PubMed Health⌕ Search

Biomedical subjects

R A Applebaum

Publications and source records attributed to R A Applebaum.

13 recordsLinked to original sources
PubMed2001

Infections in nursing homes: assessing quality of care.

BACKGROUND: Each year more than 25% of nursing home patients are taken to the hospital emergency room or hospitalized for the evaluation and treatment of infections. These transfers may have an adverse impact on the quality and the cost of patient care. METHODS: Using both Medicare and Medicaid records from a sample of dually eligible elderly people in Ohio, we identified patients receiving antibiotic prescriptions in the nursing home and measured the frequency of nursing home physician visits and the hospital transfer rate. RESULTS: Among the study sample (N = 1306), two thirds experienced a total of 3685 episodes of infections. Just under 5% of the sample were hospitalized as a result of the infection. In one third of the episodes, physicians saw the resident in person within 5 days (before or after) of the initiation of the medication. The hospital transfer rate was slightly higher (7% vs 3.5%) for those patients directly evaluated by a physician before receiving the prescription. CONCLUSIONS: A majority of prescriptions were written without direct physician examination, raising key questions about practice patterns and the effect on patient care and costs.

Aged↗
PubMed1996

Ohio's options for elders initiative: cutting corners or the cutting edge?

This article presents results from the evaluation of Ohio's community-based long-term-care demonstration project. The initiative, named "Options for Elders," was an attempt to develop a more comprehensive and rational service delivery system for disabled older people. The demonstration involved a single point of entry to long-term-care services, a telephone screen, varying levels of care management, and funding for services. The needs of clients were initially assessed by telephone, and clients were assigned to levels of care management and services based on the concept of medical triage. By placing additional responsibility on a telephone screener, the Options approach attempted to reduce the amount of in-home care management provided. The model is a unique and controversial attempt to develop a more cost-effective system of care management.

Aged↗
PubMed1992

Estimating the prevalence of long-term disability for an aging society.

Using information from two national data sets, this report provides projections of disability rates for the U.S. population age 65 and above. The research develops a series of projections based upon alternative sets of assumptions about mortality and disability. Using 1986 baseline disability data, estimates by single year of age are projected through the year 2040. The social policy implications of these projections are discussed in the final section.

Activities of Daily Living↗
PubMed1992

What price quality? Assuring the quality of case-managed in-home care.

Case managed community-based long-term care has now become an established component of the service delivery system in the United States. As case management has developed, it has gone through an evolutionary process. In the initial phase of case management, considerable attention was placed on gaining access to resources by the case manager. This article addresses issues of assuring the quality of case-managed care. It focuses on the current concerns and potential problems associated with evaluating the effectiveness of services arranged by case managers, and describes a model, developed in Ohio, to ensure the quality of care. In addition, it discusses the continued challenges for and costs of quality assurance and notes the difficulty of obtaining empirical data in the effort to assure quality.

Cost Control↗
PubMed1989

Assuring the quality of home-delivered long-term care: the Ohio Quality Assurance Project.

Home-delivered care is an important development for functionally disabled clients and for the long-term care system. However, questions and concerns about home care quality have been raised. At this point, home care quality is not well understood, and most case management and provider agencies have very little experience designing and implementing quality assurance programs. This article reports on the Ohio Quality Assurance Project. During this 17-month pilot project, the Ohio Department of Aging and the Scripps Gerontology Center, Miami University, collaborated on a model quality assurance system for case managed, in-home care. Using two demonstration sites within Ohio's PASSPORT program, the Ohio Quality Assurance Project developed and tested quality assurance standards and strategies that could be applicable to home care and case management agencies nationwide.

Administrative Personnel↗
PubMed1988

The evaluation of the National Long Term Care Demonstration. 9. The effect of channeling on mortality, functioning, and well-being.

A key component of the channeling evaluation was its focus on the life quality of program clients and their caregivers. In this article, life quality results in the areas of mortality, functioning, and client and caregiver well-being are presented for research treatment and control group members. Results show no significant differences in mortality, some beneficial program effects on client and caregiver well-being, and somewhat mixed effects on client functioning.

Activities of Daily Living↗
PubMed1988

The evaluation of the National Long Term Care Demonstration. 3. Recruitment and characteristics of channeling clients.

The National Long Term Care Demonstration (channeling) was designed to provide coordinated community-based long-term care services to those older persons at high risk of nursing home placement. A key component of the program was the process established to accomplish this targeting effort. In this article, the outreach and eligibility procedures developed in the demonstration are described. Characteristics of channeling clients are compared to those of clients from other long-term care demonstrations, a national nursing home sample, and a simulated national sample of functionally impaired older persons. Results indicate that the channeling clients were quite frail, more so than the clients served in most of the other long-term care demonstrations, but were younger, slightly less disabled, and more likely to be married than a national sample of nursing home residents.

Activities of Daily Living↗
PubMed1988

The evaluation of the National Long Term Care Demonstration. 4. Case management under channeling.

The channeling demonstration involved provision of comprehensive case management and direct service expansion. This article considers the former. Under both models, comprehensive case management was implemented largely as intended; moreover, channeling substantially increased the receipt of comprehensive care management. However, channeling was not a pure test of the effect of comprehensive case management: roughly 10-20 percent of control group members received comparable case management services. This was particularly the case for the financial control model. Thus, the demonstration was not a test of case management compared to no case management; rather, it compared channeling case management to the existing community care system, which already was providing comprehensive case management to some of the population eligible for channeling.

Aged↗
PubMed1987

Prescreening at-risk elders for entry into a community-based long-term care program.

Despite the expansion of community-based service alternatives, demand for case coordinated community care continues to rise. Many programs, under pressure to target their services to te most disabled, have developed comprehensive entry criteria to determine eligibility. Their criteria generally require an in-person assessment to make the determination, but because of the volume of potential applicants, in-person assessment of each applicant has proven to be impractical. Although most programs have developed some type of screening method and a wide range of approaches are used, little research exists to validate the screening efforts. This study reports on a screening method used in the national channeling demonstration and compares the results of a telephone screen to the results of an in-person assessment.

Aged↗
PubMed1985

Transcutaneous PO2 monitoring during sodium nitroprusside infusion.

To determine the effect of vasodilator-induced hypotension on the relationship between transcutaneous PO2 (PtcO2) and PaO2, six mongrel dogs and 20 patients were monitored before and during infusion of sodium nitroprusside (SNP), with PtcO2 sensors heated to 45 degrees C. First, SNP infusion was used to lower the mean arterial pressure (MAP) of anesthetized dogs, in steps of approximately 25%, to 49 +/- 3 (SD) mm Hg. There were no significant changes in cardiac output, oxygen consumption, PtcO2, PaO2, or PtcO2 index (PtcO2/PaO2). Twenty patients were monitored during general anesthesia. Fifteen patients were being treated for acute hypertension with SNP, and in five patients hypotension was induced with SNP to minimize blood loss. There was a significant decrease in MAP, PaO2, and PtcO2, and a significant increase in alveolar-arterial PO2 difference during SNP infusion. PtcO2 index did not change significantly from its preinfusion value in either group.

Adult↗
PubMed1985

Targeting services to chronically disabled elderly: the preliminary experiences of the National Long Term Care Channeling Demonstration.

In response to concerns about the adequate provision of long term care, the National Long Term Care Channeling Demonstration has been funded by the Department of Health and Human Services. The project is designed to provide coordinated community services as an alternative to institutionalization to those elderly individuals at risk of placement. This preliminary work examines the demonstration's experience in its attempt to target services to these individuals. Although final research results are not yet available, the method, problems, and results of the initial case finding and screening approaches provide additional knowledge concerning the targeting experience.

Aged↗