Journal of the American Medical Directors Association最新文献

{"title":"Innovative Patient Access to Home-Based Primary Care in Central Virginia","authors":"Benjamin J. Cahill MD,&nbsp;Justin B. Mutter MD","doi":"10.1016/j.jamda.2025.105608","DOIUrl":"10.1016/j.jamda.2025.105608","url":null,"abstract":"<div><div>Home-based primary care (HBPC) is uniquely capable of meeting the health care needs of homebound older adults, many of whom experience diminished access to primary care. Research demonstrations of HBPC have often recruited patients based on prior acute care utilization or around the time of hospital discharge. To transform HPBC from a research demonstration to a routine means of accessing primary care, new methods of identifying and enrolling patients are needed. The Virginia at Home program has piloted a pragmatic and innovative approach to HBPC in Central Virginia with the goal of empowering local providers to refer any homebound patient in need of improved access to primary care. Using a public-facing referral tool, the Virginia at Home program aims to widen access to HBPC enrollment, while maintaining the unique benefits of HPBC for homebound people.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105608"},"PeriodicalIF":4.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Multiple Determinants of Infection Prevention and Control Practices in Nursing Homes: A Scoping Review","authors":"Kanako Fujimoto MHS, RN ,&nbsp;Momoe Utsumi PhD, RN ,&nbsp;Toshiyuki Swa PhD ,&nbsp;Aoi Furuya MSN, RN ,&nbsp;Ayumi Ikuji RN ,&nbsp;Ayami Nakanishi BSN, RN ,&nbsp;Nahoko Harada PhD, RN","doi":"10.1016/j.jamda.2025.105593","DOIUrl":"10.1016/j.jamda.2025.105593","url":null,"abstract":"<div><h3>Objectives</h3><div>To map the barriers and facilitators influencing infection prevention and control (IPC) practices in nursing homes (NHs) from a behavior change perspective and to identify research gaps.</div></div><div><h3>Design</h3><div>Scoping review using the Joanna Briggs Institute methodology.</div></div><div><h3>Setting and Participants</h3><div>NHs for older adults and health care workers in NHs.</div></div><div><h3>Methods</h3><div>We conducted database searches in March 2022 and updated them in November 2024, including additional sources from citation tracking and reference list checks. We analyzed barriers and facilitators using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation–Behavior (COM-B) model.</div></div><div><h3>Results</h3><div>Of 1591 identified records, 54 reports published between 2003 and 2024 met our inclusion criteria. The analysis identified 101 determinants (25 in Capability, 46 in Opportunity, and 30 in Motivation within the COM-B model) categorized into 36 categories and 16 themes as barriers and facilitators. The most frequently mentioned barriers were related to the “Environmental context and resources” domain of the TDF. Relatively few reports addressed the determinants of the TDF domain classified within the Motivation area of the COM-B model. Although many facilitators were identified in this area, including beliefs, intentions, and goals, they were coded based on limited descriptions.</div></div><div><h3>Conclusions and Implications</h3><div>This review provides a detailed mapping of the barriers and facilitators to IPC in NHs based on existing literature. It demonstrates the complexity of sustaining IPC practices, influenced by multiple determinants. Although Motivation may impact IPC adherence, its determinants remain insufficiently studied, indicating a research gap. Further research is needed to explore these determinants and understand how Motivation interacts with other factors in IPC implementation.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105593"},"PeriodicalIF":4.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subtypes of Older Adults Starting Long-Term Care in Japan: Application of Latent Class Analysis","authors":"Yoko Hamasaki MPH ,&nbsp;Masao Iwagami PhD ,&nbsp;Jun Komiyama PhD ,&nbsp;Yuji Ito MD ,&nbsp;Yuta Taniguchi PhD ,&nbsp;Ryota Inokuchi PhD ,&nbsp;Taeko Watanabe PhD ,&nbsp;Tadahiro Goto PhD ,&nbsp;Naoaki Kuroda PhD ,&nbsp;Ai Suzuki MPH ,&nbsp;Satoru Yoshie MSc ,&nbsp;Keitaro Kume PhD ,&nbsp;Tatsuro Ishizaki PhD ,&nbsp;Katsuya Iijima PhD ,&nbsp;Nanako Tamiya PhD","doi":"10.1016/j.jamda.2025.105589","DOIUrl":"10.1016/j.jamda.2025.105589","url":null,"abstract":"<div><h3>Objectives</h3><div>Older adults requiring long-term care (LTC) exhibit heterogeneity in physical and cognitive functions; however, an established classification is lacking. We aimed to identify distinct subgroups of older adults with LTC needs and to examine differences in their prognoses.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Using survey data for care-need certification (linked to LTC and medical claims) in City A, Japan, we identified community-dwelling adults aged ≥65 years who started LTC. Data from City B were used to examine the validity of clustering.</div></div><div><h3>Methods</h3><div>We applied latent class analysis to group the participants in City A based on all 74 items [20 on body function/bed mobility, 12 on activities of daily living (ADLs), 6 on instrumental ADLs, 9 on cognitive functions, 15 on behavioral problems, and 12 on medical procedures] from the standardized care-needs certification survey. Then, we examined associations between identified subtypes and 4 outcomes, including death, hospitalization, admission to LTC facilities, and care-need level deterioration, using regression models.</div></div><div><h3>Results</h3><div>Among 3841 participants in City A (median age: 83 years; 59.3% female), 5 subtypes were identified: (1) mild physical, (2) mild cognitive, (3) moderate physical, (4) moderate multicomponent, and (5) severe multicomponent. The results of clustering were validated in City B. Compared with the mild physical subtype, the severe multicomponent subtype showed the highest risk of death [adjusted hazard ratio (aHR), 2.56; 95% confidence interval (CI), 2.02–3.24] and admission to LTC facilities (aHR, 5.91; 95% CI, 4.57–7.63). The moderate physical subtype showed a higher risk of hospitalization (aHR, 1.32; 95% CI, 1.16–1.49), and the moderate multicomponent subtype was more likely to experience care-need deterioration (adjusted odds ratio, 1.67; 95% CI, 1.26–2.22).</div></div><div><h3>Conclusions and Implications</h3><div>This study identified 5 subtypes of older adults requiring LTC. These findings inform individualized care decisions and tailored planning of medical and LTC services.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105589"},"PeriodicalIF":4.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Dyadic Psychosocial Education on People Living with Cognitive Impairment and Their Informal Caregivers: A Systematic Review and Meta-Analysis","authors":"Ping Ni MSN ,&nbsp;Hongxiu Chen PhD ,&nbsp;Meiling Ge PhD ,&nbsp;Li Liu MSN ,&nbsp;Fang Wang PhD ,&nbsp;Xiuying Hu PhD","doi":"10.1016/j.jamda.2025.105584","DOIUrl":"10.1016/j.jamda.2025.105584","url":null,"abstract":"<div><h3>Objectives</h3><div>Cognitive impairment places a substantial burden on both patients and caregivers. Dyadic psychosocial education may be a potential solution, but its effects have not been systematically evaluated. This study aimed to evaluate the effects of dyadic psychosocial education on outcomes and dyadic relationships among cognitively impaired adults and their informal caregivers.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Settings and Participants</h3><div>People living with cognitive impairment and their informal caregivers.</div></div><div><h3>Methods</h3><div>Six electronic databases were systematically searched from January 1, 2004, to October 13, 2024. Two researchers independently screened the literature by title, abstract, and full text. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias for included studies. A meta-analysis was performed using a random effects model, followed by subgroup and sensitivity analyses.</div></div><div><h3>Results</h3><div>Sixteen studies representing 2446 dyads were identified. No effects were found on overall neuropsychiatric symptoms, agitation, apathy, or depression, nor caregiver quality of life and depression. Pooled results showed dyadic psychosocial education significantly reduced dyadic conflict (SMD = −0.42, 95% CI: −0.66 to −0.18, <em>I</em>² = 0). No significant effects of dyadic psychosocial education were found on overall cognitive function (SMD = 0.12, 95% CI: −0.13 to 0.38, <em>I</em>² = 69%) or caregiver burden (SMD = −0.20, 95% CI: −0.43 to 0.03, <em>I</em>² = 56%). However, subgroup analyses indicated that interventions ≤6 months improved overall cognitive function (SMD = 0.30, 95% CI: 0.06-0.54, <em>I</em>² = 19%) and reduced caregiver burden (SMD = −0.26, 95% CI: −0.51 to −0.01, <em>I</em>² = 32%).</div></div><div><h3>Conclusions and Implications</h3><div>These findings demonstrate that dyadic psychosocial education can reduce dyadic conflict. The intervention also benefited cognitive function and caregiver burden, but the intervention duration influenced the effectiveness. Given the instability of the results, the findings of this study need to be interpreted with caution.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 6","pages":"Article 105584"},"PeriodicalIF":4.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PALTmed Events and Product","authors":"","doi":"10.1016/S1525-8610(25)00157-4","DOIUrl":"10.1016/S1525-8610(25)00157-4","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105640"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Practice in Nursing Homes: Addressing Gaps in Quality, Commitment, and Training","authors":"Paul R. Katz MD, CMD ,&nbsp;Darly Dash MSc","doi":"10.1016/j.jamda.2025.105547","DOIUrl":"10.1016/j.jamda.2025.105547","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105547"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding PACE Benefits/Services to Naturally Occurring Retirement Communities and More","authors":"Richard G. Stefanacci DO, MGH, MBA, AGSF, CMD","doi":"10.1016/j.jamda.2025.105501","DOIUrl":"10.1016/j.jamda.2025.105501","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105501"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physicians Who Provide Primary Care in US Nursing Homes: Characteristics and Care Patterns","authors":"Seiyoun Kim PhD ,&nbsp;Hyunkyung Yun MS, MSW ,&nbsp;Yutong Zhang MS ,&nbsp;Soong-Nang Jang PhD ,&nbsp;Mark Aaron Unruh PhD ,&nbsp;Hye-Young Jung PhD","doi":"10.1016/j.jamda.2024.105475","DOIUrl":"10.1016/j.jamda.2024.105475","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine practice trends and characteristics of primary care physicians providing care in US nursing homes.</div></div><div><h3>Design</h3><div>Retrospective cohort study using Medicare Fee-for-Service claims.</div></div><div><h3>Setting and Participants</h3><div>Physicians who provided primary care to long-stay nursing home residents.</div></div><div><h3>Methods</h3><div>Residents were attributed to physicians based on a plurality of evaluation and management visits in a given year. Trends in the proportion of nursing home residents seen by physicians in each primary care specialty over the period 2012-2019 were examined using linear regression. Comparisons of resident, physician, and nursing home characteristics in 2019 were made using analysis of variance tests and χ² tests for multiple comparisons.</div></div><div><h3>Results</h3><div>Internal medicine specialists provided care to the largest portion of nursing home residents (47.3%), followed by family practitioners (42.6%), geriatricians (4.8%), general practice physicians (2.8%), and physical medicine and rehabilitation specialists (2.5%). Geriatricians and physical medicine and rehabilitation physicians had the highest average percentage of services provided in nursing homes (63.8% and 73.0%, <em>P</em> &lt; .001) and were more likely to be specialized nursing home physicians (42.0% and 61.3%, <em>P</em> &lt; .001). They also tended to care for residents with more complex needs. Geriatricians were more frequently concentrated in higher-quality nursing homes with more resources, and in metropolitan areas, compared with facilities where other types of physicians provided care.</div></div><div><h3>Conclusions and Implications</h3><div>There is wide variation associated with physician primary care specialty in the amount of care provided to nursing homes residents, in the characteristics of residents treated, and in the types of nursing homes where primary care physicians provide care. Further study is warranted to determine the sources of this variation, including whether it is associated with systemic problems in nursing home care (eg, shortages of geriatricians, low clinician reimbursements, undervaluation of nursing home clinicians compared with their counterparts, malpractice liability).</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105475"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Directions & Connections","authors":"","doi":"10.1016/S1525-8610(25)00156-2","DOIUrl":"10.1016/S1525-8610(25)00156-2","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105639"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Information","authors":"","doi":"10.1016/S1525-8610(25)00155-0","DOIUrl":"10.1016/S1525-8610(25)00155-0","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105638"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}