TY - JOUR T1 - Gender Differences in Institutional Long-Term Care Transitions. JF - Womens Health Issues Y1 - 2015 A1 - Mudrazija, Stipica A1 - Thomeer, Mieke Beth A1 - Jacqueline L. Angel KW - Aged KW - Aged, 80 and over KW - Continuity of Patient Care KW - Family Characteristics KW - Female KW - Geriatric Assessment KW - Home Care Services KW - Humans KW - Length of Stay KW - Logistic Models KW - Long-term Care KW - Male KW - Marital Status KW - Middle Aged KW - Nursing homes KW - Patient Discharge KW - Residence Characteristics KW - Sex Characteristics KW - United States AB -

INTRODUCTION: This study investigates the relationship between gender, the likelihood of discharge from institutional long-term care (LTC) facilities, and post-discharge living arrangements, highlighting sociodemographic, health, socioeconomic, and family characteristics.

METHODS: We use the Health and Retirement Study to examine individuals age 65 and older admitted to LTC facilities between 2000 and 2010 (n = 3,351). We examine discharge patterns using survival analyses that account for the competing risk of death and estimate the probabilities of post-discharge living arrangements using multinomial logistic regression models.

RESULTS: Women are more likely than men to be discharged from LTC facilities during the first year of stay. Women are more likely to live alone or with kin after discharge, whereas men are more likely to live with a spouse or transfer to another institution. Gender differences in the availability and use of family support may partly account for the gender disparity of LTC discharge and post-discharge living arrangements.

CONCLUSION: Our findings suggest that women and men follow distinct pathways after LTC discharge. As local and federal efforts begin to place more emphasis on the transition from LTC facilities to prior communities (e.g., transitional care initiatives under the Patient Protection and Affordable Care Act), policymakers should take these gender differences into account in the design of community transition programs.

PB - 25 VL - 25 UR - http://www.sciencedirect.com/science/article/pii/S1049386715000638 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26123639?dopt=Abstract U2 - PMC4569522 U4 - Long Term Care/discharge likelihood/discharge planning/sociodemographic differences/sociodemographic differences/LTC discharge ER - TY - JOUR T1 - Continuity of care with a primary care physician and mortality in older adults. JF - J Gerontol A Biol Sci Med Sci Y1 - 2010 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Li Liu A1 - John F Geweke A1 - Elizabeth A Cook A1 - Maksym Obrizan A1 - Elizabeth A Chrischilles A1 - Kara B Wright A1 - Michael P Jones A1 - Gary E Rosenthal A1 - Robert L. Ohsfeldt A1 - Robert B Wallace KW - Aged KW - Continuity of Patient Care KW - Female KW - Health Services for the Aged KW - Humans KW - Male KW - Mortality KW - Physicians, Family AB -

BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.

RESULTS: Two thousand nine hundred and fifty-four (54%) participants died during the follow-up period. Using the cumulative exposure measure, 27% never had continuity of care, whereas 31%, 20%, 14%, and 8%, respectively, had continuity for 1%-33%, 34%-67%, 68%-99%, and 100% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1%-33%, 34%-67%, 68%-99%, and 100% categories of the cumulative exposure measure).

CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

PB - 65A VL - 65 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19995831?dopt=Abstract U2 - PMC2844057 U4 - continuity of care/medicare/primary care physician/MORTALITY ER - TY - JOUR T1 - Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services. JF - BMC Health Serv Res Y1 - 2007 A1 - Frederic D Wolinsky A1 - An, Hyonggin A1 - Li Liu A1 - Thomas R Miller A1 - Gary E Rosenthal KW - Aged KW - Aged, 80 and over KW - Ambulatory Care KW - Cluster Analysis KW - Continuity of Patient Care KW - Emergency Service, Hospital KW - Episode of Care KW - Hospital Mortality KW - Hospitals, Veterans KW - Humans KW - Male KW - Medicare KW - Proportional Hazards Models KW - United States KW - Veterans AB -

BACKGROUND: Older veterans may use both the Veterans Health Administration (VHA) and Medicare, but the association of dual use with health outcomes is unclear. We examined the association of indirect measures of dual use with mortality.

METHODS: Our secondary analysis used survey, claims, and National Death Index data from the Survey on Assets and Health Dynamics among the Oldest Old. The analytic sample included 1,521 men who were Medicare beneficiaries. Veterans were classified as dual users when their self-reported number of hospital episodes or physician visits exceeded that in their Medicare claims. Veterans reporting inpatient or outpatient visits but having no Medicare claims were classified as VHA-only users. Proportional hazards regression was used.

RESULTS: 897 (59%) of the men were veterans, of whom 134 (15%) were dual users. Among dual users, 60 (45%) met the criterion based on inpatient services, 54 (40%) based on outpatient services, and 20 (15%) based on both. 766 men (50%) died. Adjusting for covariates, the independent effect of any dual use was a 38% increased mortality risk (AHR = 1.38; p = .02). Dual use based on outpatient services marginally increased mortality risk by 45% (AHR = 1.45; p = .06), and dual use based on both inpatient and outpatient services increased the risk by 98% (AHR = 1.98; p = .02).

CONCLUSION: Indirect measures of dual use were associated with increased mortality risk. New strategies to better coordinate care, such as shared medical records, should be considered.

PB - 7 VL - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17490488?dopt=Abstract U2 - PMC1884152 U4 - Veterans: statistics/numerical/medicare/mortality/Physician visits/Physician visits/HOSPITALIZATION ER - TY - JOUR T1 - An interpersonal continuity of care measure for Medicare Part B claims analyses. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Frederic D Wolinsky A1 - Thomas R Miller A1 - John F Geweke A1 - Elizabeth A Chrischilles A1 - An, Hyonggin A1 - Robert B Wallace A1 - Claire E Pavlik A1 - Kara B Wright A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal KW - Aged KW - Aged, 80 and over KW - Continuity of Patient Care KW - Disability Evaluation KW - Female KW - Health Services Accessibility KW - Health Surveys KW - Humans KW - Insurance Claim Review KW - Male KW - Medicare Part B KW - Mobility Limitation KW - Physician-Patient Relations KW - Primary Health Care KW - United States AB -

OBJECTIVES: This article presents an interpersonal continuity of care measure.

METHODS: We operationalized continuity of care as no more than an 8-month interval between any two visits during a 2-year period to either (a) the same primary care physician or (b) the same physician regardless of specialty. Sensitivity analyses evaluated two interval censoring algorithms and two alternative intervals. We linked Medicare Part A and B claims to baseline survey data for 4,596 respondents to the Survey on Asset and Health Dynamics Among the Oldest Old. We addressed the potential for selection bias by using propensity score methods, and we explored construct validity.

RESULTS: Interpersonal continuity with a primary care physician was 17.3%, and interpersonal continuity of care with any physician was 26.1%. Older participants; men; individuals who lived alone; people who had difficulty walking; and respondents with medical histories of arthritis, cancer, diabetes, heart conditions, hypertension, and stroke were most likely to have continuity. Individuals who had never married, were widowed, were working, or had low subjective life expectancy were least likely to have continuity.

DISCUSSION: Researchers can measure interpersonal continuity of care using Medicare Part B claims. Replication of these findings and further construct validation, however, are needed prior to widespread adoption of this method.

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507591?dopt=Abstract U2 - PMC2914469 U4 - Medicare/Health Care Utilization ER - TY - JOUR T1 - Medication costs, adherence, and health outcomes among Medicare beneficiaries. JF - Health Aff (Millwood) Y1 - 2003 A1 - Ramin Mojtabai A1 - Mark Olfson KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Continuity of Patient Care KW - Family Characteristics KW - Female KW - Financing, Personal KW - Health Services Research KW - Humans KW - Income KW - Insurance, Pharmaceutical Services KW - Longitudinal Studies KW - Male KW - Medicare KW - Patient Compliance KW - Prevalence KW - Probability KW - Self Administration KW - Treatment Outcome KW - United States AB -

In a two-year period more than two million elderly Medicare beneficiaries did not adhere to drug treatment regimens because of cost. This poor adherence tended to be more common among beneficiaries with no or partial medication coverage and was associated with poorer health and higher rates of hospitalization. The risk for cost-related poor adherence was especially pronounced among lower-income beneficiaries with high out-of-pocket drug spending. We argue that this pattern of cost-related poor medication adherence should inform the design of Medicare prescription drug benefit legislation.

PB - 22 VL - 22 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12889771?dopt=Abstract U4 - Medicare ER -