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Biomedical subjects

J E Beaulieu

Publications and source records attributed to J E Beaulieu.

8 recordsLinked to original sources
PubMed1994

Rural case management: a pilot study.

The long term goal of this research is to improve the quality, effectiveness and efficiency of home and community-based services for rural long term care clients. Case management has been espoused as one method to improve services. Long term care case management models have been tested in urban areas with good results, but it is not known to what extent these models are applicable to the special circumstances of rural home and community-based care. The purposes of this pilot study are: 1. To describe case management in long term home health care as practiced in rural Kentucky. 2. To analyze case management for factors that promote or impede effective and efficient delivery of long term home health care for older rural Kentuckians. 3. To propose a model appropriate to case management in long term home health care for older rural Americans.

Activities of Daily Living↗
PubMed1992

Rationing and the long-term-care system.

Rationing is a concept newly introduced in health-systems analysis in the United States. Although rationing, when applied to health care, is a fearful word to the elderly, at the most basic level it is simply a method that enables government to intervene in the private marketplace to allocate resources to achieve particular policy ends. This intervention to affect allocation of health care resources has long been used by all levels of government in the United States. Intervention by government in the private marketplace is examined as a means of expanding or limiting the supply of health care services or expanding or limiting the demand for such services. The Oregon rationing experiment with Medicaid services has significantly contributed to the introduction of the concept of rationing of health care. As expected, there is a disproportionate interest by the elderly in rationing health care; thus the effect of the Oregon rationing experiment on the elderly is discussed, as are other allocation interventions on long-term care, as a service of particular interest to the elderly.

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PubMed1992

Small rural hospitals with long-term care: 1983 to 1987.

Rural hospitals were under tremendous stress in the 1980s, as evidenced by decreasing use and closures. Rural populations increased in the two proportions of people older than 65 years relative to urban areas. Rural communities had more chronically ill residents than urban areas. Population aging and hospital stress have opened an option for small rural hospitals to develop long-term care units. Analysis of a national cohort of 750 small rural hospitals was undertaken in 1983, 1985, and 1987 to identify the characteristics of these hospitals, their communities, and the relative contribution of the small rural hospital to long-term care bed supply. Hospitals more likely to have long-term care during this period of time had lower occupancy rates and higher expenses per admission both prior to and after developing long-term care. While only 14 percent of the 750 hospitals studied had long-term care, they contributed nearly 30 percent of the total long-term care bed supply in their counties. Population-based need and bed supply measures were not significantly different in counties having a small rural hospital with long-term care. Areas of further analysis of the small rural hospital as a resource for long-term care are suggested. The implications for the health care system of small rural hospitals with long-term care are discussed.

Bed Conversion↗
PubMed1991

The quality of home and community-based services.

The quality of long-term home health services is particularly difficult to study because of (a) the multidimensionality and chronicity of patients' needs, (b) the complexity of and the number of social and health-related services provided, (c) the isolation of care in individual homes, and (d) the lack of norms and standards on which to base judgments. A study was undertaken of the quality of care received by two client groups receiving home- and community-based services, in which some of these difficulties were addressed. An expert committee of home health practitioners wrote criteria for process and outcomes of care based on local norms of practice. Applying these criteria to the care received by the study groups, the committee found a high degree of quality of care. Specific problems identified in the care were a lack of appropriate case management and poor chart documentation. In most cases, if good care was received, the client experienced good outcomes.

Chi-Square Distribution↗
PubMed1991

Results of the assessment of Kentucky's Medicaid home- and community-based services waiver.

In states where a Home- and Community-based Services Waiver is operating under the Medicaid program, HCFA requires an independent assessment of the program. This paper reports on two assessments of the costs and use of services under Kentucky's HCBS waiver: one comparing waiver clients to a matched control group of regular Medicaid home health clients, and the other comparing elderly female waiver clients to a matched control group from nursing homes. Analyses of costs and use of home health services, hospital care, physician services, nursing home admission, and other services showed little difference between waiver clients and control groups. Waiver clients used more home health, but used other services at the same rate. Their costs were lower overall.

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