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Biomedical subjects

S A Levenson

Publications and source records attributed to S A Levenson.

9 recordsLinked to original sources
PubMed1998

Subacute settings: making the most of a new model of care.

Subacute programs care for individuals in various stages of acute illness and injury, usually after but sometimes instead of hospitalization for an acute episode. Typical reasons why older patients are hospitalized prior to subacute care include life-threatening conditions. Moreover, older patients tend to have one or more comorbidities related or unrelated to their primary acute condition. Therefore, an essential task for the physician is to assess each patient's medical stability within 24 to 48 hours of admission to subacute care. In subacute settings, interdisciplinary providers deliver a coordinated package of care. Physicians coordinate the medical treatments with the observations and input of nurses and providers in other disciplines who are managing patients' functional and psychosocial problems.

Activities of Daily Living↗
PubMed1997

Assessing medical care of dying residents in nursing homes.

Although approximately one of five people in the United States die in nursing homes (NHs), little has been written about their quality of dying, including the quality of terminal medical care. The purpose of this study is to review actual medical practices in NHs to suggest factors important for delivering good quality terminal care. Four NHs were surveyed for management of residents who died in 1992. A convenience sample of charts of newly admitted and longer term residents were abstracted for demographic variables, death, diagnostic categories, and various laboratory and other parameters. Charts of those residents who died were further reviewed using indicators of quality medical care, such as presence of advance directives, control of pain, and control of dyspnea, based upon recent published clinical practice guidelines for terminal care in NHs. Three hundred and seventy-one charts were abstracted. Forty-one charts documented the resident's death. We found that NHs without regulatory difficulties usually had expected deaths that were managed approximately as measured by terminal medical care quality indicators. NHs with a history of regulatory difficulties had a higher prevalence of residents who died suddenly and unexpectedly, often with problems in the quality of care as measured by the same indicators. There was a correspondence between physician certification, antemortem diagnosis of terminal illness, and appropriate terminal care. We conclude that physicians are able to recognize impending death and redirect the medical care of dying NH residents toward goals of terminal care management. This is more likely to occur in a NH environment that places greater emphasis upon total quality management. We suggest that another indicator in providing good NH terminal care is the physician's performance in predicting a short life expectancy.

Aged↗
PubMed1995

Policy and procedure development and implementation.

A basic medical director function is to help draft and implement policies and procedures. Physicians should not underestimate the knowledge and skills involved in doing it well. Instead of viewing this role as merely unpleasant paper work, they should look beneath the surface for the much broader implications. Effective medical directors must be astute problem solvers and and analysts of attitudes, systems, and processes. The vital role of effective processes in helping apply knowledge effectively and improve outcomes deserves much greater recognition and study.

Aged↗
PubMed1994

Indicators of quality medical care for the terminally ill in nursing homes.

PURPOSE: To identify medical care indicators for nursing home terminal care. DATA SOURCES: Studies examining care of terminally ill patients were identified using computer, bibliography, and expert searches; input from nursing home medical directors in Maryland; and input from expert geriatricians. STUDY SELECTION: More than 900 articles, books, and abstracts from meetings covering medical care for terminally ill patients were reviewed. Information from more than 100 publications is included. DATA EXTRACTION: Indicators of medical care for terminally ill patients, which can be used to quantify performance with respect to standards, guidelines, and options, were identified initially through review of the literature. DATA SYNTHESIS: Indicators were refined by input from medical directors of Maryland long-term care facilities and subsequent review by expert geriatricians. CONCLUSIONS: Minimum standards for which 100% performance is expected are communication of advance directives, attention to pain control, and attention to relief of dyspnea. Performance indicators for medical care guidelines and options in terminal care of nursing home patients are also described.

Home Care Services↗
PubMed1993

Nursing home medical directors: ideals and realities.

OBJECTIVE: To evaluate what nursing home medical directors actually do, what they and other nursing home personnel believe would be desirable to do, and what problems and deficiencies are perceived. DESIGN: Mail survey with follow-up telephone interview when necessary. SETTING: Forty-five nursing facilities in upstate New York. PARTICIPANTS: The medical directors, administrators, and directors of nursing of the 45 facilities. MEASUREMENTS: Inventory of what medical directors reported as to their actual activities and time spent, and of what they, the administrators, and the directors of nursing felt should be their responsibilities and activities under ideal circumstances. RESULTS: For part-time medical directors, self-reported time spent on medical directorship activities averaged 12 hours per month; of all directors, 45% spent 8 hours or less per month. Proportion of time spent on various specific activities varied widely. There was general agreement that substantially more time should be spent, in particular, on evaluating and addressing problems of adequacy and quality of care, communicating with attending physicians about problems, and assisting with inservice training programs. CONCLUSIONS: To fill the role adequately, more time should be spent by many part-time medical directors, which will require greater financial commitment by facilities and reimbursement systems. Efforts need to made to better coordinate the expectations of medical directors and facility staff.

California↗
PubMed1981

Ethical considerations in critical and terminal illness in the elderly.

In a Baltimore geriatric center and hospital, a program was developed to individualize the treatment of critically and terminally ill patients. Part of this program was an effort to involve the patients themselves in the discussion of their personal wishes, and the provision of a set of guidelines for staff members to help them individualize the care of the patients. Some of the practical problems involved the the application of these ethical ideals are discussed. Merely implementing the protocol helped staff members to become more aware of these complex questions. Physicians should deal forthrightly with "right-to-die" and associated issues. The decision-making should remain in medical hands, and out of the courts and legislatures.

Aged↗