Background: Acutely ill older persons often experience adverse events when cared for in the acute care hospital. Objective: To assess clinical feasibility and efficacy of providing hospital-level a patient's home hospital at home. Design: Prospective quasi-experiment. Setting: 3 Medicare-managed (Medicare + Choice) health systems 2 sites Veterans Administration medical center. Participants: 455 community-dwelling elderly patients who required admission to an community-acquired pneumonia,...

Increasing numbers of older, community-dwelling adults have functional impairments that prevent them from leaving their homes. It is uncertain how many people who live in the United States are homebound.To develop measures frequency and ability to leave home use these estimate size homebound population US population.Cross-sectional data National Health Aging Trends Study collected 2011 contiguous States. Participants were a nationally representative sample 7603 noninstitutionalized Medicare...

Treatment of chronic diseases such as obstructive pulmonary disease (COPD) is complicated by the presence comorbidities. The objective this analysis was to estimate prevalence comorbidity in COPD using nationally-representative data. This study draws from a multi-year analytic sample 14,828 subjects aged 45+, including 995 with COPD, National Health and Nutrition Examination Survey (NHANES), 1999–2008. defined self-reported physician diagnosis bronchitis or emphysema; patients who reported...

The Future of Home Health project sought to support transformation home health and home-based care meet the needs patients in evolving U.S. system. Interviews with key thought leaders stakeholders resulted themes about future care. By synthesizing this qualitative research, a literature review, case studies, from 2014 Institute Medicine National Research Council workshop on “The Care,” authors articulate vision for recommend bold framework Medicare-certified agency future. also identify...

Hospitals are the standard acute care venues in United States, but hospital is expensive and can pose health threats for older people. Albuquerque, New Mexico–based Presbyterian Healthcare Services adapted Hospital at Home® model developed by Johns Hopkins University Schools of Medicine Public Health to provide hospital–level within patients’ homes. Patients show comparable or better clinical outcomes compared with similar inpatients, they higher satisfaction levels. Available Medicare...

The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program, funded by the Center Medicare and Medicaid Innovation, aims to reduce impact of disability among low-income older adults addressing individual capacities home environment. described this innovation profile, uses an interprofessional team (an occupational therapist, a registered nurse, handyman) help participants achieve goals they set. For example, it provides assistive devices makes repairs modifications...

Hospital-at-home (HaH) care provides acute hospital-level in a patient's home as substitute for traditional inpatient care. In September 2017, the Physician-Focused Payment Model Technical Advisory Committee recommended implementation of an alternative payment model new HaH that bundles episode with 30 days postacute transitional care.To report outcomes this care.Case-control study patients concurrent control group hospital inpatients recruited from emergency departments (EDs) and residences...

Abstract The annual cost of hospital care services in the US has risen to over $1 trillion despite relatively worse health outcomes compared similar nations. These trends accentuate a growing need for innovative delivery models that reduce costs and improve outcomes. HaH—a program provides patients acute-level at home—has made significant progress past two decades. Technological advancements remote patient monitoring, wearable sensors, information technology infrastructure, multimodal data...

<h3>Background</h3> The effect of interdisciplinary primary care teams on the use health services by patients with multiple chronic conditions is uncertain. This study aimed to measure guided multimorbid older patients' services. <h3>Methods</h3> Eligible from 3 systems in Baltimore, Maryland–Washington, DC, area were cluster-randomized receive or usual for 20 months between November 1, 2006, and June 30, 2008. Eight a nurse working partnership physicians provided: comprehensive assessment,...

Purpose: The purpose of this study was to test the feasibility a new model health care designed improve quality life and efficiency resource use for older adults with multimorbidity. Design Methods: Guided Care enhances primary by infusing operative principles seven chronic innovations: disease management, self-management, case lifestyle modification, transitional care, caregiver education support, geriatric evaluation management. To practice Care, registered nurse completes an educational...

To determine effect size and acceptability of a multicomponent behavior home repair intervention for low-income disabled older adults.Prospective randomized controlled pilot trial.Participants' homes.Forty adults with difficulties in one or more activities daily living (ADLs) two instrumental (IADLs).The Community Aging Place, Advancing Better Living Elders (CAPABLE), coordinated occupational therapy, nursing, handyman visits, was compared attention-control visits. The consisted up to six...

Background: The number of people living with multiple chronic conditions is increasing, but we know little about the impact multimorbidity on life expectancy. Objective: We analyze expectancy in Medicare beneficiaries by conditions. Research Design: A retrospective cohort study using single-decrement period tables. Subjects: fee-for-service (N=1,372,272) aged 67 and older as January 1, 2008. Measures: Our primary outcome measure categorize subjects sex, race, selected (heart disease, cancer,...

Background. The quality of health care for older Americans with multiple chronic conditions is suboptimal. We designed “Guided Care” (GC) to enhance by integrating a registered nurse, intensively trained in care, into primary practices work physicians providing comprehensive 50–60 multimorbid patients.

OBJECTIVES: To evaluate hospital readmission rates and mortality at 6‐month follow‐up in selected elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). DESIGN: Prospective randomized, controlled, single‐blind trial follow‐up. SETTING: San Giovanni Battista Hospital Torino. PARTICIPANTS: One hundred four admitted to the for COPD were randomly assigned a general medical ward (GMW, n=52) or geriatric home hospitalization service (GHHS, n=52). MEASUREMENTS:...

Background: Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden. Objectives: To describe and validate a measure of healthcare task difficulty (HCTD) sample older adults multimorbidity. Research Design: Cross-sectional longitudinal secondary data analysis. Subjects: Multimorbid aged 65 years or from primary care clinics. Measures: We generated scale (0–16) self-reported 8 HCTD conducted factor analysis assess its...

As the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents rationale design for a randomized clinical trial novel interdisciplinary program reduce disability among low income older adults based on previous pilot same showing strong effect. The CAPABLE (Community Aging in Place, Advancing Better Living Elders) controlled which with self-care are assigned one two groups: an team nurse, occupational...

Objectives To examine the value of unstructured electronic health record (EHR) data (free‐text notes) in identifying a set geriatric syndromes. Design Retrospective analysis EHR notes using natural language processing (NLP) algorithm. Setting Large multispecialty group. Participants Older adults (N=18,341; average age 75.9, 58.9% female). Measurements We compared number syndrome cases identified structured claims and data. also calculated these rates population‐level database as reference...

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,...

Disability among older adults is a strong predictor of health outcomes, service use, and care costs. Few interventions have reduced disability adults.To determine whether 10-session, home-based, multidisciplinary program reduces disability.In this randomized clinical trial 300 low-income community-dwelling with in Baltimore, Maryland, between March 18, 2012, April 29, 2016, 65 years or older, cognitively intact, self-reported difficulty 1 more activities daily living (ADLs) 2 instrumental...