A5070140317- Geriatric Care and Nursing Homes
- Frailty in Older Adults
- Dementia and Cognitive Impairment Research
- Healthcare Policy and Management
- Health disparities and outcomes
- Primary Care and Health Outcomes
- Palliative Care and End-of-Life Issues
- Health Systems, Economic Evaluations, Quality of Life
- Patient Satisfaction in Healthcare
- Emergency and Acute Care Studies
- Chronic Disease Management Strategies
- Global Health Care Issues
- Migration, Aging, and Tourism Studies
- Healthcare Systems and Public Health
- Pressure Ulcer Prevention and Management
- Health and Wellbeing Research
- Intergenerational Family Dynamics and Caregiving
- Balance, Gait, and Falls Prevention
- Nutrition and Health in Aging
- Intensive Care Unit Cognitive Disorders
- Cerebral Palsy and Movement Disorders
- Pharmaceutical Practices and Patient Outcomes
- Cardiac, Anesthesia and Surgical Outcomes
- COVID-19 and healthcare impacts
- Global Health Workforce Issues
University of California, Los Angeles
2016-2025
RAND Corporation
2016-2025
VA Greater Los Angeles Healthcare System
2015-2025
Los Angeles Medical Center
2022-2024
West Los Angeles College
2019-2024
Geriatric Research Education and Clinical Center
2015-2024
United States Department of Veterans Affairs
2015-2024
Veterans Health Administration
2019-2024
Health Services Research & Development
2004-2024
VA West Los Angeles Medical Center
2003-2024
OBJECTIVES: To develop a simple method for identifying community‐dwelling vulnerable older people, defined as persons age 65 and at increased risk of death or functional decline. assess whether self‐reported diagnoses conditions add predictive ability to function‐based survey. DESIGN: Analysis longitudinal survey data. SETTING: A nationally representative community‐based PARTICIPANTS: Six thousand two hundred five Medicare beneficiaries older. MEASUREMENTS: Bivariate multivariate analyses...
OBJECTIVES: To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents. DESIGN: Medical records were reviewed as a component project designed to develop pilot test clinical practice tools reducing hospitalization. SETTING: NHs in Georgia. PARTICIPANTS: In 10 with high low hospitalization rates, randomly selected, including long‐ short‐stay MEASUREMENTS: Ratings using structured review by expert NH clinicians. RESULTS: Of 200...
Many people 65 years of age and older are at risk for functional decline death. However, the resource-intensive medical care provided to this group has received little evaluation. Previous studies have focused on general conditions aimed prolonging life, not geriatric issues important quality life. To measure vulnerable elders by evaluating process using Assessing Care Vulnerable Elders indicators (QIs). Observational cohort study. Managed organizations in northeastern southwestern United...
Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately with respect serious consequences ranging from severe illness and hospitalization increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals health supplies address these issues have focused attention on how resources are ultimately allocated used. Some strategies, for example, misguidedly use age as an arbitrary criterion that disfavors in resource allocation...
OBJECTIVES: To develop and test a standardized instrument, the purpose of which is to assess (1) whether skilled nursing facilities (SNFs) transfer residents emergency departments (ED) inappropriately, (2) are admitted hospitals (3) factors associated with inappropriate transfers. DESIGN: A structured implicit review (SIR) medical records. SETTING AND PARTICIPANTS: Using nested random sampling in eight community SNFs, we identified SNF hospital records 100 unscheduled transfers one 10...
Background. Recent work has highlighted a negative correlation between proprietary status and nursing home quality of care. This relationship might be explained by the context in which homes operate. However, another possible explanation is that some take excessive profit to detriment care quality. Objective. To examine levels nonproprietary (NHs), accounting for resident market characteristics. Methods. Data on 1098 free-standing NHs were taken from California Office Statewide Health...
Although assessment of the quality medical care often relies on measures process care, linkage between performance these during usual clinical and subsequent patient outcomes is unclear.To examine link that patients received their survival.Observational cohort study.Two managed organizations.Community-dwelling high-risk 65 years age or older who were continuously enrolled in organizations from 1 July 1998 to 31 1999.Quality by (as measured a set indicators covering 22 conditions) survival...
To test the predictive properties of Vulnerable Elders-13 Survey (VES-13) a short tool that predicts functional decline and mortality over 1- to 2-year follow-up interval 5-year interval.Longitudinal evaluation with mean 4.5 years.Two managed-care organizations.Six hundred forty-nine community-dwelling older adults (> or = 75) enrolled in Assessing Care Elders observational study who screened positive for symptoms falls fear falling, bothersome urinary incontinence, memory problems.VES-13...
OBJECTIVES: To test the accuracy of a brief cognitive assessment nursing home (NH) residents and to determine whether facility nurses can reliably perform this assessment. DESIGN: Cross‐sectional, independent screening tests with NH residents. SETTING: Six Department Veteran Affairs facilities. PARTICIPANTS: Three hundred seventy‐four from six regionally distributed NHs. MEASUREMENTS: instruments: Brief Interview Mental Status (BIMS), created for study; Minimum Data Set (MDS) 2.0 Cognitive...
Objectives To examine the independent association between five stages of activities daily living ( ADL s) and mortality after accounting for known diagnostic sociodemographic risk factors. Design For s (0 to IV ), determined according severity pattern limitations, unadjusted life expectancies adjusted associations with were estimated using a Cox proportional hazards regression model. Setting Community. Participants Nine thousand four hundred forty‐seven participants aged 70 older from second...
Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately, from severe illness and hospitalization increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals health supplies address these needs have focused attention on how resources are ultimately allocated used. Some strategies misguidedly use age as an arbitrary criterion, inappropriately disfavoring adults. This statement represents the official policy position...
Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care. Home-based medical care can improve outcomes reduce health costs, but this operates a quality measurement desert, having been largely left out national conversation on quality. To address shortcoming, two authors created National Home-Based Primary Palliative Care Network, an organization whose members include exemplary home-based practices, professional societies,...
Importance Recent work suggests that instability in nursing home staffing levels may be an important marker of quality. Whether association holds when controlling for average is unknown. Objective To examine whether instability, defined as the percentage days below levels, associated with quality levels. Design, Setting, and Participants This improvement study 14 717 homes used merged Centers Medicare & Medicaid Services Payroll Based Journal, Minimum Data Set, Nursing Home Care...
OBJECTIVES: To examine whether the Vulnerable Elders Survey (VES‐13) score predicts risk of death and functional decline in vulnerable older adults. DESIGN: Longitudinal evaluation with mean follow‐up 11 months (range 8–14 months). SETTING: Two managed care organizations United States. PARTICIPANTS: Four hundred twenty community‐dwelling people identified as having moderate to high based on a VES‐13 3 or higher. These were enrolled Assessing Care observational study. MEASUREMENTS: Baseline:...
Objective. To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and effects on pressure ulcer care. Data Sources/Study Settings. Primary data were collected from staff at 35 homes maintained by the Department of Veterans Affairs (VA) measures related to QI culture. These combined information obtained abstractions medical records analyses an existing database. Study Design. A cross‐sectional analysis among different was performed....
To assess the relative impact of clinical factors versus nonclinical factors-such as postacute care (PAC) supply-in determining whether patients receive from skilled nursing facilities (SNFs) or inpatient rehabilitation (IRFs) after discharge acute care.Medicare hospital, IRF, and SNF claims provided data on PAC choices; predictors site chosen were generated Medicare claims, provider services, enrollment file, Area Resource File data.We used multinomial logit models to predict use by elderly...
Objective. To assess the relative impact of clinical factors versus nonclinical factors—such as postacute care (PAC) supply—in determining whether patients receive from skilled nursing facilities (SNFs) or inpatient rehabilitation (IRFs) after discharge acute care. Data Sources and Study Setting. Medicare hospital, IRF, SNF claims provided data on PAC choices; predictors site chosen were generated claims, provider services, enrollment file, Area Resource File data. Design. We used...
The Medicare Consumer Assessments of Healthcare Providers and Systems (MCAHPS) survey, a primarily English-language mail survey with English Spanish telephone follow-up, is the primary means assessing health care experiences American seniors. We examine unit (whole survey) item nonresponse for this to explore issues regarding surveying seniors about their care.We describe overall rates analyze predictors 695,197 beneficiaries selected 2007 MCAHPS (335,249 respondents, 49% response...
Purpose Most malignancies are diagnosed in older adults who potentially susceptible to aging-related health conditions; however, the manifestation of geriatric syndromes during surgical cancer treatment is not well quantified. Accordingly, we sought assess prevalence and ramifications events major surgery for cancer. Patients Methods Using Nationwide Inpatient Sample data from 2009 2011, examined hospital admissions among elderly patients (ie, age ≥ 65 years) a referent group 55 64 years....