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Biomedical subjects

R Abrahams

Publications and source records attributed to R Abrahams.

14 recordsLinked to original sources
PubMed1999

Abdominal tuberculosis: the problem of diagnostic delay.

Abdominal tuberculosis can be difficult to diagnose. In order to minimize diagnostic delay, an audit study showed that the Mantoux test and/or culture of ascitic fluid did not reveal tuberculosis immediately. Laparoscopy/laparotomy with Ziel-Nielson staining and culture of tissue biopsy always confirmed the diagnosis. It is suggested that biopsy should be the first line in investigating patients suspected of having abdominal tuberculosis.

Adult↗
PubMed1997

Measuring the adequacy of home care for frail elders.

Community elders (N = 330) were interviewed by telephone twice at baseline using both computer-assisted telephone interviews (CATI) and nurse clinicians, and at four-month follow-up using CATI to collect alternative paraprofessional home care adequacy measures. Measurement format influenced both reliability and observed levels of adequacy but alternative adequacy measures converged and were not closely linked to functional status. The predictive validity of measures based on clinical standards with respect to health outcomes was also demonstrated. These findings support emerging approaches in primary care and home health quality measurement that consider multiple dimension of user response to formal and informal care.

Aged↗
PubMed1993

The administration of eligibility for community long-term care.

Eligibility assessment systems for community long-term care vary widely across current programs funded by states and Medicaid and in proposals to expand federal funding. Improved equity and efficiency in both current and proposed programs will require better specification of eligibility criteria, timing and setting of assessments, language of assessment items, training of assessors, procedures for appeal and review, and consideration of the costs of care management. Recent research and demonstrations provide models and technology for more uniform approaches in national programs.

Activities of Daily Living↗
PubMed1992

Integrating care for the geriatric patient. Examples from the Social HMO (SHMO).

Managing the care of geriatric patients with chronic disease focuses attention on the functional impairments that place these patients at risk in the home environment. Maintaining patients in their preferred home settings requires physicians to coordinate effective discharge planning and long-term community care resources. A service coordinator or case manager can play a key role in coordinating the broad array of services needed, as well as linking the providers involved. A coordinated acute and long-term care service delivery system is described, with examples from the Social HMO (SHMO). Data are presented on SHMO enrollee demographic characteristics, chronic disease conditions and functional levels, as well as data on care plans, utilization and costs. A case example illustrates how ongoing medical and long-term care are integrated. Implications for geriatric care and HMO practice are discussed, with recommendations for improving geriatric care in the next generation of SHMO sites.

Aged↗
PubMed1992

Across the great divide. Integrating acute, post-acute and long-term care.

The importance of integrating acute, post-acute and long-term care is underscored by analyses of the extent of medical complexity among the SHMO enrollee population that qualified for a long-term care benefit on functional (not medical) criteria. In the SHMO programs, initiatives to promote integration of services at all levels of care have largely come from the care management units. Integrative practices will vary in different organizational settings. Examples from two very different SHMO sites illustrate how integrative practices are implemented. It is concluded that in order to serve adequately a medically complex and functionally impaired elder population a key function of care management is to develop cooperative relationships, and mechanisms for information exchange, with providers at all system levels, reaching across the great divide between the acute and long-term care systems.

California↗
PubMed1990

The social/HMO. Case management in an integrated acute and long-term care system.

The Social/HMO is a national demonstration that has been in operation for five years at four private, nonprofit sites around the country. Key functions of Social/HMO case management include targeting the long-term care benefit/eligibility determination, service prescription that integrates post-acute and long-term care, close monitoring of clients, and fiscal accountability for long-term care benefit budgets.

Aged↗
PubMed1989

Variations in care planning practice in the social/HMO: an exploratory study.

In this exploratory study, we examined the influence of provider settings, organizational structures, and community climates on long-term care resource allocation. We analyzed care plan decisions at each of the four Social/HMO sites for the same seven clients. Differences by site were found in eligibility determination and allocation of care plans, as well as types and mix of services prescribed. Issues are raised about the influence of provider settings on legitimation of types of needs and clients that are served.

Activities of Daily Living↗
PubMed1988

Developing reliable assessment in case-managed geriatric long term care programs.

Analyses of frail elderly populations and their service needs are increasingly important in shaping future policies for long term care (LTC) financing and service delivery. Because assessment information on elderly LTC clients generates essential data bases on programs and the population, it is important that the data be reliable. This article describes a method for obtaining reliable assessment data in multisite programs involving many clinical assessors. Regular reliability checks showed marked improvement over time and generally high levels of interrater reliability.

Activities of Daily Living↗