Abstract：
OBJECTIVES:Little is known about the relationship between how medical care is organized and delivered in nursing homes. Taking a lead from the acute care arena, we hypothesize that nursing home medical staff organization (NHMSO) is an important predictor of clinical outcomes in the nursing home. METHODS:A total of 202 usable surveys from a 2-wave survey process using the Dillman Method were returned from medical directors who were randomly selected from the AMDA membership and were asked to fill out a survey on the structure of medical organization in their primary nursing home practice. Quality measures that are likely to be affected by physician practice patterns were culled from NH Compare and OSCAR data sets and matched to the physician surveys, ie, long stay residents' prevalence of pain, restraint use, catheter use, pressure ulcers, pneumococcal vaccination, influenza vaccination, presence of advanced directives, prescription of antibiotics, and prevalence of depression. RESULTS:Using a series of hierarchical multiple regressions, significant R(2) changes were found when the medical staff organization dimensions were added in the regressions after controlling for nursing home structural characteristics for the following outcomes: pneumococcal vaccination and restraint use. Near significant findings were noted for pain prevalence among long-stay residents, catheter use, and prevalence of pressure ulcers. CONCLUSIONS:This study is the first to demonstrate a relationship between medical staff organizational dimensions and clinical outcomes in the nursing home setting and as such represents an initial "proof of concept." NHMSO should be considered as a potentially important mediating or moderating variable in the quality of care equation for nursing homes.
journal_name
J Am Med Dir Assocjournal_title
Journal of the American Medical Directors Associationauthors
Katz PR,Karuza J,Lima J,Intrator Odoi
10.1016/j.jamda.2010.06.004subject
Has Abstractpub_date
2011-11-01 00:00:00pages
655-9issue
9eissn
1525-8610issn
1538-9375pii
S1525-8610(10)00207-0journal_volume
12pub_type
杂志文章abstract：OBJECTIVE:Older adults receiving Medicare home health services who experience undernutrition may be at increased risk of experiencing adverse outcomes. We sought to identify the association between baseline nutritional status and subsequent health service utilization and mortality over a 1-year period in older adults r...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2010.08.017
更新日期：2011-05-01 00:00:00
abstract：BACKGROUND/OBJECTIVES:Polypharmacy and multimorbidity is a threat to older people; hence, listing approaches should support physicians to optimize medication. The FORTA (Fit fOR The Aged) classification of drug appropriateness for older people provides positive or negative labels: A (A-bsolutely), B (B-eneficial), C (C...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2019.07.023
更新日期：2020-03-01 00:00:00
abstract：OBJECTIVES:Rehabilitation plays a vital role in the mitigation and improvement of functional limitations associated with aging and chronic conditions. Moderating factors such as sex, age, the medical diagnosis, and rehabilitation timing for admission status, as well as the expected change related to inpatient rehabilit...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2020.05.034
更新日期：2020-12-01 00:00:00
abstract：OBJECTIVES:To examine the independent associations between atrial fibrillation (AF) and objectively measured mobility in a nationally representative cohort. DESIGN:Wave 1 of The Irish Longitudinal Study on Ageing (TILDA), a population-based study assessing health, economic, and social aspects of ageing. SETTING:Commu...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2014.08.005
更新日期：2014-12-01 00:00:00
abstract：OBJECTIVE:To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion. DESIGN:Randomized, controlled, assessor-blinded, single-center trial. SETTING:...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamda.2015.12.008
更新日期：2016-03-01 00:00:00
abstract：OBJECTIVES:To evaluate whether STOPP/START v2 potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) are associated with 6-month mortality and unplanned hospitalization in hospital-discharged older patients. DESIGN:Multicenter prospective cohort observational study. SETTING AND PARTIC...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2019.03.023
更新日期：2019-11-01 00:00:00
abstract：OBJECTIVE:To evaluate whether botulinum toxin can decrease the burden for caregivers of long term care patients with severe upper limb spasticity. METHOD:This was a double-blind placebo-controlled trial with a 24-week follow-up period. SETTING:A 250-bed long term care hospital, the infirmary units of 3 regional hospi...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamda.2012.03.005
更新日期：2012-06-01 00:00:00
abstract：OBJECTIVES:The aim of this study was to examine the effects of a home-based and volunteer-administered physical training and nutritional intervention program compared with social support intervention on nutritional and frailty status in prefrail and frail community-dwelling older persons. DESIGN:This was a randomized ...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamda.2016.04.018
更新日期：2016-07-01 00:00:00
abstract：OBJECTIVE:This study examined the impact of hospice enrollment on the probabilities of hospital and nursing home admissions among a sample of frail dual-eligible assisted living (AL) residents. DESIGN:The study used a retrospective cohort design. We estimated bivariate probit models with 2 binary outcome variables: an...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2011.06.001
更新日期：2012-02-01 00:00:00
abstract：OBJECTIVES:We sought to examine the associations of osteosarcopenia with physical performance, balance, and falls and fractures in community-dwelling older adults. Additionally, we aimed to determine which clinical outcomes are associated with specific components of osteosarcopenia. DESIGN:Cross-sectional study. SETT...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2019.09.005
更新日期：2020-02-01 00:00:00
abstract：OBJECTIVES:The purpose of this review was to describe the characteristics of late-life obesity, including prevalence, pathophysiology, and influences on morbidity and mortality. A second objective was to systematically review the empiric evidence on the effects of intentional weight loss interventions in older individu...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,评审
doi：10.1016/j.jamda.2008.01.006
更新日期：2008-06-01 00:00:00
abstract：OBJECTIVE:To assess the proposed prevalence of unresponsiveness of older men and women to augment lean body mass, muscle fiber size, muscle strength, and/or physical function following prolonged resistance-type exercise training. DESIGN/SETTING/PARTICIPANTS:A retrospective analysis of the adaptive response to 12 (n = ...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2015.01.071
更新日期：2015-05-01 00:00:00
abstract：BACKGROUND:Dementia is a syndrome associated with stigma and social isolation. Forty-two percent of people with dementia in the United States and almost 40% in the United Kingdom live in assisted living and residential care facilities. Up to 90% of residents with dementia experience behavioral and psychological symptom...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,评审
doi：10.1016/j.jamda.2015.11.015
更新日期：2016-02-01 00:00:00
abstract：OBJECTIVES:The number of older people dying in long-term care facilities (LTCFs) is increasing globally, but care quality may be variable. A framework was developed drawing on empirical research findings from the Palliative Care for Older People (PACE) study and a scoping review of literature on the implementation of p...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2020.01.009
更新日期：2020-08-01 00:00:00
abstract：:Singapore faces a rapidly aging population. By 2030, 19% of her population will be aged 65 years and above. Other Asian countries face similar problems, with South Korea having the fastest aging population worldwide, followed by China and Thailand. With Singapore possessing an advanced aging population, its policy pro...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2013.12.082
更新日期：2014-06-01 00:00:00
abstract：OBJECTIVES:Elderly persons with low muscle mass (LMM) or sarcopenia are prone to frailty and functional decline. This study aimed to investigate the relationship between serum selenium level and skeletal muscle mass in community-dwelling elderly. DESIGN:Cross-sectional observational study. SETTING AND PARTICIPANTS:A ...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2014.06.014
更新日期：2014-01-01 00:00:00
abstract：OBJECTIVES:Nursing facilities have lagged behind in the adoption of interoperable health information technology (ie technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic he...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2018.11.002
更新日期：2019-08-01 00:00:00
abstract：OBJECTIVES:To examine the predictive validity of a quick frailty screening tool, the FRAIL-NH, for adverse health outcomes in nursing home residents, using variables from the Minimum Data Set (MDS). The screening items were compiled from the MDS for potential direct application in long-term care facilities using this h...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2015.09.006
更新日期：2015-12-01 00:00:00
abstract：:Heart failure (HF) in older adults presents challenges that are different in many ways than those for younger adults. Diagnosis of HF in older adults can be delayed due to attributing early symptoms to normal changes of aging or, in the setting of a normal ejection fraction, failing to appreciate diastolic heart failu...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,评审
doi：10.1016/j.jamda.2008.03.004
更新日期：2008-07-01 00:00:00
abstract：:Loneliness is a common problem in long-term care facilities (LTCF) and previous work has shown that animal-assisted therapy (AAT) can to some degree reverse loneliness. Here, we compared the ability of a living dog (Dog) and a robotic dog (AIBO) to treat loneliness in elderly patients living in LTCF. In comparison wit...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamda.2007.11.007
更新日期：2008-03-01 00:00:00
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2017.06.019
更新日期：2018-02-01 00:00:00
abstract：INTRODUCTION:Hospital admissions due to traumatic brain injuries (TBIs) in older persons are increasing. Falls are the leading mechanism of injury in this age group. TBIs are associated with unfavorable outcomes such as mortality and institutionalization. OBJECTIVES:To estimate rates of TBIs in older persons with seve...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2016.02.032
更新日期：2016-07-01 00:00:00
abstract：:Vitamin D deficiency is a common finding in institutionalized older persons. Vitamin D-deficient elderly persons are at higher risk of falls and fractures. Long-term care residents should be considered at high risk of vitamin D deficiency and therefore vitamin D supplementation is highly recommended in this population...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,评审
doi：10.1016/j.jamda.2010.09.013
更新日期：2011-03-01 00:00:00
abstract：BACKGROUND:Health care-related adverse events (HCRAEs), which should not be confused with (blameworthy) medical errors, are common; they can lead to hospital admissions and can have grave consequences. Although they are sometimes potentially preventable, information is lacking on HCRAEs leading to admission to differen...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2015.06.019
更新日期：2015-12-01 00:00:00
abstract：OBJECTIVE:To systematically review the risks for aspiration pneumonia in frail older people and the contribution of bad oral health among the risk factors. DESIGN:Systematic literature review. SETTING:PubMed (Medline), Web of Science, Cochrane Library, EMBASE, and CINAHL were searched for eligible studies, published ...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,评审
doi：10.1016/j.jamda.2010.12.099
更新日期：2011-06-01 00:00:00
abstract：OBJECTIVES:To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care. DESIGN:Assessor-blinded, single-center randomized controlled trial. SETTING:AGU in an acute hospital in southeastern Sweden. PARTICIPANTS:Co...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamda.2015.01.074
更新日期：2015-06-01 00:00:00
abstract：OBJECTIVES:To investigate the effects of light therapy on cognition, depression, sleep, and circadian rhythms in a general, nonselected population of seniors living in a long term care facility. DESIGN:A double-blind, placebo-controlled trial. SETTING:The experiment took place at a long term care facility in Pennsylv...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamda.2011.05.006
更新日期：2012-02-01 00:00:00
abstract：OBJECTIVES:In nursing home settings, providers often think that most percutaneous endoscopic gastrostomy (PEG) tubes are placed in older people, some perhaps inappropriately. We sought to describe the relationships between patient age and the indications for, the decision making behind, and the outcomes of gastrostomy ...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2005.05.010
更新日期：2005-11-01 00:00:00
abstract：OBJECTIVE:To compare the immunogenicity and safety between full-dose (15 μg) intramuscular (i.m.) and full-dose (15 μg) intradermal (i.d.) immunization of the trivalent influenza vaccine in nursing home older adults. DESIGN:A single-center, randomized, controlled, open-label, parallel group trial from October 2013 to ...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamda.2014.05.002
更新日期：2014-08-01 00:00:00
abstract：:Nutritional problems are frequent in nursing homes including undernutrition, obesity, and diabetes mellitus, mainly related to disability and behavior troubles. Adequate nutritional care relies both on the quality of menus for regular and modified diet (texture-modified and enriched food) and on the staff knowledge of...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,评审
doi：10.1016/j.jamda.2009.04.003
更新日期：2010-01-01 00:00:00
