Disparities in home health service providers among Medicare beneficiaries with stroke

This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services’ Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.     

Health insurance knowledge among Medicare beneficiaries

OBJECTIVE: To assess the effect of new consumer information materials about the Medicare program on beneficiary knowledge of their health care coverage under the Medicare system. DATA SOURCE: A telephone survey of 2,107 Medicare beneficiaries in the 10-county Kansas City metropolitan statistical area. STUDY DESIGN: Beneficiaries were randomly assigned to a control group and three treatment groups each receiving a different set of Medicare informational materials. The "handbook-only" group received the Health Care Financing Administration's new Medicare & You 1999 handbook. The "bulletin" group received an abbreviated version of the handbook, and the "handbook + CAHPS" group received the Medicare & You handbook plus the Consumer Assessment of Health Plans (CAHPS) survey report comparing the quality of health care provided by Medicare HMOs. Beneficiaries interested in receiving information were oversampled. DATA COLLECTION METHODS: Data were collected during two separate telephone surveys of Medicare beneficiaries: one survey of new beneficiaries and another survey of experienced beneficiaries. The intervention materials were mailed to sample members in advance of the interviews. Knowledge for the treatment groups was measured shortly after beneficiaries received the intervention materials. PRINCIPAL FINDINGS: Respondents' knowledge was measured using a psychometrically valid and reliable 15-item measure. Beneficiaries who received the intervention materials answered significantly more questions correctly than control group members. The effect on beneficiary knowledge of providing the information was modest for all intervention groups but varied for experienced beneficiaries only, depending on the intervention they received. CONCLUSIONS: The findings suggest that all of the new materials had a positive effect on beneficiary knowledge about Medicare and the Medicare + Choice program. While the absolute gain in knowledge was modest, it was greater than increases in knowledge associated with traditional Medicare information sources.     

Health insurance coverage among disabled Medicare enrollees

In this article, we use the Survey of Income and Program Participation to identify patterns of non-Medicare insurance coverage among disabled Medicare enrollees. Compared with the aged, the disabled are less likely to have private insurance coverage and more likely to have Medicaid. Probit analysis of the determinants of private insurance for disabled Medicare enrollees shows that income, education, marital status, sex, and having an employed family member are positively related to the likelihood of having private health insurance, whereas age and the probability of Medicaid enrollment are negatively related to this likelihood.     

The prevalence of urinary incontinence and its burden on the quality of life among older adults with medicare supplement insurance

Purpose  

Estimate the prevalence and burden of urinary incontinence (UI) on the quality of life (QOL) among adults (65 or older) with Medigap insurance.     

Total joint replacement surgery in a rural centre

OBJECTIVE: To demonstrate that total joint replacement surgery can be safely and effectively performed in rural hospitals with acceptable outcomes. DESIGN: Case series. SETTING: A rural district hospital. Participants: Participants were 64 patients, 30 men and 34 women, who underwent total knee replacements (TKR); and 63 patients, 41 men and 22 women, who had total hip replacements (THR). Main outcome measures: Level of patient satisfaction following total joint replacement surgery, obtained by patient interview. Incidence of postoperative joint specific complications, for example infection, THR dislocation and manipulation under anaesthetic (MUA) of a TKR. RESULTS: None of the TKR or THR patients developed a deep wound infection. In this study 8.8% TKR patients had an MUA but all during a period of limited physiotherapy services; 5.8% THR patients suffered a dislocated prosthesis. Following TKR 95.3% patients reported to be 'happy' with the outcome of their surgery. Of the THR patients 97.0% declared they were 'happy' with their surgical outcome. CONCLUSIONS: There was a high level of patient satisfaction, low infection rate, acceptable levels of MUA for TKR and dislocation for THR following total joint replacement in our rural district hospital. The surgeons performed a medium volume of total joint replacements and an appropriate multidisciplinary team was in place. In such settings joint replacement surgery can be safely and successfully performed in rural centres to the benefit of rural patients, surgeons and GPs.     

Dental insurance visits and expenditures among older adults

OBJECTIVES: We examined the effect of age, income, and coverage on dental service utilization during 1996. METHODS: We used data from the 1996 Medical Expenditure Panel Survey. RESULTS: Edentulous and poorer older adults are less likely to have coverage and less likely to report a dental visit than dentate or wealthier older adults. CONCLUSIONS: These analyses help to describe the needs of older adults as they cope with diminishing resources as a consequence of retirement, including persons previously accustomed to accessing oral health services with dental insurance.     

Changes in diet,physical activity,and supplement use among adults diagnosed with cancer

OBJECTIVE: To investigate the prevalence and predictors of changes in diet, physical activity, and dietary supplement use among cancer patients. Design/subjects Telephone interviews of a population-based sample of 126 breast, 114 prostate, and 116 colorectal cancer patients from the state of Washington. ANALYSIS: Logistic regression was used to estimate the odds ratio as a measure of the association of participant characteristics with lifestyle changes in the 12 months before the interview. RESULTS: Overall, 66.3% of patients reported making lifestyle changes: 40.4% made one or more dietary changes, 20.8% added new physical activity, and 48.0% started taking new dietary supplements. Compared with men, women were 2.2 times more likely to take new dietary supplements (P <.01). Compared with patients aged 35 to 59, those aged 60 to 69 and 70 or older were statistically significantly less likely to make dietary changes (odds ratio = 0.39 and 0.54, respectively) or to take new supplements (odds ratio = 0.42 and 0.69, respectively). Compared with patients who received only one medical treatment, those receiving three or more treatments were more likely to make dietary changes (odds ratio = 2.6) or to start new physical activity (odds ratio = 3.0). Patients diagnosed 12 to 24 months before the interview were as likely to report making lifestyle changes as those diagnosed within one year of the interview. Having a stronger desire for personal control or internal locus of control predicted use of new dietary supplements (P for trend <.05 for both). Applications/conclusions Cancer survivors are likely to be making lifestyle changes and represent a group that could benefit from counseling on diet and physical activity.     

Disparities in physical access and healthcare utilization among adults with and without disabilities in South Africa

Background

In South Africa barriers to accessing health services by persons with a disability would appear to be exacerbated by the overburdened state of public healthcare.

Dietary supplement use among Iranian adults: a study in northern Iran

This study aimed to investigate dietary supplement use among Iranian adults in northern Iran. A cross-sectional study was undertaken on randomly selected men and women in Guilan province, northern Iran. The study population was parents of children and adolescents studying in schools. Totally, 1,425 women and 676 men were studied and data on age, body weight, height, educational level, and supplement use was gathered using a self-administrated questionnaire. These data showed that supplement use was related to sex, body mass index, and educational levels in both sexes. Most common supplements used in this population were Iron, calcium, multivitamin/multiminerals and fish oils. These results showed that 13.3, 3.4, 2.2, and 1.1 % of the study men used iron, calcium, multivitamin/multimineral, and fish oil, respectively. In women, 27.1, 10.7, 5.1, and 5.5 % used Iron, calcium, multivitamin/multimineral, and fish oil, respectively. More educated men and women and those with more healthy weight were more likely to use any dietary supplement than the less educated and overweight/obese men and women. This study showed that iron was the most common dietary supplement in this study middle aged Iranians. Using the other supplements was mostly related to age, educational level, and body weight status in this population. These data indicated that dietary supplement use was inversely related to some health-related behaviors and socioeconomic factors.     

Outcomes of surgery among the Medicare aged: mortality after surgery.

This study examines post-surgical mortality, up to 1 year after surgery, for eight common operations among aged Medicare enrollees. The operations with the highest mortality in the 1.5 months after surgery were femur fracture reduction, hip arthroplasty (other, i.e., not total replacement), and coronary artery bypass. Mortality was still above average for femur fracture reduction, hip arthroplasty (other), and transurethral prostatectomy 1 year after surgery. The highest mortality rates following surgery were for people 85 years of age or over. This raises the following question: Should certain elective surgery be performed at younger ages if it appears that surgery may eventually be needed?     

Examination of vitamin intakes among US adults by dietary supplement use

BackgroundMore than half of US adults use dietary supplements. Some reports suggest that supplement users have higher vitamin intakes from foods than nonusers, but this observation has not been examined using nationally representative survey data.ObjectiveThe purpose of this analysis was to examine vitamin intakes from foods by supplement use and how dietary supplements contribute to meeting or exceeding the Dietary Reference Intakes for selected vitamins using data from the National Health and Nutrition Examination Survey among adults (aged ≥19 years) in 2003-2006 (n=8,860).ResultsAmong male users, mean intakes of folate and vitamins A, E, and K from food sources were significantly higher than among nonusers. Among women, mean intakes of folate and vitamins A, C, D, and E from foods were higher among users than nonusers. Total intakes (food and supplements) were higher for every vitamin we examined among users than the dietary vitamin intakes of nonusers. Supplement use helped lower the prevalence of intakes below the Estimated Average Requirement for every vitamin we examined, but for folic acid and vitamins A, B-6, and C, supplement use increased the likelihood of intakes above the Tolerable Upper Intake Level.ConclusionsSupplement use was associated with higher mean intakes of some vitamins from foods among users than nonusers, but it was not associated with the prevalence of intakes less than the Estimated Average Requirement from foods. Those who do not use vitamin supplements had significantly higher prevalence of inadequate vitamin intakes; however, the use of supplements can contribute to excess intake for some vitamins.     

人工关节置换术的护理分析

目的总结人工关节置换术病人的护理经验。方法对21例关节置换术病人从心理护理、术前准备、术后护理和康复指导方面帮助患者恢复肢体功能,提高生活质量。结果 21例患者中,除1例因有脑梗塞后遗症,一侧肢体活动不灵,不能早期下床活动外,其余20例患者出院前均可下床活动,肢体功能恢复好。结论人工关节置换术是帮助患者尽早恢复肢体功能和恢复生产生活的好方法。     

Disparities in breast cancer treatment among American Indian, Hispanic and non-Hispanic White Women Enrolled in Medicare

Because racial/ethnic disparities in breast cancer survival have persisted, we investigated differences in breast cancer treatment among American Indian, Hispanic, and non-Hispanic White (NHW) women. Surveillance, Epidemiology and End Results data linked to Medicare claims in New Mexico and Arizona (1987-1997) among enrollees aged 65 and older were used to identify treatment, treatment interval, and mortality risk associated with delays in care. We identified 2,031 women (67 American Indian, 333 Hispanic and 1,631 NHW women with time to treatment information. Treatment intervals from diagnosis to surgery (all stages, 18 versus 4 days, p.     

Post-Acute Care Use Associated with Medicare Shared Savings Program and Disparities

ObjectivesMedicare Shared Savings Program (MSSP) was implemented in 2012, but the impact of the MSSP on institutional post-acute care (PAC) use, and by race/ethnicity and payer status is less studied. We studied the impact of hospital participation in the MSSP on institutional PAC use and variations by race/ethnicity and payer status among 3 Medicare patient groups: ischemic stroke, hip fracture, and elective total joint arthroplasty (TJA).DesignA retrospective analysis of 2010–2016 Medicare Provider Analysis and Review files.Setting and ParticipantsMedicare fee-for-service patients originally admitted for ischemic stroke, hip fracture, or elective TJA in MSSP-participating hospitals or nonparticipating hospitals.MethodsPatient-level linear probability models with difference-in-differences approach were used to compare the changes in institutional PAC use in MSSP-participating hospitals with nonparticipating hospitals as well as to compare the changes in differences by race/ethnicity and payer status in institutional PAC use over time.ResultsHospital participation in MSSP was significantly associated with increased institutional PAC use for the ischemic stroke cohort by 1.5 percentage points [95% confidence interval (CI) 0.00–0.3, P < .05] compared with non-MSSP participating hospitals. Regarding variations by race/ethnicity and payer status, for the elective TJA patients, racial minority patients in MSSP-participating hospitals had 3.8 percentage points greater (95% CI 0.01–0.06, P < .01) in institutional PAC use than white patients. Also, for ischemic stroke cohort, dual-eligible patients in MSSP-participating hospitals had 2.0 percentage points greater (95% CI 0.00–0.04, P < .10) in institutional PAC use than Medicare-only patients.Conclusions and ImplicationsThis study found that hospital participation in the MSSP was associated with slightly increased institutional PAC use for ischemic stroke Medicare patients. Also, compared to non-MSSP participating hospitals, MSSP-participating hospitals were more likely to discharge racial minority patients for elective TJA and dual-eligible patients for ischemic stroke to institutional PAC.     

Vitamin supplement use and diabetes mellitus incidence among adults in the United States

In some studies, use of vitamin supplements has been inversely associated with the risk of several chronic diseases, but little is known about whether vitamin use affects the risk of diabetes mellitus. Using data from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study, the author examined whether vitamin use was related to diabetes incidence in a cohort of United States adults aged 25--74 years. In the analytic sample of 9,573 participants, 1,010 participants developed diabetes mellitus during about 20 years of follow-up. A smaller percentage of participants with incident diabetes (21.4%) reported using vitamins during the previous month at baseline compared with participants who remained free of this disease (33.5%) (p < 0.001). After multiple adjustment, the hazard ratios for participants using vitamin supplements were 0.76 (95% confidence interval (CI): 0.63, 0.93) for all participants, 0.70 (95% CI: 0.54, 0.92) for men, and 0.84 (95% CI: 0.64, 1.11) for women. Sex did not modify the association between vitamin use and diabetes incidence. Whether specific vitamins or other factors closely correlated with vitamin use account for this observation is unclear.     

Social and health policy issues in total joint replacement surgery.

Total joint replacement has restored function and provided comfort to many patients who would otherwise have suffered. However, success and widespread diffusion of this procedure pose a number of important questions. The patient's and the doctor's criteria of success may not be the same: Which are to be used? Health resources are becoming limited: Should money be spent to restore function and for pain relief to those late in life or past their work life? Who makes this choice? A medical technology is tested in the best of settings but routinely practiced in many: How should society and health care professionals monitor the results of surgery? Who should do surgery and where should it be done?