Biomedical subjects

T E Fogarty

Publications and source records attributed to T E Fogarty.

8 recordsLinked to original sources

PubMed1998

Predictors of California nursing facilities' acceptance of people with HIV/AIDS.

OBJECTIVE: To examine factors that might predict the provision of HIV/AIDS care among California nursing facilities (NFs) in 1990. STUDY DESIGN: Logistic regression to examine the probability that a NF had admitted a person with AIDS/HIV (PWA/H). Independent variables of key interest included whether the facility was hospital-based; whether it sustained a financial loss in FY 1990; whether it had a hospice; the percentage of its residents on Medicare; the percentage of its residents on MediCal; the number of PWA/Hs per elderly in the county where the facility was located; the ratio of home-based hospices to elderly in the county; and the ratio of NF beds to elderly in the county. DATA COLLECTION METHODS: Data on all California NFs, obtained from the Office of Statewide Health Planning and Development (OSHPD), were merged with state data on the cumulative incidence of AIDS cases by county; U.S. census data on the number of elderly by county; and home-based hospice data from the 1990 Case Management Resource Guide for California. PRINCIPAL FINDINGS: Of the 902 facilities examined, 7.65 percent served AIDS residents. The financial loss variable was not significant. The community-based hospice variable was significant and negative. All other key variables were significant and positive. CONCLUSIONS: This study (1) suggests that NFs respond to external pressures to provide AIDS care even in the absence of financial incentives or a positive financial margin; (2) supports concerns that competition may exist between the elderly and PWA/H for NF beds; (3) shows that NFs are less likely to provide care if substitute services are available; and (4) demonstrates that facilities capable of providing a higher level of clinical and psychosocial care may be particularly willing, perhaps able, to provide AIDS care.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Defining the challenges of providing long-term care: the case of the nursing home industry's response to the AIDS epidemic.

Acquired Immune Deficiency Syndrome (AIDS) is now viewed as a chronic disease requiring long-term management. As a result, more persons with AIDS (PWAs) are seeking long-term care in facilities that have primarily served the elderly. In some regions, however, the nursing home market into which PWAs may introduce new demand is a market already characterized by excess demand. In light of this, competition for limited long-term care resources may develop between the frail elderly and PWAs. The nursing home industry has raised many issues regarding the feasibility of admitting AIDS patients as residents, but little is known about how important these issues are in deciding admissions policy. How the industry perceives and resolves the concerns it has regarding delivery of care to PWAs can affect the overall long-term care system and thus affect the traditional users-the frail elderly. Knowing the concerns and preferences of the industry may help guide and anticipate future changes in the system. In this pilot study, a random sample of 250 nursing home administrators in the five highest AIDS-incidence areas in the United States was surveyed to determine (1) the industry's concerns and issues regarding AIDS care, (2) data regarding requests for admission by PWAs to nursing homes, and (3) data concerning the industry's preferred way of delivering AIDS care. Important admissions policy issues cited by the respondents included the ability to meet special care needs, costs of care, and inadequate reimbursement. The majority also believed the most appropriate methods of providing care were special care units for AIDS within nursing homes or dedicated HIV/AIDS nursing facilities.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Providing long-term care for persons with AIDS. Results from a survey of nursing homes in the United States.

In this pilot study, a random sample of 50 nursing homes located in each of the five U.S. cities with the highest AIDS incidence were surveyed (total N = 250) to determine: (1) the frequency of admission inquiries by, and actual admissions of PWAs, (2) the frequency of adoption of formal AIDS admission policies, (3) the industry's concerns regarding provision of care in traditional nursing homes, and (4) the industry's preferred way of delivering long-term care (LTC) to PWAs. The majority of the facilities cited ability to meet special care needs, the costs of this care, and inadequate reimbursement as important admission policy issues. The majority indicated a preference for either special care units for AIDS or AIDS-specific skilled nursing facilities as the most appropriate setting for the provision of LTC to persons living with AIDS. While almost half (48.2 percent) of the facilities had been approached, at least informally, about admitting a PWA, only 15.4 percent of the nursing homes had admitted a resident with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Cost analysis for guideline implementation in prevention and early treatment of pressure ulcers.

One of the goals of the Agency for Health Care Policy and Research (AHCPR) is to improve the quality of medical care by developing and disseminating clinical practice guidelines. One indication of the effectiveness of a clinical guideline is the relationship between the costs of current practice and the costs of using the guideline. Using four model cases of patients at high risk for pressure ulcers, the costs of implementing the appropriate prevention and treatment procedures for each model were identified and compared to current practice costs. On the average, the overall cost of implementing the guideline is not much different from that of current practice.

Cost-Benefit Analysis↗

PubMed1991

Assessment and quality control of incontinence care in long-term nursing facilities.

A statistical quality-control process was used to assess how well incontinence management procedures were being implemented by indigenous nursing staff in four nursing homes. Eighty-one incontinent patients were treated with the prompted-voiding toileting procedure. Thirty-six of these patients proved responsive to the toileting procedures, and nursing home staff was instructed to maintain the toileting program for these responsive patients. The first part of the quality-control model involved setting job standards specifying how dry the patients should be if toileted on a 2-hour schedule. Second, a job-monitoring control chart was used to continuously assess how well the job standards were being met. The remaining forty-five patients, who were unresponsive to the toileting protocol, were managed with a 2-hour changing schedule. Job standards specifying how wet (volume) the patient would be if changed on a two-hour basis were set. Control-chart monitoring of these patients urine output assessed how well the changing procedures were being implemented. Incontinence care in nursing homes is difficult to supervise because of problems in measuring how consistently nursing aides change or toilet patients. This paper describes a management system for effective incontinence care.

Aged↗

PubMed1989

Statistical quality control in nursing homes: a key indicator to evaluate patient incontinence care.

The authors provide descriptive data regarding incontinence care within the framework of statistical quality control technology. Descriptive data of patient wetness frequencies were collected for 126 incontinent patients from six nursing homes in Middle Tennessee under conditions guaranteeing that they were checked and changed on a two-hour basis. One hundred inspection subsamples were randomly selected for five incontinent-patient sample sizes: 10, 15, 20, 25, and 30 patients. The average and expected variability of patient wetness frequency was calculated for each of these subsamples. These measures help nursing homes determine if they are in compliance with state and federal regulations regarding the timeliness of incontinence care. The authors suggest how nursing home management and regulatory agencies can use statistical quality control techniques.

Aged↗

PubMedDate not supplied

Nursing resource requirement and support services.

How can medical-surgical and critical care units reduce their nursing care hours per patient day (HPPD)? When nurse executives understand the impact of professional, nonprofessional, and technological support services on HPPD they can work toward further cost reduction without adversely affecting the quality of patient care.

Health Resources↗

PubMedDate not supplied

The relationship between length of stay and required nursing care hours.

The average length of stay (LOS) of patients in hospitals has declined rapidly since the introduction of the prospective payment system. It has been argued by nurses that reduced LOS is associated with increased nursing resource consumption, but there has been little empirical evidence to support the argument. The authors offer evidence of a relationship between LOS and hours per patient day in eleven clinical specialty areas. These findings have major implications for budgeting and the delivery of nursing care services.

Hospital Units↗