Statin therapy for prevention of coronary artery disease. The earlier the better or the longer the better?

Cholesterol lowering with statin therapy has been shown to reducecardiovascular events in a variety of patient categories, rangingfrom patients with established cardiovascular disease to high-riskindividuals with no previous history.¹ The degree of benefitrelates primarily to a patient's absolute risk of cardiovascularevents and to the absolute reduction in low-density lipoprotein(LDL)-cholesterol. The optimal intensity of     

Measuring worker turnover in long-term care: lessons from the better jobs better care demonstration

PURPOSE: Turnover among direct-care workers (DCWs) continues to be a challenge in long-term care. Both policy makers and provider organizations recognize this issue as a major concern and are designing efforts to reduce turnover among these workers. However, there is currently no standardized method of measuring turnover to define the scope of the problem or to assess the effectiveness of interventions. This article draws on our experience of the Better Jobs Better Care Demonstration (BJBC) to explicate some important issues in measuring and interpreting turnover related to interventions designed to improve DCW jobs. DESIGN AND METHODS: We used turnover data from a selected group of BJBC providers (N = 9) to demonstrate some of the measurement issues we uncovered in developing a turnover tracking system for BJBC. We also illustrate how the data elements collected in the tracking system make it possible to construct measures that are useful at both policy and practice levels. RESULTS: Differences in definitions of turnover and the data elements used to construct the measure can have large effects on turn over rates, how they are used, and what they mean. IMPLICATIONS: Policy makers, researchers, and managers who need comparative turnover information to address the impending demand for DCWs should be aware that turnover measures differ, and they should take steps to ensure that measures they use have common definitions and data elements.     

Baseline management practices at providers in better jobs better care

High turnover and difficult recruitment of direct care workers are challenges for long-term care providers. This study reports the extent and variation of the use of management practices for direct care workers and their supervisors across four long-term care settings in the Better Jobs Better Care demonstration. Overall, there is limited use of direct care worker training, career advancement opportunities, and mentoring programs. Participation in care planning, communication about tasks, and direct care worker supervisor training and development practices vary significantly across long-term care settings. The paucity of training, career advancement opportunities, and mentoring programs suggests that government policies may be needed to encourage their use.