Home About us Contact
|
Home About us Contact | ||
|
|
||
Top Quartile (top + quartile)
Selected AbstractsMeeting the Need for Personal Care among the Elderly: Does Medicaid Home Care Spending Matter?HEALTH SERVICES RESEARCH, Issue 1p2 2008Peter Kemper Objective. To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data Sources. Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n=6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Study Design. Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Principal Findings. Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. Conclusion. These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help. [source] Elderly Patients' Preferences and Experiences with Providers in Managing Their Drug CostsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007Chien-Wen Tseng MD OBJECTIVES: To determine whether elderly patients with high drug expenditures want and receive providers' help in managing drug costs. DESIGN: Cross-sectional survey. SETTING: A Medicare managed care plan (>400,000 members) in one state in 2002. PARTICIPANTS: One thousand one hundred six seniors (62% response rate) sampled so that half exceeded caps on their drug benefits the previous year, and all had total drug expenditures in the top quartile of members in their cap level. MEASUREMENTS: Participants' preferences and experiences with providers discussing costs and participation in choosing medications. RESULTS: Two-thirds reported difficulty paying for medications, and one-fourth decreased medication use because of cost. Most wanted providers to ask about medication affordability (81%), consider cost (86%), offer choices (70%), and to persuade them or decide for them which medication to use (88%), but few said providers asked about affordability (17%), usually or always discussed prices (19%), or offered choices (45%), although nearly all said providers chose their medications (93%). Sixty-two percent had asked providers for help with drug costs, although 34% who used less medication because of cost or had difficulty paying for medications had not asked for help. CONCLUSION: Providers should be aware that elderly patients want their help in managing drug costs but do not always receive it or ask for help when they need it. Providers could improve communication by initiating conversations about cost and by asking patients about preferences when prescribing. [source] Sex Differences in the Effect of Heart Rate on Mortality in the ElderlyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2003Gila Perk MD Objectives:, To examine the association between heart rate and mortality risk in the elderly. Design:, Longitudinal cohort. Setting:, Outpatient. Participants: Four hundred twenty-two people, aged 70 upon entry, were surveyed and followed for 6 years. Measurements: Pulse rate was measured manually, while sitting and standing, and heart rate was measured from electrocardiogram recordings. The population was divided into quartiles of heart rate, with the top quartile comprising those with heart rate greater than 77 beats per minute (bpm) and the bottom quartile those with heart rate less than 60 bpm. Results: After controlling for possible confounders, there was a clear correlation (r) between heart rate and all-cause mortality in elderly women (r=0.25, P=.0003). The correlation in women was observed using the three different methods for measuring heart rate. Heart rate was associated with all-cause and cardiovascular mortality. There was no relationship between heart rate and level of exercise or smoking status. In multiple regression analysis, the increased risk of death in the women was independent of previous cardiovascular or cerebrovascular disease, hypertension, anemia, congestive heart failure, smoking, and level of exercise or activities of daily living (relative odds ratio (ROR)=3.37, 95% confidence interval (CI)=0.96,11.8). When women using beta-blockers were excluded, this relationship became even stronger (ROR=8.5, 95% CI=1.19,60.1). Conclusion: Elevated heart rate is related to increased mortality in elderly women, thus representing a simple index of general health status in this population. Elevated heart rate did not predict mortality in elderly men. [source] Moderate,vigorous physical activity and body fatness in Chinese urban school childrenPEDIATRICS INTERNATIONAL, Issue 2 2007LIUBAI LI Abstract Background: The exact relation between moderate,vigorous physical activity (MVPA) and body fatness in children has yet to be fully defined. This study examined the relationship between MVPA and body fatness in Chinese urban school children aged 9,11 years, in an 8 month longitudinal study. Methods: Two hundred and ten children (aged 9,11 years; 97 boys and 113 girls) were recruited from two public primary schools in the Beijing urban area. The baseline and the 8 month follow-up percent body fat (fat%), fat mass (FM), body mass index (BMI), waist size, hip size and the waist : hip ratio were investigated as measures of body fatness. Habitual MVPA level (activity-related energy expenditure, AEE) was measured using a validated self-report questionnaire recall. Results: Nine-year-old girls who were in the top quartile for MVPA had significantly lower fat% than other girls at the same age (P < 0.05); 10,11-years girls who were in the top quartile for MVPA had significantly less increase in all of the indices of body fatness (P < 0.05). There was no difference in fat% between the highly physically active (top quartile for MVPA) and less active 9,11 year boys in both cross-sectional and longitudinal statistical analyses. Conclusions: Highly physically active girls had lower fat% and less increase in body fatness. In light of world trends showing increasing childhood obesity, this study supports the hypothesis that MVPA might be effective in fighting excess body fat gain in Chinese school-age girls. [source] The Relationship Between the Emergent Primary Percutaneous Coronary Intervention Quality Measure and Inpatient Myocardial Infarction MortalityACADEMIC EMERGENCY MEDICINE, Issue 8 2010Rahul K. Khare MD ACADEMIC EMERGENCY MEDICINE 2010; 17:793,800 © 2010 by the Society for Academic Emergency Medicine Abstract Background:, In the setting of acute ST-segment elevation myocardial infarction (STEMI), reperfusion therapy with emergent primary percutaneous coronary intervention (PCI) significantly reduces mortality. It is unknown whether a hospital's performance on the Centers for Medicare & Medicaid Services (CMS) quality metric for time from patient arrival to angioplasty is associated with its overall hospital acute myocardial infarction (AMI) mortality rate. Objectives:, The objective of this study was to evaluate if hospitals with higher performance on the time-to-PCI quality measure are more likely to achieve lower mortality for patients admitted for any type of AMI. Methods:, Using merged 2006 data from the Nationwide Inpatient Sample (NIS), the American Hospital Association (AHA) annual survey, and CMS Hospital Compare quality indicator data, we examined 69,101 admissions with an International Classification of Diseases, Ninth Revision (ICD-9)-coded principal diagnosis of AMI in the 116 hospitals that reported more than 24 emergent primary PCI admissions in that year. Hospitals were categorized into quartiles according to percentage of admissions in 2006 that achieved the primary PCI timeliness threshold (time-to-PCI quality measure). Using a random effects logistic regression model of inpatient mortality, we examined the significance of the hospital time-to-PCI quality measure after adjustment for other hospital and individual patient sociodemographic and clinical characteristics. Results:, The unadjusted inpatient AMI mortality rate at the 27 top quartile hospitals was 4.3%, compared to 5.1% at the 32 bottom quartile (worst performing) hospitals. The risk-adjusted odds ratio (OR) of inpatient death was 0.83 (95% confidence interval [CI] = 0.72 to 0.95), or 17% lower odds of inpatient death, among patients admitted to hospitals in the top quartile for the time-to-PCI quality measure compared to the case if the hospitals were in the bottom 25th percentile. Conclusions:, Hospitals with the highest and second highest quartiles of time-to-PCI quality measure had a significantly lower overall AMI mortality rate than the lowest quartile hospitals. Despite the fact that a minority of all patients with AMI get an emergent primary PCI, hospitals that perform this more efficiently also had a significantly lower mortality rate for all their patients admitted with AMI. The time-to-PCI quality measure in 2006 was a potentially important proxy measure for overall AMI quality of care. [source] New postnatal urinary incontinence: obstetric and other risk factors in primiparaeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2006CMA Glazener Objective, To identify obstetric and other risk factors for urinary incontinence that occurs during pregnancy or after childbirth. Design, Questionnaire survey of women. Setting, Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). Population, A total of 3405 primiparous women with singleton births delivered during 1 year. Methods, Questionnaire responses and obstetric case note data were analysed using multivariate analysis to identify associations with urinary incontinence. Main outcome measures, Urinary incontinence at 3 months after delivery first starting in pregnancy or after birth. Results, The prevalence of urinary incontinence was 29%. New incontinence first beginning after delivery was associated with older maternal age (oldest versus youngest group, OR 2.02, 95% CI 1.35,3.02) and method of delivery (caesarean section versus spontaneous vaginal delivery, OR 0.28, 95% CI 0.19,0.41). There were no significant associations with forceps delivery (OR 1.18, 95% CI 0.92,1.51) or vacuum delivery (OR 1.16, 95% CI 0.83,1.63). Incontinence first occurring during pregnancy and still present at 3 months was associated with higher maternal body mass index (BMI > 25, OR 1.68, 95% CI 1.16,2.43) and heavier babies (birthweight in top quartile, OR 1.56, 95% CI 1.12,2.19). In these women, caesarean section was associated with less incontinence (OR 0.39, 95% CI 0.27,0.58) but incontinence was not associated with age. Conclusions, Women have less urinary incontinence after a first delivery by caesarean section whether or not that first starts during pregnancy. Older maternal age was associated with new postnatal incontinence, and higher BMI and heavier babies with incontinence first starting during pregnancy. The effect of further deliveries may modify these findings. [source] | ||||||||||