社会经济地位、数字素养、代际支持与老年人社区智慧养老支付意愿——一个有中介的调节作用

目的：研究老年人社区智慧养老的支付意愿及其影响因素，促进社区智慧养老的可持续发展。方法：基于湖南省长沙市455位老人的微观调研数据，实证检验了社会经济地位对老年人社区智慧养老支付意愿的影响效应，论证了数字素养的中介作用与代际支持的调节作用。结果：老年人社区智慧养老的总体支付意愿较高但支付水平较低，而且社会经济地位越高的老年人，表现出更高的社区智慧养老支付意愿。此外，越年轻、身体越健康的城镇老人越倾向于支付社区智慧养老的费用。数字素养在社会经济地位与支付意愿之间具有部分中介作用。情感支持和生活照料负向调节社会经济地位与老年人社区智慧养老支付意愿的关系。结论：应通过提高老年人养老金、合理定价社区智慧养老产品及服务、普及老年人数字素养教育等措施促进老年人社区智慧养老支付意愿，提升老年人养老的获得感。     

城市老年人智慧健康养老服务的支付意愿及影响因素研究

目的:探究城市老年人对智慧健康养老服务的支付意愿及影响因素,了解其需求.方法:通过问卷调查收集数据,采用有序多分类逻辑回归模型分析数据.结果:老年人对智慧健康养老服务的支付意愿较低,受教育程度、职业、医保类型、主要照料人四个因素对老年人的支付意愿具有重要影响.结论:完善智慧健康养老体系,加强智慧健康养老产品的适老性,细...     

基于决策实验室分析的智慧医疗服务老年患者使用行为影响因素研究

目的 以吉林省某三甲医院智慧医疗系统为例,识别和分析影响智慧医疗服务老年患者使用行为的关键影响因素,为促进智慧医疗服务老年患者使用和智慧医疗服务适老化改造提供依据。方法 通过分析智慧医疗服务老年患者使用行为影响因素,运用决策实验室分析法对影响智慧医疗服务老年患者使用行为的因素进行关联分析。结果 对所有影响因素的中心度和原因度进行计算,识别影响智慧医疗服务老年患者使用行为的关键影响因素。其中原因度因素主要有医院适老化改造意愿、关键人群影响和国家相关政策支持,中心度主要因素为患者感知成本。结论 从改进智慧医疗服务、提升老年患者健康信息素养和发挥社会支持效应等方面降低老年患者的感知成本,促进老年患者的智慧医疗服务使用行为。     

基于分类树模型的老年人智慧健康养老服务购买意愿影响因素分析

目的 了解老年人智慧健康养老服务购买意愿及其影响,为智慧健康养老服务产业发展决策提供参考思路借鉴。方法 采用分层随机抽样对重庆市九龙坡区981名老年人进行问卷调查,运用分类树模型分析影响老年人智慧健康养老服务购买意愿的影响因素,采取索引图、Risk统计值对模型进行评估。结果 41.5%的老年人具有购买智慧健康养老服务意愿。分类树模型结果显示退休前职业、网络使用情况、智能手机使用情况、智慧健康养老认知、养老方式5个解释变量为影响老年人智慧健康养老服务购买意愿因素,其中退休前职业是最主要影响因素。结论 智慧健康养老服务市场可优先选择政府机关事业单位、企业退休人员进行培育,逐步推广。强化老年人现代信息技能的培训及智慧健康养老服务的宣传力度,丰富智慧健康养老服务供给。     

西北农村老人互助参与状况及影响因素实证分析

目的：了解西北农村地区老年人互助养老参与状况及其影响因素,为农村互助养老长效发展提供策略和思路。方法：采用自制问卷对西北五省农村60岁以上老年人进行抽样调查。共发放问卷2800份,回收有效问卷2454份,有效回收率87.6%。提出研究假设,建立模型,采用分步Logistic回归分析数据。结果：文化水平、身体健康状况、年收入、社会网络关系、互助设施的位置、数量、适老化等对农村互助养老参与意愿产生了显著影响。结论：西北农村老年人互助参与意愿偏低,互助服务层次低。由此,应从培养老人社区参与能力、开发农村老人社会网络资源、注重配套设施和空间环境设计、建立互助参与机制等方面激发互助养老参与意愿,并促其长效发展。     

厦门市城乡老年人养老意愿及其影响因素分析

目的研究城乡老年人养老意愿的影响因素,为优化配置养老资源和提高老年人生活质量提供依据。方法采用多阶段抽样方法对厦门市60岁以上常住老年人进行问卷调查,采用多分类logistic回归分析城乡老年人养老意愿影响因素。结果有效调查问卷城区652份、农村622份。城、乡老年人选择家庭养老、社区居家养老、机构养老和暂未考虑比例分别为67.5%、18.6%、12.7%、1.2%和71.1%、23.1%、4.7%、1.1%,差异有统计学意义(P0.05),且城乡老年人在文化程度、患慢性病、子女是否提供养老费、退休金以及距最近医疗单位的距离等方面分布差异也有统计学意义(P0.05)。以家庭养老为参照,城乡,年龄大于80岁者更倾向于机构养老(城、乡的OR(95%CI)分别为3.84(1.845～7.99)和3.64(1.07～12.47)),距最近医疗单位较远者倾向于社区居家养老(城、乡的OR(95%CI)分别为1.73(1.04～2.86)和2.12(1.31～3.42))。但城区老年人文化程度较高、退休金较多和子女有提供养老费者更愿意选择非家庭养老,而农村在婚老年人倾向于选择机构养老。结论城乡老年人养老意愿均以家庭养老为主,但农村老年人更倾向于社区居家养老,城区老年人更倾向于机构养老,城乡间的经济、文化差异是造成这种差异的主要原因。建议除强化家庭养老的功能外,应针对城乡差异合理配置城乡养老资源。     

宁波市社区养老服务供需现况调查

目的：研究宁波市社区养老服务供需现况,并分析问题和提出对策。方法：采用问卷现场调研宁波市8个社区的400名社区老年人。采用访谈法调研4家社区养老服务中心。结果：60～69岁社区老年人主要需要精神文化方面的养老服务,70～79岁社区老年人主要需要基本的医疗康复和安全保障,80岁及以上社区老年人主要需要生活照料和医疗康复服务。在是否愿意参加社区活动的调查中,有43%的社区老年人选择一般愿意。在社区养老服务满意度调查中,有53%的社区老年人选择基本满意。社区养老服务中心的服务供给情况显示,大部分社区养老服务中心可以提供生活照料和健康护理,但对精神慰藉和身心健康服务提供不足。结论：社区老年人轻度功能障碍者所占比例最大。不同年龄的社区老年人服务需求不同。同时,社区老年人对社区组织活动参与意愿不高,对提供的社区养老服务内容基本满意。因此,需要全面深入评估社区老年人的服务需求,并针对性地提高养老服务供给水平。     

云计算环境下医养融合的智慧养老服务体系构建探讨——以甘肃省平凉市为例

我国是世界上老年人口最多的国家,健康养老已成为重大的民生课题。通过分析甘肃省平凉市养老服务发展现状,认为目前养老服务存在以下主要问题:供需不匹配,养老机构较低的入住率与现实需求不符;养老形式单一,对社区养老服务重视不足;医疗与养老分家,造成公共医疗资源浪费;传统养老服务模式急需更新升级为智慧养老。建议通过建立多元主体协同供给机制、发挥云计算等信息技术优势、积极推进医养融合养老发展等策略,构建智慧养老服务体系,从而满足老年人的养老需求。     

基于老人养老意愿与需求的居家照护体系构建

人口的快速老化及老年人口的剧增使得中国养老问题日益凸显。在考察老年人自身养老意愿与需求的基础上,探索适合当前社会发展的老年照护模式,提出构建以社区为依托的居家养老照护服务体系,形成社区养老助老的新模式。     

智慧居家养老信息平台建设与管理探析——以郑州大学第五附属医院为例

人口老龄化在全球成为普遍现象,在我国“9073”养老格局下,90%的老年人在居家养老。随着信息技术的普及推广和5G时代的到来,智慧居家养老将成为我国未来养老的主流。本文通过智慧居家养老服务终端需求调查以及以“智慧居家养老信息服务”为主题进行了文献检索研究,提炼了4个方面的智慧养老的难点堵点问题：智慧居家养老研究不足,养老供需研究不充分;居家老年人智能设备需求与使用存在矛盾;医疗资源供给无法满足90%居家养老老年人需求;智慧居家养老服务专业人才不能切合当下需要,导致老年人对“智慧养老”认知与使用不足。基于问题导向,郑州大学第五附属医院以社区居家养老服务实际需求为切入点,在福华街社区卫生服务中心构建了智慧居家医养结合服务云平台,进行研究与实践。笔者结合郑州大学第五附属医院的实践,提出以下对策：发挥三甲医院专业引领作用,以企业和机构为主体,社区为纽带,构建社区 居家智慧医养结合服务云平台;下沉三甲资源、整合社会照护与信息服务资源打造居家智慧便捷服务,满足老年人“十助”服务需求;通过网络服务与教育解决老年人智能设备使用困难的困扰;融合智慧服务与人文体娱乐于一体,从社区至居家延伸,全方位助力提高老年人主动性。通过近2年的智慧居家养老信息平台应用实践,居家老人满意度高达96%。同时,社会反馈也印证了郑州大学第五附属医院智慧居家养老信息平台建设与管理实践契合老年人与社会的需求,已经得到了社会各界的广泛认可,各级医养结合及养老机构都在学习、复制,证明这项事业与产业发展前景可期。     

A Quality of Care Framework for Home-Based Medical Care

More than 6 million adults in the United States are homebound or semi-homebound and would benefit from home-based medical care (HBMC). There is currently no nationally recognized quality of care framework for home-based medical care. We sought to capture diverse stakeholder perspectives on the essential aspects of quality HBMC and create a quality of care framework for homebound adults. A qualitative analysis of semistructured interviews from purposive sampling of key HBMC stakeholders was performed. Leaders from 12 exemplar HBMC practices (clinicians and administrators), advocacy groups (American Association of Retired Persons, National Partnership for Women and Families, Kaiser Family Foundation), and representatives from 3 key professional medical societies associated with HBMC participated in phone interviews. Semistructured interviews were based on domains of quality developed by the National Quality Forum (NQF) for individuals with multiple chronic conditions. We identified 3 categories of quality HBMC: provider and practice activities; provider characteristics; and outcomes for patients, caregivers, and providers. Within these 3 categories, we identified 10 domains and 49 standards for quality HBMC. These included 3 new domains (comprehensive assessment, patient/caregiver education, and provider competency) as well as specification and adaptation of the NQF Framework for Multiple Chronic Conditions domains for HBMC. Notably, several quality domains emanating from the NQF Framework for Multiple Chronic Conditions (transitions, access, and patient/caregiver engagement) were applicable to HBMC. This quality of care framework serves as a guide for HBMC practices seeking to improve their care quality and as a starting point for health systems and payers to ensure value from HBMC practices with whom they work.     

Managed Care Organizational Characteristics and Health Care Use among Children with Special Health Care Needs

Objective. To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children.
Data Sources. Telephone survey data from 2,223 parents of children with special health care needs, MCO-administrator interview data, and health care claims data.
Study Design. Cross-sectional survey data from families about the number of consequences of their children's conditions and from MCO administrators about their plans' organizational features were used. Indices reflecting the MCO characteristics were developed using data reduction techniques. Hierarchical models were developed to examine the relationship between child sociodemographic and health characteristics and the MCO indices labeled: Pediatrician Focused (PF) Index, Specialist Focused (SF) Index, and Fee-for-Service (FFS) Index, and outpatient use rates and charges, inpatient admissions, emergency room (ER) visits, and specialty consultations.
Data Collection/Extraction Methods. The telephone and MCO-administrator survey data were linked to the enrollment and claims files.
Principal Findings. The child's age, gender, and condition consequences were consistent predictor variables related to health care use and charges. The PF Index was associated with decreased outpatient use rates and charges and decreased inpatient admissions. The SF Index was associated with increased ER visits and decreased specialty consultations, while the FFS Index was associated with increased outpatient use rates and charges.
Conclusion. After controlling for sociodemographic and health characteristics, the PF, SF, and FFS indices were significantly associated with children's health care use patterns.     

Successful Implementation of Integrated Care in Slovenian Primary Care

For the purpose of celebrating the 40th anniversary of Alma Ata declaration, the WHO published a successful model of integrated patient care being performed in Slovenia. After two years, the WHO experts evaluated the success in practise during a visit to the Slovenian primary care environment. This report showed that Slovenia was a notable exception regarding developing effective primary care systems. The country has an impressive primary care which performs very well.     

Virtual Fracture Care in Long-Term Care Homes Avoiding Emergency Department Visits

Long-term care residents with suspected fractures as a result of a fall typically transfer to the emergency department (ED) for diagnostic imaging and care. During the COVID-19 pandemic, transfer to the hospital increased the risk of COVID-19 exposure and resulted in extended isolation days for the resident. A fracture care pathway was developed and implemented to provide rapid diagnostic imaging results and stabilization in the care home, reducing transportation and exposure risk to COVID-19. Eligible residents with a stable fracture would receive a referral to a designated fracture clinic for consultation; fracture care is provided in the care home by long-term care staff. Evaluation of the pathway was completed and demonstrated that 100% of residents did not transfer to the ED and 47% of the residents did not transfer to a fracture clinic for additional care.     

Home Health Care Post-PPS

California home health data for the years 1982 through 1987 are analyzed to explore the effects of the implementation of the Prospective Payment System in 1983 and the increase in denial rate for Medicare reimbursed home care in late 1985. After 1983 the following declined: average number of patients per agency, average number of visits per patient, number of freestanding agencies and percentage of reimbursement from Medicare. After 1985 there were declines in the number of patients served, total number of visits, average number of visits per aged client, and number of agencies (proprietary and non-profit) submitting annual reports.     

Patterns of Emergency Care Use in Residential Care Settings: Opportunities to Improve Quality of Transitional Care in the Elderly

SUMMARY

Emergent care is a prominent feature in the complex matrix of care transitions for vulnerable elders. This article evaluates local patterns of emergent care transport using ambulance transport data for the year 2003, analyzed by residential setting (independent senior apartments, licensed residential care and nursing homes). Significant differences were found between categories and between facilities within categories (p > .001). The more than three-fold difference in ambulance transport rate between nursing homes reinforces the need to recognize these transitions as quality indicators. Differences between senior apartments and licensed residential care settings provide initial insight suggesting opportunities for quality improvement in these community settings.     

Reimagining Nutrition Care and Mealtimes in Long-Term Care

Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; eg, nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centered care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. In this special article, we reimagine LTC nutrition by reframing the evidence-based recommendations into relationship-centered care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. We then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (eg, food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents’ nutrition and well-being is required.     

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.     

Medicaid Managed Care and Health Care for Children

Objective. Many states expanded their Medicaid managed care programs during the 1990s, causing concern about impacts on health care for affected populations. We investigate the relationship between Medicaid managed care enrollment and health care for children.
Data Sources and Measures. Repeated cross-sections of Medicaid-covered children under 18 years of age from the 1996/1997 and 1998/1999 Community Tracking Study Household Surveys ( n =2,602) matched to state-year CMS Medicaid managed care enrollment data. For each individual, we constructed measures of health care utilization (provider and emergency department visits, hospitalizations, surgeries); health care access (usual source of care, unmet medical needs, put-off needed care); and satisfaction (satisfaction overall, with doctor choice, and with last visit).
Study Design. Regression analysis of the relationship between within-state changes in Medicaid managed care enrollment rates and changes in mean utilization, access, and satisfaction measures for children covered by Medicaid, controlling for a range of potentially confounding factors.
Principal Findings. Increases in Medicaid health maintenance organization (HMO) enrollment are associated with less emergency room use, more outpatient visits, fewer hospitalizations, higher rates of reporting having put off care, and lower satisfaction with the most recent visit. Medicaid primary care case management (PCCM) plans are associated with increases in outpatient visits, but also with higher rates of reporting unmet medical needs, putting off care, and having no usual source of care.
Conclusions. Both Medicaid HMO and PCCM plans can have important impacts on health care utilization, access, and satisfaction. Some impacts may be positive (e.g., less ED use and more outpatient provider use), although concern about increasing challenges in access to care and satisfaction is also warranted.