Ishizuka K, Harita Y, Kajiho Y, Tsurumi H, Asano T, Nishiyama K, Sugawara N, Chikamoto H, Akioka Y, Yamaguchi Y, Igarashi T, Hattori M, Bantis C, Heering PJ, Kouri NM, Stangou M, Siekierka-Harreis M, Efstratiadis G, Rump LC, Ivens K, Sahay M, Monova DV, Monov SV, Wang YY, Cheng H, Wang GQ, Dong HR, Chen YP, Wang CJ, Tang YL, Buti E, Dervishi E, Bergesio F, Ghiandai G, Mjeshtri A, Paudice N, Caldini AL, Nozzoli C, Minetti EE, Sun L, Feng J, Yao L, Fan Q, Ma J, Wang L, Kirsanova T, Merkusheva L, Ruinihina N, Kozlovskaya N, Elenshleger G, Turgutalp K, Karabulut U, Ozcan T, Helvaci I, Kiykim A, Kaul A, Bhadhuaria D, sharma R, Prasad N, Gupta A, Clajus C, Schmidt J, Haller H, Kumpers P, David S, Sevillano AM, Molina M, Gutierrez E, Morales E, Gonzalez E, Hernandez E, Praga M, Conde Olasagasti JL, Vozmediano Poyatos C, Illescas ML, Tallon S, Uson Carrasco JJ, Roca Munoz A, Rivera Hernandez F, Ismail G, Jurubita R, Andronesi A, Bobeica R, Zilisteanu D, Rusu E, Achim C, Sevillano AM, Molina M, Gutierrez E, Morales E, Huerta A, Hernandez E, Caro J, Gutierrez-Solis E, Praga M, Pasquariello A, Pasquariello G, Innocenti M, Grassi G, Egidi MF, Ozturk O, Yildiz A, Gul CB, Dilek K, Monov SV, Monova DV, Tylicki L, Jakubowska A, Weber E, Lizakowski S, Swietlik D, Rutkowski B, Postorino A, Costa S, Cristadoro S, Magazzu G, Bellinghieri G, Savica V, Buemi M, Santoro D, Lu Y, Shen P, Li X, Xu Y, Pan X, Wang W, Chen X, Zhang W, Ren H, Chen N, Mitic BP, Cvetkovic T, Vlahovic P, Velickovic Radovanovic R, Stefanovic V, Kostic S, Djordjevic V, Ao Q, Ma Q, Cheng Q, Wang X, Liu S, Zhang R, Ozturk S, Ozmen S, Akin D, Danis R, Yilmaz M, Hajri S, Barbouche S, Okpa H, Oviasu E, Ojogwu L, Fotouhi N, Ghaffari A, Hamzavi F, Nasri H, Ardalan M, Stott A, Ullah A, Anijeet H, Ahmed S, Kohli HS, Rajachandran R, Rathi M, Jha V, Sakhuja V, Yenigun E, Dede F, Turgut D, Koc E, Akoglu H, Piskinpasa S, Ozturk R, Odabas A, Bajcsi D, Abraham G, Kemeny E, Sonkodi S, Legrady P, Letoha A, Constantinou K, Ondrik Z, Ivanyi B, Lucisano G, Comi N, Cianfrone P, Summaria C, Piraina V, Talarico R, Camastra C, Fuiano G, Proletov I, Saganova E, Galkina O, Bogdanova E, Zubina I, Sipovskii V, Smirnov A, Bailly E, Pierre D, Kerdraon R, Grezard O, Gnappi E, Delsante M, Galetti M, Maggiore U, Manenti L, Hasan MJ, Muqueet MA, Mostafi M, Chowdhury I, Haque W, Khan T, Kang YJ, Bae EJ, Cho HS, Chang SH, Park DJ, Li X, Xu G, Lin H, Hu Z, Yu X, Xing C, Mei C, Zuo L, Ni Z, Ding X, Li D, Chen N, Ren H, Shen P, Li X, Pan X, Zhang Q, Feng X, Lin L, Zhang W, Chen N. Clinical nephrology - miscellaneous. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nahm ES, Orwig D, Resnick B, Magaziner J, Bellantoni M, Sterling R. Recruitment of Older Adult Patient-Caregiver Dyads for an Online Caregiver Resource Program: Lessons Learned. Ageing Int 2012; 37:489-504. [PMID: 23549905 PMCID: PMC3580773 DOI: 10.1007/s12126-011-9128-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Hip fracture is a significant health problem for older adults and generally requires surgery followed by intensive rehabilitation. Informal caregivers (CGs) can provide vital assistance to older adults recovering from hip fracture. Caregiving is a dyadic process that affects both CGs and care recipients (CRs). In a feasibility study, we assessed the effects of using a theory-based online hip fracture resource program for CGs on both CGs and CRs. In this article, we discuss our recruitment process and the lessons learned. Participants were recruited from six acute hospitals, and CGs used the online resource program for 8 weeks. A total of 256 hip fracture patients were screened, and 164 CRs were ineligible. CG screening was initiated when CRs were determined to be eligible. Among 41 eligible dyads, 36 dyads were recruited. Several challenges to the recruitment of these dyads for online studies were identified, including a low number of eligible dyads in certain hospitals and difficulty recruiting both the CR and the CG during the short hospital stay. Field nurses often had to make multiple trips to the hospital to meet with both the CR and the CG. Thus, when a subject unit is a dyad recruited from acute settings, the resources required for the recruitment may be more than doubled. These challenges could be successfully alleviated with careful planning, competent field staff members, collaboration with hospital staff members, and efficient field operations.
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Affiliation(s)
- Eun-Shim Nahm
- University of Maryland School of Nursing, 655 W. Lombard St, Suite 455 C, Baltimore, MD 21201, Tel: (W) 410-706-4913 / FAX: 410-706-3289,
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Laffan AM, McKenzie R, Forti J, Conklin D, Marcinko R, Shrestha R, Bellantoni M, Greenough WB. Lactoferrin for the prevention of post-antibiotic diarrhoea. J Health Popul Nutr 2011; 29:547-551. [PMID: 22283027 PMCID: PMC3259716 DOI: 10.3329/jhpn.v29i6.9889] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Antibiotic-associated diarrhoea (AAD) is a common cause of morbidity and mortality. Older individuals in long-term care facilities are particularly vulnerable due to multisystem illnesses and the prevailing conditions for nosocomial infections. Lactoferrin, an antimicrobial protein in human breastmilk, was tested to determine whether it would prevent or reduce AAD, including Clostridium difficile in tube-fed long-term care patients. Thirty patients were enrolled in a randomized double-blind study, testing eight weeks of human recombinant lactoferrin compared to placebo for the prevention of antibiotic-associated diarrhoea in long-term care patients. Fewer patients in the lactoferrin group experienced diarrhoea compared to controls (p = 0.023). Based on the findings, it is concluded that human lactoferrin may reduce post-antibiotic diarrhoea.
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Affiliation(s)
- Alison M. Laffan
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Robin McKenzie
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Jennifer Forti
- Division of Geriatric Medicine, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Dawn Conklin
- Division of Geriatric Medicine, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Richard Marcinko
- Division of Geriatric Medicine, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Ruchee Shrestha
- Division of Geriatric Medicine, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Michele Bellantoni
- Division of Geriatric Medicine, Johns Hopkins University, Baltimore, MD 21224, USA
| | - William B. Greenough
- Division of Geriatric Medicine, Johns Hopkins University, Baltimore, MD 21224, USA
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Leng SX, Tian X, Liu X, Lazarus G, Bellantoni M, Greenough W, Fried LP, Shen T, Durso SC. An international model for geriatrics program development in China: the Johns Hopkins-Peking Union Medical College experience. J Am Geriatr Soc 2010; 58:1376-81. [PMID: 20533962 DOI: 10.1111/j.1532-5415.2010.02927.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
China has the world's largest and most rapidly growing older adult population. Recent dramatic socioeconomic changes, including a large number of migrating workers leaving their elderly parents and grandparents behind and the 4:2:1 family structure caused by the one-child policy, have greatly compromised the traditional Chinese family support for older adults. These demographic and socioeconomic factors, the improved living standards, and the quest for higher quality of life are creating human economic pressures. The plight of senior citizens is leading to an unprecedented need for geriatrics expertise in China. To begin to address this need, the Johns Hopkins University School of Medicine (JHU) and Peking Union Medical College (PUMC) have developed a joint international project aimed at establishing a leadership program at the PUMC Hospital that will promote quality geriatrics care, education, and aging research for China. Important components of this initiative include geriatrics competency training for PUMC physicians and nurses in the Division of Geriatric Medicine and Gerontology at JHU, establishing a geriatrics demonstration ward at the PUMC Hospital, faculty exchange between JHU and PUMC, and on-site consultation by JHU geriatrics faculty. This article describes the context and history of this ongoing collaboration and important components, progress, challenges, and future prospects, focusing on the JHU experience. Specific and practical recommendations are made for those who plan such international joint ventures. With such unique experiences, it is hoped that this will serve as a useful model for international geriatrics program development for colleagues in the United States and abroad.
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Affiliation(s)
- Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, The Johns Hopkins University, John R. Burton Pavilion, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
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Sorock GS, Quigley PA, Rutledge MK, Taylor J, Luo X, Foulis P, Wang MC, Varadhan R, Bellantoni M, Baker SP. Central nervous system medication changes and falls in nursing home residents. Geriatr Nurs 2009; 30:334-40. [PMID: 19818269 DOI: 10.1016/j.gerinurse.2009.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 07/08/2009] [Accepted: 07/14/2009] [Indexed: 11/18/2022]
Abstract
We investigated the role of changes in 6 mutually exclusive medication categories on the risk of falling in nursing home residents. The 6 categories were: gastrointestinal, hypoglycemics, antibiotics, central nervous system (CNS) acting, cardiovascular disease agents, and analgesics. A change was defined as a new start, a dose change, an as-needed dose, or a discontinuation. Incident reports were used to determine the fall date and time. Medication records were abstracted to identify the date of changes before the date of each fall. The 158 residents who fell had 419 recorded falls during 2002 and 2003; they were on average 80.5 years old (SD 8.1; range 65-103), and 67% were men. Within 1-3 days of a change in any CNS medication (antipsychotic, sedative, antidepressant, or antiseizure), the fall risk (odds ratio) increased 3.4-fold (95% confidence interval 1.2-9.5) using 7-9 days prior as comparable control days. No changes in other medication categories had a significant effect on fall risk. These data suggest that the risk of falls among nursing home residents is significantly elevated within 3 days of a CNS medication change.
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Bellantoni M. Consultation corner. Bone loss drug gives users a break. Johns Hopkins Med Lett Health After 50 2007; 19:6. [PMID: 18225340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Bellantoni M. Is it time to see a geriatrician? Johns Hopkins Med Lett Health After 50 2007; 19:6. [PMID: 17657886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Bellantoni M. Planning for unexpected medical needs. Johns Hopkins Med Lett Health After 50 2003; 15:6. [PMID: 12838915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Appling SE, Allen JK, Bellantoni M, Brager R, Hallerdin J, Olsen S, VanZandt S, Gaines J, Young KL. Factors associated with hormone replacement therapy use in low-income urban women. Womens Health Issues 1999. [DOI: 10.1016/s1049-3867(99)00025-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Newschaffer CJ, Bush TL, Penberthy LE, Bellantoni M, Helzlsour K, Diener-West M. Does comorbid disease interact with cancer? An epidemiologic analysis of mortality in a cohort of elderly breast cancer patients. J Gerontol A Biol Sci Med Sci 1998; 53:M372-8. [PMID: 9754143 DOI: 10.1093/gerona/53a.5.m372] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although widely believed that co-occurring chronic diseases in elderly persons do not act independently in causing death, there has been little empirical research assessing prognostic interrelationships between comorbidities. METHODS Nonconcurrent prospective follow-up of 3,549 Virginia-resident elderly women diagnosed with a first breast cancer and 2,114 elderly women with no breast cancer history admitted to Virginia hospitals with principal diagnoses of genital prolapse during 1986-1988 was conducted through linkage of cancer registry and Medicare administrative records. Aggregate comorbidity was measured from Medicare claims via the Charlson comorbidity index (CCI). Mortality rates and relative risks were estimated for the breast cancer and non-breast-cancer groups stratified by the presence and level of comorbidity. Proportional hazards models were used to estimate Rothman's synergy index (S) measure of additive interaction. RESULTS Over full follow-up, the excess mortality rate for women with breast cancer and other comorbidity was 17% greater than expected under the null hypothesis that risks were additive and independent (S = 1.17, p = .12). Stratified analyses revealed a pattern of S estimates across cancer stage subgroups that was biologically sensible, but this pattern was not supported by strong statistical evidence. CONCLUSIONS This study provides the first empirical estimates of statistical interaction between breast cancer and other chronic comorbidity. S index values tended to be small, but these small effects would translate into substantial numbers of deaths attributable to interaction between cancer and comorbidity. Interactions between breast cancer and comorbid disease should be explored further in large studies that can estimate these effects with increased precision.
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Affiliation(s)
- C J Newschaffer
- Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA.
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Yang KH, dePapp AE, Soifer NE, Dreyer BE, Wu TL, Porter SE, Bellantoni M, Burtis WJ, Insogna KL, Broadus AE. Parathyroid hormone-related protein: evidence for isoform- and tissue-specific posttranslational processing. Biochemistry 1994; 33:7460-9. [PMID: 8003511 DOI: 10.1021/bi00189a054] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Parathyroid hormone-related protein (PTHrP) is expressed by malignant tumors and leads to the syndrome of humoral hypercalcemia of malignancy. It is also expressed by a wide variety of nonmalignant tissues, in which it appears to play distinct paracrine and/or autocrine roles. The human PTHrP gene encodes three cDNA-predicted initial translational products of 139, 141, and 173 amino acids. Most human cell lines contain mRNAs encoding all three PTHrP isoforms. The physiological rationale for the existence of these three highly similar transcripts is unknown. In order to determine whether the protein products derived from these three transcripts differ, we transfected Chinese hamster ovary (CHO) cells and rat insulinoma (RIN) cells individually with cDNAs encoding human PTHrP(1-139), PTHrP(1-141), and PTHrP(1-173). Cell extracts and conditioned medium were then chromatographed using reversed-phase HPLC and analyzed using region-specific PTHrP immunoassays. As we had previously observed in SKRC-1 (renal cell carcinoma) and RIN(1-141) cells, multiple amino-terminal PTHrP species as well as a separate midregion PTHrP species were identified in all six cell lines. In addition, both CHO and RIN cell lines transfected with the PTHrP(1-139) construct contained a previously unrecognized carboxy-terminal fragment that reacted with a PTHrP(109-138) antiserum. This carboxy-terminal fragment was physically distinct from the midregion fragment discovered earlier and was also present in conditioned medium, indicating that it is a secretory form, rather than a biosynthetic intermediate or a degradation product.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K H Yang
- Division of Endocrinology, West Haven Veterans Affairs Medical Center, Connecticut 06516
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