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Biomedical subjects

J H Swan

Publications and source records attributed to J H Swan.

At least 19 recordsLinked to original sources
PubMed1997

The effect of certificate of need and moratoria policy on change in nursing home beds in the United States.

OBJECTIVES: This study examined the effects of state certificate of need and/or moratorium requirements on the change in nursing home bed growth in states over a 13-year period. METHODS: Data were collected from five telephone surveys of state officials about state certificate of need and moratorium policies, state Medicaid nursing home reimbursement rates, and the licensed nursing home beds in each state for the 1979 through 1993 period. Two-stage least squares regression analysis treated certificate of need and/or moratorium and Medicaid reimbursement rates as endogenous variables in predicting the change in nursing home beds per aged population in states. RESULTS: States that had a certificate of need and/or moratorium did have significant reductions in the growth in nursing home beds but Medicaid nursing home reimbursement rates were not related to change in bed stock. The percentage of the population living in a metropolitan area, the personal income per 1,000 population, the percent unemployed, a state's tax effort, and time were positively associated with change in nursing home beds. The ratio of nursing home beds per 1,000 aged population in the previous year was a negative predictor of change in bed stock in a given year. CONCLUSIONS: State regulatory policies have an effect on bed growth in contrast to reimbursement policies.

Certificate of Need↗
PubMed1997

Medicare revenue in large medical groups.

The aged are the heaviest users of physician services. A ageing population and escalation in medical costs have pressured Medicare budgets, which have increased fastest in Part B physician reimbursement. Policy responses include adoption of the Resource Based Relative Value Scale (RBRVS) for physician payment. This paper considers receipt of Medicare revenues by large medical groups and expectations of how groups will fare under RBRVS. In a 73-percent sample of U.S. large group practices, Medicare coverage accounted for one-fourth of clients, Medicare-related revenues for slightly more than one-fourth of revenues, suggesting a slightly higher revenue intensity for Medicare clients, but showing no evidence of truly disproportionate revenues from Medicare users. Medicare shares of revenues are explained by factors related to Medicare clientele and geriatric service provision. Overly-strict Medicare assignment policy may control costs by limiting access to needed care, rather than by limiting overpayments to physicians. Expectations as to how groups will fare under RBRVS are not found to be related to reliance on Medicare, rather to group auspices and ability to contain costs under Medicare payment. The findings are important not only to physician payment under RBRVS but also under health care reform.

Aged↗
PubMed1997

State-imposed limits on Medicaid reimbursement for nursing facility care.

OBJECTIVES: Nursing cost-center limits were examined, along with their effects on Medicaid. METHODS: A national survey of Medicaid nursing facility reimbursement provided data on cost centers for nursing, administration, and capital, whether in specific, larger, or multiple cost centers. RESULTS: Most states impose nursing and administration limits. Far fewer states impose capital limits, but only capital limits may be related to constraint of reimbursement rates. CONCLUSIONS: Shifting toward limiting capital costs, or simply eliminating cost-center limits, might accommodate cost control while removing negative constraints on direct resident care.

Cost Allocation↗
PubMed1995

Use of covered services in Medicare home health care.

Using data on 295 patients entering Medicare home health care at discharge from Medicare hospital stays, we explain receipt of Medicare home health nursing, PT and OT visits, and length of stay. Care reflected need, but other factors also affected service allocation. Medicare program requirements, as well as variation in provider structure and case load, appear to introduce inequities. Critical in light of recurrent proposals to change Medicare coverage and benefits, findings underline the need to reconsider Medicare home health policies that lead to denial of needed services, inequitable allocation of benefits, and premature termination of care.

Aged↗
PubMed1995

Nursing home waits for admission in an era of change.

Access by older persons to nursing home care is a major concern. Turmoil in the health care industry in the 1980s worsened access problems, including waits for admission, already severe at the start of the decade. This paper examines waits for nursing home admission, relating them to facility and market factors.

Aged↗
PubMed1994

Privatization, system membership, and access to home health care for the elderly.

Home health agency (HHA) access based on organizational and market factors is considered, employing a theoretical model of isomorphism for organizational factors and ecological and economic theories for market factors. Data derive from 1986 and 1987 telephone surveys that randomly sampled 185 HHAs from nine metropolitan areas in five states. Results show that competition limits restrictions on access; for-profit status and system membership increase the likelihood that clients will be refused for financial reasons. Findings support the isomorphism theory that fewer access and other behavioral differences appear within systems: nonprofits and for-profits tend to behave alike within systems, whereas freestanding nonprofits are less likely than their for-profit counterparts to refuse access. Findings for system members may account for some of the problems of legitimacy experienced by nonprofit health care organizations.

Aged↗
PubMed1993

BW619C89, a glutamate release inhibitor, protects against focal cerebral ischemic damage.

BACKGROUND AND PURPOSE: The excitatory amino acid neurotransmitter glutamate is involved in excitotoxic brain injury and neurodegeneration after cerebral ischemia. Therefore, compounds that block the release of glutamate may be useful as cerebroprotective agents. The purpose of this study was to evaluate the cerebroprotective properties of a glutamate release inhibitor, BW619C89. METHODS: In the studies reported here, the effect of BW619C89 [4-amino-2-(4-methyl-1-piperazinyl)-5-(2,3,5-trichlorophenyl)pyrimidine] on neurotransmitter release (endogenous amino acids, gamma-aminobutyric acid, and acetylcholine) from slices of rat brain cerebral cortex in vitro has been determined. The neuroprotective efficacy of BW619C89 has been evaluated using the middle cerebral artery occlusion model of focal cerebral ischemia in the Fischer 344 rat. RESULTS: In the in vitro studies, BW619C89 inhibited veratrine- (but not potassium-) evoked release of both endogenous glutamate and aspartate from rat cerebral cortex slices with IC50 values of approximately 5 microM. BW619C89 was approximately 10-fold less potent to inhibit veratrine-evoked 3H-gamma-aminobutyric acid release (IC50 = 51 microM), fourfold less potent to inhibit 3H-acetylcholine release (IC50 = 21 microM), and at 10 microM had only weak activity at excitatory amino acid (N-methyl-D-aspartate, kainate, and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) binding sites. When administered intravenously to Fischer 344 rats 5 minutes after permanent middle cerebral artery occlusion, BW619C89 produced marked reductions of both total (cortex and basal ganglia) and cortical infarct volumes. Cortical infarct size was reduced by 20% at a dose of BW619C89 of 5 mg/kg (n = 6, not significant); 43% at 10 mg/kg (n = 8, P < .01); 59% at 20 mg/kg (n = 8, P < .001); 61% at 30 mg/kg (n = 8, P < .001), and 53% at 40 mg/kg (n = 8, P < .001). BW619C89 at doses of 20 and 30 mg/kg also significantly reduced noncortical (basal ganglia) infarct volumes, demonstrating that a proportion of this tissue also appears to be salvageable. Behavioral effects observed were dose related, generally minor, and at doses of 20 mg/kg IV and above consisted of body tremor and mild ataxia lasting approximately 2 hours. CONCLUSIONS: These results suggest that glutamate release inhibitors such as BW619C89 may provide an alternative to excitatory amino acid receptor antagonists in the treatment of focal cerebral ischemia and stroke.

Acetylcholine↗
PubMed1993

The posthospital experience of elderly Medicare home health users.

This study describes the home health experience of 295 Medicare elderly persons following hospitalization. While a subset of persons improved medically and functionally during the home health service period, some declined on one or both dimensions and many showed not change. The most heavily utilized, non-Medicare, services were personal care and homemaker/chore, reflecting the functional needs of some posthospital elderly. One-fifth of Medicare home health users were reinstitutionalized or died during the service period. Those discharged to home had a range of continuing service needs, both medical and functional, after home health discharge.

Activities of Daily Living↗
PubMed1993

Nursing home queues and home health users.

Home health market growth suggests the need for models explaining home health utilization. We have previously explained state-level Medicare home health visits with reference to nursing home markets. Here we introduce a model whereby state-level Medicare home health use is a function of nursing home queues and other demand and supply factors. Medicare home health users per state population is negatively related to nursing home bed stock, positively to Medicaid eligibility levels and to Medicaid nursing home recipients per population, as well as to various other demand and supply measures. This explanation of home health users explains previously-reported findings for home health visits. The findings support the argument that home health use is explained by factors affecting lengths of nursing home queues.

Health Services Needs and Demand↗
PubMed1993

IV drug use, dementia, and nursing home care for PWAs (persons with AIDS).

Despite the usual focus on daily costs, because PWAs have higher costs per day than other SNF residents, LOS and days of care are important cost indices. Data on LOS for 102 admissions and annual days of care for 90 PWAs show average 64-day LOS and 67 days of care. Regression analysis and survival analysis show dementias and IV drug use to mean longer LOS and more days of care. Higher PWA costs must be sustained over longer periods for PWAs with dementias and for IV drug users, who may claim increasing shares of the SNF care provided to PWAs.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Trends in Medicaid nursing home reimbursement: 1978-89.

Medicaid nursing home reimbursement is of concern because of implications for nursing home expenditures. This article presents data on State Medicaid nursing home reimbursement methods, ratesetting methods, and average per diem rates, refining earlier data and updating through 1989. A trend in the early 1980s toward adopting prospective systems played out by the end of the decade. There were trends, however, toward casemix methods, which may increase access for high-need patients, and toward cost-center limits on nursing, which may provide incentives to lower quality care. Analysis supports previous findings that prospective systems allow greater control over increases in rates.

Data Collection↗
PubMed1992

Reduction of glutamate release and protection against ischemic brain damage by BW 1003C87.

BW 1003C87, 5-(2,3,5-trichlorophenyl)-2,4-diaminopyrimidine ethane sulphonic acid, has been tested for its in vitro and in vivo effects on glutamate release in rat brain tissue, and for its cerebro-protective action in two rodent models of cerebral ischemia. In rat brain slices the release of glutamate evoked by veratrine is inhibited by BW 1003C87 (IC50 = 1.6 microM). In anaesthetised rats with microdialysis probes implanted in the dorsal hippocampus the increase in extracellular glutamate evoked by veratrine is markedly reduced by co-infusion of BW 1003C87, 100 microM. In anaesthetised rats with microdialysis probes implanted in the cortex and the caudate nucleus ipsilateral to a middle cerebral artery (MCA) occlusion the increase in dialysate glutamate concentration seen in the first 2 h following MCA occlusion is markedly attenuated by the prior administration of BW 1003C87, 20 mg/kg i.v. In rats subjected to 10 min of bilateral common carotid artery occlusion the loss of CA1 pyramidal neurons (assessed 7 days later) is reduced by administration of BW 1003C87 (20 mg/kg i.v., at the time of ischemia and 4 h later). The volume of cortex showing infarction 72 h after unilateral MCA occlusion is reduced by treatment with BW 1003C87 (20 mg/kg, i.v., beginning 5 min after occlusion). Inhibition of glutamate release may provide a therapeutic approach in cerebral ischemia as well as in epilepsy.

Animals↗
PubMed1992

Skilled nursing facility care for persons with AIDS: comparison with other patients.

We compared average daily hours of care for patients with and without acquired immunodeficiency syndrome (AIDS) in a hospital-based skilled nursing facility. Patients with AIDS averaged over an hour more direct nursing care per patient day (6.5 vs 5.4 hours). These findings support other reports of greater nursing time and higher costs of caring for nursing home patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Running as fast as they can: organizational changes in home health care.

During the 1980s, as the health care industry experienced what observers have dubbed a revolution, the home health industry also experienced its own transformation. Utilizing three organizational theories (neoinstitutional, resource dependency and population ecology), the authors report on a study of a probability sample of 163 home health agencies (HHAs) that were interviewed in 1986 and again in 1987 on the effects of Medicare policy changes including prospective payment (DRGs). This study tests hypotheses concerning the influence of environmental factors (e.g., state policy and characteristics of the local market) and organizational characteristics of the HHA (e.g., tax status and Medicare reliance) in explaining the propensity of HHAs to be (or become) parts of chains and/or multi-facility systems; and to develop particular types of interorganizational relations. The paper discusses the results in the context of public policy changes and the implications for future research and practice.

Data Collection↗