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Biomedical subjects

Robin E Remsburg

Publications and source records attributed to Robin E Remsburg.

11 recordsLinked to original sources
PubMed2006

Differences in hospice use between black and white patients during the period 1992 through 2000.

PURPOSE: We examined differences in hospice use rates among blacks and whites and investigated trends in racial differences in hospice patients during the period 1992 through 2000. We tested differences in length of hospice survival from hospice enrollment to death between black and white patients during this period. METHODS: We analyzed data from the 1991-2000 Underlying and Multiple Cause-of-Death Files and the 1992-2000 National Home and Hospice Care Surveys using z tests, chi tests, and Cox regression models. RESULTS: Compared with 1992, the hospice use rate doubled for white patients (P < 0.0001) and increased almost 4-fold for black patients (P < 0.0001) in 2000. Hospice use rates among black patients were significantly lower than those among white patients from 1992 to 1994 but not from 1996 to 2000. Black hospice patients discharged throughout the 1990s were more likely to be younger, have Medicaid-only as their payment source, and have HIV/AIDS than their white counterparts. Black hospice patients were more likely to be referred by hospitals than white hospice patients during 1996 to 2000. Throughout the 1990s, length of hospice survival did not significantly differ between black and white hospice patients after adjusting for covariates. CONCLUSIONS: Hospice use rates significantly increased for both whites and black patients. Black patients had lower hospice use rates than white patients from 1992 to 1994, but not from 1996 to 2000, which may reflect the diffusion of hospice care to black patients with the rapid growth in hospice programs. Despite differences in patient characteristics, the length of hospice survival was similar among both groups. Future research is needed to assess whether racial disparities exist in quality of hospice care.

Black or African American↗
PubMed2005

Changes in use of voluntary workers in nursing homes: United States, 1985 and 1999.

OBJECTIVE: This report describes changes in the use of voluntary workers in nursing homes between 1985 and 1999. Statistics are presented on selected characteristics of nursing homes using voluntary workers and the services they perform. Factors that may contribute to the increased use of voluntary workers are also discussed. METHODS: The data presented in this report were collected from the 1985 and 1999 National Nursing Home Surveys (NNHS). NNHS is a part of the National Health Care Survey, which measures health care utilization across various types of providers. Conducted periodically since 1973, NNHS obtains information from a nationally representative sample of nursing home facilities based on interviews with administrators and staff. Sample data are weighted to produce annual national estimates. RESULTS: In 1999, 87 percent of all nursing homes reported using voluntary workers, up from 78 percent in 1985. In 1985, unpaid workers were most likely found in large nursing homes (100 beds or more). By 1999, about the same proportion of nursing homes, large and small, reported their use. In 1999, the Northeast region had the greatest proportion of nursing homes that used volunteers--93 percent. Chain-affiliated and independent facilities used volunteers with about the same frequency, and about the same percentage of nursing homes not certified by either Medicaid or Medicare used voluntary workers as did dually-certified facilities. However, in 1999, proportionately fewer proprietary (for-profit) nursing homes reported having volunteers (85 percent) than did nonproprietary facilities (93 percent).

Humans↗
PubMed2005

Nursing home resident and facility characteristics associated with pneumococcal vaccination: national nursing home survey, 1995-1999.

OBJECTIVES: To assess Advisory Committee for Immunization Practices recommendations for the pneumococcal vaccine in nursing home residents using national surveys to examine factors associated with vaccination. DESIGN: Cross-sectional national sample surveys of nursing homes and nursing home residents with a two-stage probability design, stratified on size and Medicare and Medicaid certification status. SETTING: U.S. nursing homes during 1995, 1997, and 1999. PARTICIPANTS: Six current residents were randomly selected from each facility (n=approximately 8,000 each year). MEASUREMENTS: Residents' pneumococcal vaccination status was obtained by asking the facility respondent for each resident: "Has [the resident] EVER had a pneumococcal vaccine, that is a pneumonia vaccination?" Vaccination status was coded as yes, no, and unknown. RESULTS: The proportion of residents aged 65 and older that received pneumococcal vaccination increased significantly, from 23.6% in 1995 to 28.2% in 1997 to 37.4% in 1999 (P<.001). The proportion of residents in homes with pneumococcal immunization programs increased significantly, from 65.2% in 1995 to 88.9% in 1999. CONCLUSION: The proportion of nursing home residents aged 65 and older receiving the pneumococcal vaccine increased significantly from 1995 to 1999. Residents living in nursing homes with programs for pneumococcal immunizations were significantly more likely to be vaccinated.

Aged↗
PubMed2005

Impact of the Medicare interim payment system on length of use in home care among patients with Medicare-only payment source.

Using data from the 1996 and 2000 National Home and Hospice Care Surveys (N = 2,455), we examined length of use in home care among patients with Medicare-only payment source before and during the Medicare interim payment system (IPS). Logistic regression analyses revealed that patients were 2.9 times more likely to be discharged within 60 days during IPS than before IPS. The impact of Medicare IPS on length of use in home care among patients with Medicare only was stronger than what the existing literature indicates, which combines Medicare patients with multiple payment sources and patients with Medicare-only together.

Aged↗
PubMed2004

Payment source and length of use among home health agency discharges.

PURPOSE: Our study compared (1) length of use among home health care (HHC) discharges with Medicare, Medicaid, or private health insurance between 1991 and 2000 and (2) factors associated with length of HHC use among discharges with Medicare, Medicaid, or private health insurance. METHODS: Data were obtained from the 1992, 1994, 1996, 1998, and 2000 National Home and Hospice Care Surveys (n = 18,416). Logistic regressions and stratified analyses by primary payment source were applied. RESULTS: After adjusting for covariates, Medicare HHC patients were from 0.52 to 0.75 times less likely to be discharged within 30 days in 1991-1996 than in 1997-1998. Medicaid patients were 0.37 times less likely to be discharged within 30 days in 1991-1992 than in 1997-1998. Patients with private insurance were 2.05 times more likely to be discharged within 30 days in 1993-1994 than in 1997-1998. No significant difference in length of use was found at the multivariate level between 1997-1998 and 1999-2000 among HHC patients with Medicare, Medicaid, or private health insurance. Results for being discharged within 60 days were similar to these described above. CONCLUSIONS: Our study shows that length of HHC use among Medicare discharges decreased after the implementation of the Medicare interim payment system. We did not find a spillover effect of the Medicare interim payment system on length of HHC use among discharges with Medicaid or private health insurance. Our results can help health professionals and policy makers better understand the dynamic associations between payment systems and length of use of HHC services.

Age Distribution↗
PubMedDate not supplied

Pros and cons of using paid feeding assistants in nursing homes.

Recently the Centers for Medicare and Medicaid Services (CMS), citing increasing resident acuity, staffing shortages, and high turnover rates that make it difficult for nursing homes to provide adequate feeding assistance to residents who need minimal help at mealtimes, began allowing nursing facilities to use single-task workers to provide assistance during mealtimes. This article describes the use of single-task workers to provide feeding assistance to nutritionally at-risk residents during a 6-month clinical study designed to evaluate the effectiveness and feasibility of implementing a buffet-dining program in an academic long-term care facility.

Cross-Over Studies↗
PubMedDate not supplied

Demographic and health characteristics of residents choosing to use on-site medical care in a newly opened continuing care retirement community (CCRC).

OBJECTIVE: To determine demographic and health characteristics of older adults choosing to use on-site medical care in a continuing care retirement community (CCRC). DESIGN: A descriptive study of residents moving into a newly opened CCRC. Residents responded to a self-report mail survey composed of questions related to reasons for moving to a CCRC, health and functional status,health care use during the previous 5 years. RESULTS: Of 942 residents, 642 (68%) completed the survey. Medical center users and nonusers were similar demographically and reported similar reasons for moving to the CCRC including desire for a low maintenance apartment (49% vs. 48%; P = 0.806), concern about health or spouse's health (67% vs. 63%; P = 0.345), and desire for social activities (63% vs. 58%; P = 0.151). However, on-site medical center users versus nonusers reported increased rates of fair/poor health (31% vs. 18%; P = 0.0001), fair/poor vision (27% vs. 15%; P = 0.0003),difficulty walking in the home (13% vs. 8%; P = 0.53), using the toilet (6% vs. 2%; P = 0.044), shopping (29% vs. 20%; P = 0.007), using transportation (19% vs. 10%; P = 0.005), doing laundry (13% vs. 7%; P = 0.016), using the telephone (8% vs. 3%; P = 0.002), and taking medication (5% vs. 1%; P = 0.022). CONCLUSION: For both users and nonusers of the medical center, the most frequently cited reason for moving to the CCRC was concern about health. On-site medical center users had lower perceived health, were functionally more disabled, and had health characteristics that made them at higher risk for high health care utilization. The challenges to provide high quality medical care and enhance quality of life for CCRC residents will continue to increase. Physicians should play an active role not only in providing medical care to CCRC residents, but also in providing medical leadership for these institutions.

Journal Article↗
PubMedDate not supplied

National trends in adult hospice use: 1991-1992 to 1999-2000.

This study examines hospice use among adult hospice patients based on the 1992-2000 National Home and Hospice Care Surveys, the 1997-1999 National Nursing Home Surveys, and the 1991-2000 annual Underlying and Multiple Cause-of-Death Files. The total number of adult hospice patients tripled between 1991-1992 and 1999-2000. The majority of inpatient hospice patients resided in nursing homes. The increased hospice utilization rates and increased percentage of adult hospice patients with short stays in hospice indicate changes in hospice enrollment patterns over time. Hospice is still in the process of growing toward a steady state.

Adult↗