Implications of the Adult Day Health Care Evaluation Study for program revision and research.

Abstract:

:With no additional effort to revise adult day health care (ADHC) services or the types of patients who receive them, it would appear that adding an ADHC program to a VA Medical Center would not achieve the desired objectives. The authors discuss here the advantages, disadvantages, and feasibility of 2 options for program revision. The first is to target ADHC to those types of patients who may be most likely to benefit. A targeting scheme should use the most objective criteria possible and may need to be implemented as part of a case-managed package of community-based services. The second option for program revision is to reduce the costs of ADHC services. A cost model developed as a part of the study demonstrated the effect of possible revisions, including increasing enrollment, reducing staffing costs, decreasing length of stay in ADHC, and increasing substitution of ADHC for other services. These changes differ in the level of administrative support and clinician behavior change needed for their implementation. This report then concludes with a discussion of the implications of the results for implementation of VA-ADHC versus contract ADHC, and a discussion of possible directions for future research.

journal_name

Med Care

journal_title

Medical care

authors

Hedrick SC,Chapko M,Ehreth J,Rothman ML,Kelly JR,Inui TS

subject

Has Abstract

pub_date

1993-09-01 00:00:00

pages

SS104-15

issue

9 Suppl

eissn

0025-7079

issn

1537-1948

journal_volume

31

pub_type

杂志文章
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    abstract::The effectiveness of sharing medical records in improving physician-older patient communication was evaluated in 203 ambulatory chronically ill older patients (mean age, 70.1 years) by a randomized controlled trial. Ninety-five experimental group patients received copies of their physicians' progress notes 1 week afte...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00005650-198604000-00004

    authors: Bronson DL,Costanza MC,Tufo HM

    更新日期:1986-04-01 00:00:00

  • Exploring generic drug use behavior: the role of prescribers and pharmacists in the opportunity for generic drug use and generic substitution.

    abstract:OBJECTIVES:The first objective of this study was to examine the prevalence of prescriptions that offer the opportunity for generic drug use (a prescription for a multisource drug product). The second objective was to examine the prevalence of generic drug use by examining the rate of generic drug prescribing for multis...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.MLR.0000020926.85284.8E

    authors: Mott DA,Cline RR

    更新日期:2002-08-01 00:00:00

  • Have HMOs broadened their hospital networks?: Changes in HMO hospital networks in California, 1999-2003.

    abstract:OBJECTIVE:This study uses empirical data to study changes in the structure and use of HMO hospital provider networks in California. STUDY DESIGN:Data from California HMOs are used to test whether there have been structural changes in HMO size, geographic coverage, hospital network design, and patient channeling for in...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181589bcb

    authors: Melnick GA,Ketcham JD

    更新日期:2008-03-01 00:00:00

  • Satisfaction With Quality of Health Care Among Medicare Beneficiaries With Functional Hearing Loss.

    abstract:BACKGROUND/OBJECTIVES:Nearly 38 million Americans have hearing loss. Understanding how sensory deficits such as hearing loss, which limit communication, impact satisfaction has implications for Medicare value-based reimbursement mechanisms. The aim of this study was to characterize the association of functional hearing...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001419

    authors: Reed NS,Boss EF,Lin FR,Oh ES,Willink A

    更新日期:2021-01-01 00:00:00

  • A longitudinal examination of a pay-for-performance program for diabetes care: evidence from a natural experiment.

    abstract:BACKGROUND:Numerous studies have examined the impacts of pay-for-performance programs, yet little is known about their long-term effects on health care expenses. OBJECTIVES:This study aimed to examine the long-term effects of a pay-for-performance program for diabetes care on health care utilization and expenses. MET...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31822d5d36

    authors: Cheng SH,Lee TT,Chen CC

    更新日期:2012-02-01 00:00:00

  • Psychosocial factors affecting adherence to medical regiments in a group of hemodialysis patients.

    abstract::The present research was designed to identify psychosocial correlates of adherence among patients receiving hemodialysis at two outpatient clinics. The 116 participants were interviewed concerning their knowledge of treatment, health beliefs, treatment history, social support, personal characteristics, and adherence t...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198206000-00003

    authors: Cummings KM,Becker MH,Kirscht JP,Levin NW

    更新日期:1982-06-01 00:00:00

  • Assessing the Effectiveness of Complex Interventions to Meet the Needs of VA Stakeholders: Experience of the Department of Veterans Affairs Evidence Synthesis Program.

    abstract:BACKGROUND:Complex health care interventions involve multiple distinct elements that contribute to their functioning. Conducting systematic reviews of complex interventions has substantial challenges. Although methodological guidance exists, less is known about the practical strategies and approaches undertaken by syst...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001158

    authors: Wilt TJ,Greer N,Duan-Porter W

    更新日期:2019-10-01 00:00:00

  • Pediatric nurse practitioner functions in the outpatient clinics of a tertiary care center.

    abstract::Previous research has neglected to delineate pediatric nurse practitioner (PNP) roles in tertiary care settings (TCS). New PNP roles have developed as TCS seek cost-effective solutions to providing quality patient care and to meeting new demands for outpatient care. The authors evaluated the roles of 11 PNPs in eight ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198604000-00005

    authors: Cruikshank BM,Clow TJ,Seals B

    更新日期:1986-04-01 00:00:00

  • Validation of a 10-item care-related regret intensity scale (RIS-10) for health care professionals.

    abstract:BACKGROUND:Regret after one of the many decisions and interventions that health care professionals make every day can have an impact on their own health and quality of life, and on their patient care practices. OBJECTIVES:To validate a new care-related regret intensity scale (RIS) for health care professionals. RESEA...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318280f02c

    authors: Courvoisier DS,Cullati S,Haller CS,Schmidt RE,Haller G,Agoritsas T,Perneger TV

    更新日期:2013-03-01 00:00:00

  • HIV testing of asymptomatic patients in U.S. hospitals.

    abstract::The human immunodeficiency virus (HIV) epidemic and the prevalence of HIV-positive persons in the population has provoked marked anxiety among hospital staffs of acquiring nosocomially transmitted HIV infections. A national telephone survey of key staff in a sample of 561 acute-care hospitals was undertaken to describ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199102000-00001

    authors: Freeman HE

    更新日期:1991-02-01 00:00:00

  • Early Performance of Hospital Value-based Purchasing Program in Medicare: A Systematic Review.

    abstract:BACKGROUND:Under the Affordable Care Act, the Centers for Medicare and Medicaid Services has greatly expanded inpatient fee-for-value programs including the Hospital Value-based Purchasing (HVBP) program. Existing evidence from the HVBP program is mixed. There is a need for a systematic review of the HVBP program to in...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001354

    authors: Hong YR,Nguyen O,Yadav S,Etzold E,Song J,Duncan RP,Turner K

    更新日期:2020-08-01 00:00:00

  • Non-English Language Availability of Community Health Center Websites.

    abstract:BACKGROUND:For limited English-proficient (LEP) patients, the digital divide has narrowed, creating a new population of Internet users. However, language-appropriate health information is difficult to find. Community health center (CHC) websites are health information resources and their homepages are critical access p...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001027

    authors: Rodriguez JA,Davis RB,Percac-Lima S

    更新日期:2019-06-01 00:00:00

  • Influencing behavior of physicians ordering laboratory tests: a literature study.

    abstract::There are various reasons why physicians order laboratory tests. Earlier studies have shown that in many cases test-ordering behavior lacks efficiency, resulting in excessive laboratory utilization. Throughout the years various attempts have been made to improve this situation. This review, based on the literature of ...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/00005650-199309000-00003

    authors: Axt-Adam P,van der Wouden JC,van der Does E

    更新日期:1993-09-01 00:00:00

  • Identification of differential item functioning using item response theory and the likelihood-based model comparison approach. Application to the Mini-Mental State Examination.

    abstract:BACKGROUND:An important part of examining the adequacy of measures for use in ethnically diverse populations is the evaluation of differential item functioning (DIF) among subpopulations such as those administered the measure in different languages. A number of methods exist for this purpose. OBJECTIVE:The objective o...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.mlr.0000245251.83359.8c

    authors: Orlando Edelen MO,Thissen D,Teresi JA,Kleinman M,Ocepek-Welikson K

    更新日期:2006-11-01 00:00:00

  • Out-of-pocket health spending between low-and higher-income populations: who is at risk of having high expenses and high burdens?

    abstract:OBJECTIVE:We studied the effects of health insurance, health care needs, and demographic and area characteristics on out-of-pocket health care spending for low and higher income insured populations. MATERIALS AND METHODS:We used the 2002 National Survey of America's Families to analyze out-of-pocket health spending. P...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000199692.78295.7c

    authors: Shen YC,McFeeters J

    更新日期:2006-03-01 00:00:00

  • Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients.

    abstract:BACKGROUND:Health care providers and health care training institutions need more specific, relevant, and useful information for providing culturally sensitive health care. OBJECTIVE:We sought to determine what patients considered to be culturally sensitive health care. RESEARCH DESIGN AND PARTICIPANTS:We conducted 20...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200307000-00010

    authors: Tucker CM,Herman KC,Pedersen TR,Higley B,Montrichard M,Ivery P

    更新日期:2003-07-01 00:00:00

  • Predictors of aggressive therapy for nonmetastatic prostate carcinoma in Massachusetts from 1998 to 2002.

    abstract:BACKGROUND:Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility. OBJECTIVE:We sought to compare the proportions of black and ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000257144.29928.f0

    authors: Rose AJ,Backus BM,Gershman ST,Santos P,Ash AS,Battaglia TA

    更新日期:2007-05-01 00:00:00

  • Effectiveness of long-term acute care hospitalization in elderly patients with chronic critical illness.

    abstract:BACKGROUND:For patients recovering from severe acute illness, admission to a long-term acute care hospital (LTAC) is an increasingly common alternative to continued management in an intensive care unit (ICU). OBJECTIVE:To examine the effectiveness of LTAC transfer in patients with chronic critical illness. RESEARCH D...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31826528a7

    authors: Kahn JM,Werner RM,David G,Ten Have TR,Benson NM,Asch DA

    更新日期:2013-01-01 00:00:00

  • Counter-Point: Early Warning Systems Are Imperfect, but Essential.

    abstract::Sequential analysis can be used as an early warning system about potential unintended consequences of health policy decisions, generating follow-up investigations, but it should not be used as causal evidence. ...

    journal_title:Medical care

    pub_type: 评论,杂志文章

    doi:10.1097/MLR.0000000000000896

    authors: Lu CY,Simon G,Soumerai SB,Kulldorff M

    更新日期:2018-05-01 00:00:00

  • Pharmacy-and diagnosis-based risk adjustment for children with Medicaid.

    abstract:BACKGROUND:Risk adjustment is useful for adjusting health care payments based on patients' health status. OBJECTIVE:This work seeks to examine how well pharmacy- and diagnosis-based risk adjusters predict child health expenditures in Medicaid populations. RESEARCH DESIGN:We used 1994-1995 Medicaid claims files for al...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000182551.87591.73

    authors: Kuhlthau K,Ferris TG,Davis RB,Perrin JM,Iezzoni LI

    更新日期:2005-11-01 00:00:00

  • Price and membership in a prepaid group medical practice.

    abstract::Federal interest in prepaid group practices as a means to control rising health care costs in reviving. This article is an empirical study of price and membership at a prepaid group practice among employees of Yale University. This article is the first to estimate the effect of price on the decision for membership in ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198102000-00005

    authors: McGuire TG

    更新日期:1981-02-01 00:00:00

  • Prediction modeling using EHR data: challenges, strategies, and a comparison of machine learning approaches.

    abstract:BACKGROUND:Electronic health record (EHR) databases contain vast amounts of information about patients. Machine learning techniques such as Boosting and support vector machine (SVM) can potentially identify patients at high risk for serious conditions, such as heart disease, from EHR data. However, these techniques hav...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181de9e17

    authors: Wu J,Roy J,Stewart WF

    更新日期:2010-06-01 00:00:00

  • Accurately predicting bipolar disorder mood outcomes: implications for the use of electronic databases.

    abstract:BACKGROUND:Monitoring mental health treatment outcomes for populations requires an understanding as to which patient information is needed in electronic format and is feasible to obtain in routine care. OBJECTIVE:To examine whether bipolar disorder outcomes can be accurately predicted and how much clinical detail is n...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182422aec

    authors: Busch AB,Neelon B,Zelevinsky K,He Y,Normand SL

    更新日期:2012-04-01 00:00:00

  • Predictors of safety belt initiative by primary care physicians. A social learning theory perspective.

    abstract::Even with the passage of state safety belt laws, primary care physicians can contribute to their patients' safety by brief interventions. The present study explores the prevalence of such action with adult patients and tests the power of constructs taken from social learning theory to explain physicians' behavior. The...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198804000-00006

    authors: Mullen PD,Gottlieb NH,Biddle AK,McCuan RA,McAlister AL

    更新日期:1988-04-01 00:00:00

  • The impact of having parents report about both their own and their children's experiences with health insurance plans.

    abstract:OBJECTIVES:The aim of this study was to determine whether parents rate their children's care differently when they also rate their own care than when they do not. METHODS:Subjects were employees of Washington State who had been enrolled in a health plan for at least 6 months and who had at least one covered child. Sub...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00005650-199903001-00007

    authors: Shaul JA,Fowler FJ Jr,Zaslavsky AM,Homer CJ,Gallagher PM,Cleary PD

    更新日期:1999-03-01 00:00:00

  • Impact of changes in clinical practice guidelines on assessment of quality of care.

    abstract:BACKGROUND:Measures for pay-for-performance and public reporting programs may be based on clinical practice guidelines. The impact of guideline changes over time-and whether evolving clinical evidence can render measures based on prior guidelines misleading-is not known. OBJECTIVE:To assess the impact of using differe...

    journal_title:Medical care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/MLR.0b013e3181e35b3a

    authors: Lin GA,Redberg RF,Anderson HV,Shaw RE,Milford-Beland S,Peterson ED,Rao SV,Werner RM,Dudley RA

    更新日期:2010-08-01 00:00:00

  • Patterns of primary care utilization in a triethnic urban population of school children.

    abstract::Patterns of primary health care utilization for a random sample of urban elementary school children in three ethnic groups are described. Visit type, reasons for visit, and frequency of visits remained stable from year to year. More than 50 per cent of the children were non-visitors each year; 72 per cent of those not...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198106000-00003

    authors: Brink SG,Nader PR

    更新日期:1981-06-01 00:00:00

  • Substance abuse treatment duration for Medicaid versus commercial clients in a health maintenance organization.

    abstract:BACKGROUND:As Medicaid clients have come to be enrolled in managed care, concerns have arisen about the ability of private sector systems to meet the needs of enrollees with substance abuse problems. OBJECTIVES:This project describes treatment initiation and duration for Medicaid and commercial substance abuse treatme...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000215814.01127.ce

    authors: McFarland BH,Lynch FL,Freeborn DK,Green CA,Polen MR,Deck DD,Dickinson DM

    更新日期:2006-06-01 00:00:00

  • A comparison of contract-managed and traditionally managed nonprofit hospitals.

    abstract::During the past five years, contract management of nonprofit hospitals by for-profit corporations has increased markedly. However, while a number of studies have been conducted on investor-owned hospitals and proprietary hospital systems, contract-managed hospitals have not been evaluated systematically. This paper re...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198006000-00002

    authors: Biggs EL,Kralewski JE,Brown GD

    更新日期:1980-06-01 00:00:00

  • Comparative costs of a cooperative care program versus inpatient hospital care for obstetric patients.

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    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198806000-00008

    authors: Woods JR,Saywell RM Jr,Benson JT

    更新日期:1988-06-01 00:00:00