Abstract:
OBJECTIVES:To determine the effect of home-based primary care (HBPC) on Medicare costs and mortality in frail elders. DESIGN:Case-control concurrent study using Medicare administrative data. SETTING:HBPC practice in Washington, District of Columbia. PARTICIPANTS:HBPC cases (n = 722) and controls (n = 2,161) matched for sex, age bands, race, Medicare buy-in status (whether Medicaid covers Part B premiums), long-term nursing home status, cognitive impairment, and frailty. Cases were eligible if enrolled in MedStar Washington Hospital Center's HBPC program during 2004 to 2008. Controls were selected from Washington, District of Columbia, and urban counties in Virginia, Maryland, and Pennsylvania. INTERVENTION:HBPC clinical service. MEASUREMENTS:Medicare costs, utilization events, mortality. RESULTS:Mean age was 83.7 for cases and 82.0 for controls (P < .001). A majority of both groups was female (77%) and African American (90%). During a mean 2-year follow-up, in univariate analysis, cases had lower Medicare ($44,455 vs $50,977, P = .01), hospital ($17,805 vs $22,096, P = .003), and skilled nursing facility care ($4,821 vs $6,098, P = .001) costs, and higher home health ($6,579 vs $4,169; P < .001) and hospice ($3,144 vs. $1,505; P = .005) costs. Cases had 23% fewer subspecialist visits (P = .001) and 105% more generalist visits (P < .001). In a multivariate model, cases had 17% lower Medicare costs, averaging $8,477 less per beneficiary (P = .003) over 2 years of follow-up. There was no difference between cases and controls in mortality (40% vs 36%, hazard ratio = 1.06, P = .44) or in average time to death (16.2 vs 16.8 months, P = .30). CONCLUSION:HBPC reduces Medicare costs for ill elders, with similar survival outcomes in cases and controls.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
De Jonge KE,Jamshed N,Gilden D,Kubisiak J,Bruce SR,Taler Gdoi
10.1111/jgs.12974subject
Has Abstractpub_date
2014-10-01 00:00:00pages
1825-31issue
10eissn
0002-8614issn
1532-5415journal_volume
62pub_type
杂志文章abstract:OBJECTIVES:To determine whether severe obesity in older people is independently associated with diminished lower extremity physical performance (LEP) in a random sample of homebound older adults that were considered ambulatory. DESIGN:Prospective cohort with 1 year of follow-up (2000-02). SETTING:In-home assessments ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2006.00842.x
更新日期:2006-09-01 00:00:00
abstract:OBJECTIVES:To identify fracture types in a series of older adults with pelvic fractures and to determine whether the type of pelvic fracture affected short-term outcomes and morbidity. DESIGN:Retrospective chart review. SETTING:Teaching hospital. PARTICIPANTS:One hundred eighty-one individuals aged 65 and older with...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2011.03455.x
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVES:To assess mobility disability trajectories before death in a large sample of very old adults using two analytical approaches to determine how well they corresponded. DESIGN:Decedent sample from the Health, Aging and Body Composition (Health ABC) Study. Data were collected between 1997 and 2015. SETTING:Pit...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15224
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVES:To determine whether the occurrence of depression predicts physical disability in older people. DESIGN:A longitudinal epidemiological study with a follow-up of 5 years. SETTING:A comparison between depressed and nondepressed participants. PARTICIPANTS:The series consisted of the persons who participated i...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2001.4930290.x
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVES:The primary purpose of this preliminary study was to investigate the associations between certified nursing assistant (CNA) report of pain, Minimum Data Set (MDS) report of pain, and analgesic medication use in cognitively impaired nursing home residents. DESIGN:Correlational study. SETTING:Three nursing h...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2002.50021.x
更新日期:2002-01-01 00:00:00
abstract::In 13 elderly patients, 12 of whom had Parkinson's disease, visual hallucinations and delirium developed as a side effect of amantadine hydrochloride (Symmetrel) therapy. The symptoms promptly disappearred when amantadine was discontinued. Thereafter, each parkinsonian patient was treated satisfactorily with levo-dopa...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1975.tb00187.x
更新日期:1975-05-01 00:00:00
abstract:OBJECTIVES:To determine whether resting heart rate is associated with several types of osteoporotic fractures, mortality, and cause-specific mortality in older women. DESIGN:A prospective cohort study. SETTING:Four communities across the United States. PARTICIPANTS:We prospectively assessed resting pulse rate in 9,7...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2002.50110.x
更新日期:2002-03-01 00:00:00
abstract::Thirty-two demented, elderly residents of a nursing home were admitted to a specially designed dementia unit. Each patient was assessed three times: prior to admission, and at four and 12 months after admission to the unit. Patients were evaluated using a modified version of a previously published assessment scale as ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1987.tb04638.x
更新日期:1987-04-01 00:00:00
abstract::Seventy consecutive patients receiving warfarin as an anticoagulant were evaluated for the relationship between the response to the loading dose of warfarin and the response to the maintenance dose. No patients were excluded because of complicating diseases or the concurrent use of other drugs. There was a moderate co...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1980.tb00116.x
更新日期:1980-01-01 00:00:00
abstract::Capitated or salaried managed care systems offer an important opportunity to provide high quality, cost-effective end-of-life care. However, capitated healthcare delivery systems have strong incentives to avoid patient populations in need of such care. Care currently provided at the end of life in fee-for-service prac...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1998.tb01047.x
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVES:To examine relationships between race and psychotropic drug use (antidepressant, antianxiety, sedative/hypnotic agents) in informal caregivers with symptoms of depression who provide care for elderly relatives with progressive dementia. Whether racial differences in medication use relate to racial difference...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53155.x
更新日期:2005-03-01 00:00:00
abstract::Hip fractures in older adults are a common event, leading to substantial morbidity and mortality. Hip fractures have been previously described as a "geriatric, rather than orthopedic disease." Patients with this condition have a high prevalence of comorbidity and a high risk of complications from surgery, and for this...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2008.01770.x
更新日期:2008-07-01 00:00:00
abstract::Widowed residents of two nursing homes who were oriented to person, time, and place were interviewed to determine the extent to which they had hallucinatory experiences of their deceased spouse. Fifty-two interviews were completed with 46 widows and six widowers. Results are reported for the widows. Twenty-eight (61%)...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1985.tb04619.x
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVE:To survey physicians to determine whether sociodemographic and practice-related variables are predictive of their attitudes toward suicide. DESIGN:Mailed questionnnaire survey. SETTING:Monroe County, New York. PARTICIPANTS:A 50 percent random sample of practicing primary care physicians. Of 186 potential r...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1995.tb05814.x
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVES:To test the efficacy of an individualized social activity intervention (ISAI) on decreasing daytime sleep, improving nighttime sleep, and lowering the day/night sleep ratio and to determine its cost. DESIGN:Pretest/posttest randomized with an experimental and control group. SETTING:Seven nursing homes. PA...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1532-5415.2005.53460.x
更新日期:2005-09-01 00:00:00
abstract::Cognitive function is often impaired in type I diabetes mellitus, especially when onset is in early childhood. Limited evidence suggests similar impairment in the much larger population of older persons with type II diabetes. We report here the results of 13 measures of mental efficiency in persons between 65 and 77 y...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1990.tb02398.x
更新日期:1990-05-01 00:00:00
abstract:OBJECTIVES:To investigate whether anticholinergic burden scores from nine published anticholinergic scales are associated with adverse health outcomes, including hospital admissions, hospitalizations for falls, hospital length of stay (LOS), and more visits to general practitioners (GPs). DESIGN:Pharmacoepidemiologica...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.13206
更新日期:2015-01-01 00:00:00
abstract::Low-income older adults are particularly vulnerable during care transitions. The present study evaluated the effectiveness of a transitional care model in this population. A quasi-experimental design was used to compare outcomes in the intervention group with historical controls at 30, 90, 180, and 365 days after disc...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.12276
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVES:To determine the role terminally ill patients would opt to have their loved ones and physicians play in healthcare decisions should they lose decision-making capacity and how this changes over time. DESIGN:Serial interviews. SETTING:The study institutions were The Johns Hopkins Medical Institutions in Balt...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2007.01473.x
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVES:To search for a potential role of endothelin-1 (ET-1), a potent vasoconstrictor and presumably neurotoxic 21-amino acid peptide, for dysfunction of brain signal processing and cerebrovascular morbidity in nondemented patients with cerebral arteriosclerosis. DESIGN:Cross-sectional study with longitudinal fol...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1997.tb05166.x
更新日期:1997-04-01 00:00:00
abstract::Neurotoxic effects of habitual alcohol consumption were investigated by correlating the subjects' estimates of abstinence or frequency and amount of alcohol consumed with measurements of gray matter blood flow utilizing the 133Xe inhalation method. Two hundred and twenty-two subjects were studied, including 136 health...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1983.tb02198.x
更新日期:1983-09-01 00:00:00
abstract:OBJECTIVES:To demonstrate reliability and feasibility of a standardized protocol to assess and score quality indicators relevant to pressure ulcer (PU) care processes in nursing homes (NHs). DESIGN:Descriptive. SETTING:Eight NHs. PARTICIPANTS:One hundred ninety-one NH residents for whom the PU Resident Assessment Pr...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2003.51402.x
更新日期:2003-09-01 00:00:00
abstract:BACKGROUND:Coffee and tea are two of the most widely consumed beverages worldwide and have been associated with reduced risk of mortality in some studies. However, it is unknown whether consumption of these beverages is associated with survival to an advanced age. OBJECTIVE:To examine associations of coffee and tea co...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.16467
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVES:To establish the comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults using the network meta-analysis approach. DESIGN:Systematic review and network meta-analysis. PARTICIPANTS:Individuals aged 60 and older. MEASUREMENT...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,meta分析
doi:10.1111/jgs.13395
更新日期:2015-05-01 00:00:00
abstract:OBJECTIVE:To determine patient factors that predict use of physical or occupational therapy (PT/OT) services by elderly people. DESIGN:Time-series study of the relationship of PT/OT use to a variety of characteristics present at baseline. PARTICIPANTS:Eight-hundred nine community-dwelling men and women aged 65 and ol...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1992.tb02131.x
更新日期:1992-04-01 00:00:00
abstract:OBJECTIVES:To determine whether histamine2-receptor antagonist (H2RA) dose modified for renal impairment affects gastrointestinal (GI) disease control. DESIGN:Concurrent medical record review. SETTING:One hundred forty-six nursing facilities throughout the United States. PARTICIPANTS:Three hundred thirty-six patient...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1034/j.1600-0579.2003.00209.x
更新日期:2003-05-01 00:00:00
abstract::The primary and secondary diagnoses for 100 geriatric patients consecutively admitted to a nursing home were reviewed for accuracy and omissions. Primary diagnoses were identified as the direct basis for nursing home admission. Other physical, biochemical or behavioral disorders requiring continued therapeutic care we...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1976.tb04281.x
更新日期:1976-03-01 00:00:00
abstract::Medication errors and adverse drug events are common in older adults, but locating literature addressing these issues is often challenging. The objective of this article is to summarize recent studies addressing medication errors and adverse drug events in a single location to improve accessibility for individuals wor...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/jgs.13922
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND/OBJECTIVE:The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care. DESIGN, SETTING, AND PARTICIPANTS:Single-blinded, two-arm, ran...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,随机对照试验
doi:10.1111/jgs.16247
更新日期:2020-03-01 00:00:00
abstract:OBJECTIVES:To examine the effect of mode of survey administration on response rates and response tendencies for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey and develop appropriate adjustments. DESIGN:Survey response data were obtained after sampling and fielding of the CAHPS Hosp...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15265
更新日期:2018-03-01 00:00:00