Journal of the American Medical Directors Association最新文献

{"title":"Effectiveness of My Tools for Care-in Care: A Pragmatic Randomized Controlled Trial","authors":"Hannah M. O'Rourke PhD ,&nbsp;Jennifer Swindle PhD ,&nbsp;Pamela Baxter PhD ,&nbsp;Shelley Peacock PhD ,&nbsp;Genevieve Thompson PhD ,&nbsp;Sunita Ghosh PhD ,&nbsp;Dorothy Chacinski BA (Hons) Psychology ,&nbsp;Jayna Holroyd-Leduc MD ,&nbsp;Véronique Dubé PhD ,&nbsp;Wendy Duggleby PhD","doi":"10.1016/j.jamda.2025.105484","DOIUrl":"10.1016/j.jamda.2025.105484","url":null,"abstract":"<div><h3>Objectives</h3><div>Few supports exist for family/friend care partners when the care recipient is a person living with dementia in a care home. This study assessed the effectiveness of My Tools for Care-In Care (MT4C-In Care), a self-administered, web-based psychoeducational intervention.</div></div><div><h3>Design</h3><div>The overall study was a mixed methods pragmatic randomized controlled trial, with concurrent process evaluation and an active (educational) control. The intervention group received a link to MT4C-In Care for 2 months.</div></div><div><h3>Setting and Participants</h3><div>Participants were eligible if they were an adult (aged ≥18 years) who provided care to an older person (aged ≥65 years) living with dementia in a care home in Canada (Alberta, Saskatchewan, Manitoba, or Ontario). An email address and internet access were required to participate.</div></div><div><h3>Methods</h3><div>Process evaluation included a study participation tracking form and a checklist to assess use of MT4C-In Care. We completed telephone interviews (February 2020 to October 2021) at baseline, 2 months, and 4 months to assess outcomes of social support, hope, grief, self-efficacy, loneliness, and mental health. In an intention-to-treat analysis, generalized estimating equations models were used to assess intervention impact, adjusting for covariates. Sensitivity analysis assessed whether exclusion of nonusers impacted the results.</div></div><div><h3>Results</h3><div>Participants (N = 234) were primarily white women, and spouses or an adult child of the person living with dementia. No effect between groups was observed for the primary outcome (mental health). We observed a small benefit of MT4C-In Care for a secondary outcome, social support. Use of MT4C-In Care within the intervention group was low (∼1 h/mo). Dropping nonusers from the analysis did not have a substantial impact on the main conclusions.</div></div><div><h3>Conclusions and Implications</h3><div>Future research will explore use of MT4C-In Care by more diverse participant groups, and will clarify its core mechanisms, advancing understanding of impacts of psychoeducational interventions.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105484"},"PeriodicalIF":4.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing a Statewide Nursing Home Staffing Program through Quantitative and Qualitative Survey Data","authors":"Lindsay J. Peterson PhD ,&nbsp;Kelly M. Smith PhD, CPHQ","doi":"10.1016/j.jamda.2025.105517","DOIUrl":"10.1016/j.jamda.2025.105517","url":null,"abstract":"<div><h3>Objectives</h3><div>To use quantitative and qualitative data to assess nursing home administrators’ perceptions of a program using personal care attendants (PCAs) to ease staffing challenges, and to better understand factors concerning perceptions of success of lack thereof.</div></div><div><h3>Design</h3><div>Convergent mixed methods design, in which quantitative and qualitative data were collected concurrently and analyzed separately, with results combined for interpretation.</div></div><div><h3>Setting and Participants</h3><div>Florida nursing home administrators (N = 74).</div></div><div><h3>Methods</h3><div>We developed a survey to collect data on administrators’ use and perceptions of the PCA program. Data from closed-end questions assessing the value and use of PCAs and data on nursing home characteristics (eg, bed size, profit status) were analyzed using multiple logistic regression. Open-ended responses were analyzed using deductive thematic analysis. Quantitative and qualitative data were combined for further analysis.</div></div><div><h3>Results</h3><div>We found greater use of PCAs (more PCAs hired) was associated with 6% greater odds of finding the program beneficial (odds ratio, 1.06; 95% CI, 1.0–1.12; <em>P</em> = .049), controlling for facility characteristics. Qualitative analysis identified 3 themes: benefits of the PCA program, barriers to the success of the program, and steps taken to improve the program's usefulness. In further analysis, we identified an overarching theme of administrator proactivity in the implementation of the PCA program. Integration of quantitative and qualitative results found a relationship between assessing the PCA program as beneficial and taking proactive steps to facilitate use of PCAs.</div></div><div><h3>Conclusions and Implications</h3><div>Success of the PCA program in easing staffing challenges may have depended on administrators being proactive, in contrast to those who negatively assessed the program and took a more passive approach. Results provide evidence of differing leadership styles in the use of the PCA program, suggesting leadership training could better equip nursing home leaders to implement staffing initiatives. More research is recommended on the relationship between administrative leadership, staffing, and quality.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105517"},"PeriodicalIF":4.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502126","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, Hyunkyung Yun, Yutong Zhang, Soong-Nang Jang, Mark Aaron Unruh, Hye-Young Jung","doi":"10.1016/j.jamda.2024.105475","DOIUrl":"10.1016/j.jamda.2024.105475","url":null,"abstract":"<p><strong>Objectives: </strong>To examine practice trends and characteristics of primary care physicians providing care in US nursing homes.</p><p><strong>Design: </strong>Retrospective cohort study using Medicare Fee-for-Service claims.</p><p><strong>Setting and participants: </strong>Physicians who provided primary care to long-stay nursing home residents.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%, P < .001) and were more likely to be specialized nursing home physicians (42.0% and 61.3%, P < .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.</p><p><strong>Conclusions and implications: </strong>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).</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105475"},"PeriodicalIF":4.2,"publicationDate":"2025-03-13","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":"Impacts of Skilled Nursing Facility Change of Ownership on Staffing: A Staggered Difference-in-Difference Analysis","authors":"Rachel A. Prusynski DPT, PhD ,&nbsp;Harsha Amaravadi MPH ,&nbsp;Bianca K. Frogner PhD ,&nbsp;Tracy M. Mroz PhD, OTR/L","doi":"10.1016/j.jamda.2025.105530","DOIUrl":"10.1016/j.jamda.2025.105530","url":null,"abstract":"<div><h3>Objectives</h3><div>Skilled nursing facilities (SNFs) are experiencing significant regulatory scrutiny. Recent federal rules established guidelines for increased transparency in reporting of changes in SNF ownership and controversial minimum staffing levels for nurse occupations. This study examined whether SNF changes in ownership were independently associated with changes in levels of nurse, non-nurse, administrator, and contract staff.</div></div><div><h3>Design</h3><div>Staggered difference-in-differences analysis using SNF ownership and staffing data from January 2018 to June 2023.</div></div><div><h3>Setting and Participants</h3><div>11,543 SNFs.</div></div><div><h3>Methods</h3><div>Outcomes were patient census and the following staffing variables: staffing hours per patient-day (HPPD) for all patient care staff, nurse staffing HPPD, non-nurse staffing HPPD, administrator staffing hours, and percentage of staff employed as contractors. We compared outcomes before and after ownership change for SNFs that changed ownership, using SNFs that never changed ownership as a control group. We adjusted for care quality, rural location, ownership, payer mix, occupancy, chain status, and state.</div></div><div><h3>Results</h3><div>Between January 2018 and June 2023, a total of 2508 SNFs (21.7%) changed ownership. The change in ownership average treatment effects were a census increase of 2.36 patients per day and a 0.07-HPPD decline in overall staffing, driven by a 0.09-HPPD decline in nurse staffing (−2.23% relative to control group means). Conversely, ownership change was associated with a 0.02-HPPD increase in non-nurse staffing (2.12% relative to control group means), a 0.52-hour (6.43%) increase in administrator staffing, and no change in contractor staffing.</div></div><div><h3>Conclusions and Implications</h3><div>We found that SNF ownership changes were associated with declines in overall patient care staffing, driven by nurse staffing declines. As nurse occupations comprise more than 80% of staff time in SNFs, results support concerns that SNF ownership changes may negatively impact staffing operations and suggest that SNFs undergoing changes in ownership may have increased difficulty meeting potential new nurse minimum staffing standards.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105530"},"PeriodicalIF":4.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537369","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":"Nursing Home Staffing Variability and Quality: Assessing Alternative Measures of Daily Staffing Level Variation","authors":"Christopher S. Brunt PhD ,&nbsp;John R. Bowblis PhD","doi":"10.1016/j.jamda.2025.105532","DOIUrl":"10.1016/j.jamda.2025.105532","url":null,"abstract":"<div><h3>Objectives</h3><div>Variability in daily nursing staffing levels is an important factor associated with nursing home quality and has led to calls to incorporate it in the Centers for Medicare and Medicaid’s staffing star rating calculation. This study assessed 6 distinct daily staffing level variation measures for their validity in explaining quality outcomes to determine an optimal variation measure for inclusion in the CMS staffing star rating.</div></div><div><h3>Design</h3><div>Analysis of secondary data.</div></div><div><h3>Setting and Participants</h3><div>The study analyzed data from the CMS <em>Care Compare</em> archives and Payroll-Based Journal for 2022Q1 to 2023Q3 and included 42,228 to 62,180 nursing home–quarter observations.</div></div><div><h3>Methods</h3><div>Six measures of daily staffing level variation, including the coefficient of variation (CV), total outlier days (TOD), low outlier days (LOD), coefficient of quartile variation (CQV), the mean coefficient of dispersion of the median absolute deviation (mean-CDMAD), and median coefficient of dispersion of the median absolute deviation (median-CDMAD) were each evaluated for statistical validity based on desirable properties using linear regression to evaluate their relationship with 9 patient-based nursing home quality outcomes. Performance was analyzed by assessing statistical significance and direction of correlation, goodness of fit, and monotonicity.</div></div><div><h3>Results</h3><div>The measure median-CDMAD demonstrated superior statistical properties, including the best goodness of fit in 56% to 67% of quality outcomes and consistency with the predicted direction in 51% to 89% of cases. Median-CDMAD, mean-CDMAD, and CV also demonstrated superior performance for monotonicity, indicating they are more robust against outliers and greater resistance to potential gaming by nursing homes than the other staffing level variation measures evaluated.</div></div><div><h3>Conclusion and Implications</h3><div>Median-based variation measures, particularly median-CDMAD, exhibit the greatest validity relative to nursing home quality outcomes, making them suitable for CMS's staffing star rating system. Incorporating daily staffing level variation can improve public information on staffing consistency and incentivize quality improvement in nursing homes.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105532"},"PeriodicalIF":4.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537382","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":"Association of Reversible Frailty with All-Cause Mortality Risk in Community-Dwelling Older Adults and Analysis of Factors Affecting Frailty Reversal in Older Adults","authors":"Xiuping He MPH ,&nbsp;Wenyuan Jing MPH ,&nbsp;Runze Zhu MPH ,&nbsp;Qingze Wang MPH ,&nbsp;Jiacheng Yang MPH ,&nbsp;Xinming Tang MPH ,&nbsp;Ya Yang MPH ,&nbsp;Kechun Che MPH ,&nbsp;Jiayan Deng MPH ,&nbsp;Mingjuan Yin PhD ,&nbsp;Jindong Ni PhD","doi":"10.1016/j.jamda.2025.105527","DOIUrl":"10.1016/j.jamda.2025.105527","url":null,"abstract":"<div><h3>Objectives</h3><div>Although frailty can increase the risk of premature death, whether reversal of frailty reduces the risk of premature death and what factors contribute to the reversal of frailty have not been thoroughly investigated. This study aimed to investigate the link between frailty reversal and all-cause mortality and the factors affecting frailty reversal.</div></div><div><h3>Design</h3><div>A combination of the nested case-control study and the prospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Pre-frail and frail older adults in the community follow-up cohort of Dalang Town, Dongguan City.</div></div><div><h3>Methods</h3><div>We used a nested case-control study to enroll pre-frail and frail older individuals. After follow-up, we determined frailty-reversible and -irreversible groups. In a prospective cohort study with these 2 groups, all-cause death was set as the endpoint. We analyzed the link between frailty reversibility and all-cause mortality risk via incidence density ratios and Cox regression. Logistic regression was used to analyze factors affecting frailty reversibility.</div></div><div><h3>Results</h3><div>There were 637 (33.3%) participants who had a reversal of frailty status. Compared with the irreversible group, the reversible group had a 53.9% lower risk of all-cause mortality. Age, illiteracy, cigarette smoking, and daily sedentary time were negatively associated with the reversal of frailty in older adults. Hemoglobin concentration and having an exercise habit were positively associated with frailty reversal.</div></div><div><h3>Conclusions and Implications</h3><div>The risk of all-cause mortality declined among older adults with a reversal of frailty. Hemoglobin concentration and exercise contributed to the reversal of frailty among older adults. In contrast, aging, long daily sedentary time, cigarette smoking, and illiteracy were risk factors for the reversal of frailty. These findings may provide better strategies for frailty intervention.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105527"},"PeriodicalIF":4.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537331","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":"Discharge Disposition in Veterans with Heart Failure: Impact of Dementia and Severe Mental Illness","authors":"Matthew D. Howe MD, PhD ,&nbsp;Lan Jiang MS ,&nbsp;Julia W. Browne PhD ,&nbsp;Thomas A. Bayer MD ,&nbsp;Zachary J. Kunicki PhD ,&nbsp;Alyssa N. De Vito PhD ,&nbsp;John E. McGeary PhD ,&nbsp;Wen-Chih Wu MD, MPH ,&nbsp;Jason D. Lind PhD, MPH ,&nbsp;Catherine M. Kelso MD ,&nbsp;James L. Rudolph MD","doi":"10.1016/j.jamda.2025.105533","DOIUrl":"10.1016/j.jamda.2025.105533","url":null,"abstract":"<div><h3>Objectives</h3><div>Post-acute heart failure (HF) care presents significant management challenges, particularly among veterans with cognitive and behavioral impairments due to Alzheimer disease and related dementias (AD/ADRD) or severe mental illness (SMI). We hypothesized that comorbid AD/ADRD and SMI would reduce the likelihood of discharge home following HF hospitalization. In addition, we explored how AD/ADRD and SMI influence discharge to Veterans Affairs (VA) Community Living Centers (CLCs) compared with Medicare Skilled Nursing Facilities (SNFs).</div></div><div><h3>Design</h3><div>Retrospective cohort study spanning January 1, 2011, to September 30, 2019.</div></div><div><h3>Setting and Participants</h3><div>Veterans hospitalized with acute HF at VA hospitals (n = 291,117).</div></div><div><h3>Methods</h3><div>We examined VA administrative data from HF hospitalizations to assess how AD/ADRD and SMI impact post-hospital discharge location. Using diagnostic codes from the prior year, we stratified participants by the presence of AD/ADRD and/or SMI, then employed logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for discharge location, adjusted for demographics, comorbidities, and health care utilization.</div></div><div><h3>Results</h3><div>Participants were predominantly older (mean age: 78.1 ± 11.1 years), male (97.5%), and self-identified as white (72.7%). Those with AD/ADRD alone (n = 16,212) or SMI alone (n = 33,194) outnumbered those with both conditions (n = 3612). Compared with neither condition, the presence of AD/ADRD alone [adjusted OR (aOR), 0.523; 95% CI, 0.505–0.542], SMI alone (aOR, 0.869; 95% CI, 0.843–0.896), and both conditions (aOR, 0.505; 95% CI, 0.47–0.542) all reduced likelihood of discharge home. Participants with AD/ADRD and SMI were more likely to be discharged to a CLC than a SNF (aOR, 1.225; 95% CI, 1.064–1.411).</div></div><div><h3>Conclusions and Implications</h3><div>Our findings indicate that AD/ADRD and SMI are major barriers to discharge home for patients with HF, suggesting a need for enhanced supervision during health care transitions. This study calls for further research into how discharge location affects short- and long-term clinical outcomes in patients with cognitive and behavioral impairment.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105533"},"PeriodicalIF":4.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537351","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":"Factors Associated with Receiving Therapy in Long-Term Care Homes for Residents: A Cross-Sectional Study","authors":"Seyedehtanaz Saeidzadeh PhD,&nbsp;Yinfei Duan PhD,&nbsp;Peter G. Norton MD,&nbsp;Carole A. Estabrooks PhD","doi":"10.1016/j.jamda.2025.105503","DOIUrl":"10.1016/j.jamda.2025.105503","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105503"},"PeriodicalIF":4.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441331","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":"Outcomes of Discontinuing Long-Term Opioid Therapy among Older Cancer Survivors in Long-Term Care Settings","authors":"Yu-Jung Jenny Wei PhD ,&nbsp;Almut G. Winterstein PhD ,&nbsp;Siegfried Schmidt MD, PhD ,&nbsp;Roger B. Fillingim PhD ,&nbsp;Stephan Schmidt PhD ,&nbsp;Michael J. Daniels ScD ,&nbsp;Steven T. DeKosky MD ,&nbsp;Henry Young MD ,&nbsp;Ting-Yuan David Cheng PhD","doi":"10.1016/j.jamda.2025.105522","DOIUrl":"10.1016/j.jamda.2025.105522","url":null,"abstract":"<div><h3>Objectives</h3><div>Clinical decisions to continue or discontinue long-term opioid therapy (LTOT; ≥3 months) for older cancer survivors remain challenging due to limited evidence on the risks and benefits of this treatment practice. This study aims to examine the associations of discontinuing LTOT with clinical and opioid-related adverse event (ORAE) outcomes among older cancer survivors residing in long-term care (LTC) settings.</div></div><div><h3>Designs</h3><div>This retrospective cohort study analyzed data from the 100% Medicare nursing home sample from 2010 to 2021.</div></div><div><h3>Setting and Participants</h3><div>LTC residents aged ≥65 years who were survivors of cancer for at least 1 year and received LTOT for chronic pain.</div></div><div><h3>Methods</h3><div>Discontinuation of LTOT was defined as no prescription opioid refills for at least 90 days. Clinical outcomes included worsening pain, physical function, and depression; ORAE outcomes included counts of pain-related hospitalizations, pain-related emergency department visits, opioid use disorder, and opioid overdose. We used modified Poisson models for clinical outcomes and Poisson models for ORAE outcomes, adjusting baseline covariates via inverse probability of treatment weighting.</div></div><div><h3>Results</h3><div>Of 21,861 episodes of cancer survivors with LTOT, 18,984 survivors (86.8%) continued LTOT, whereas 2877 survivors (13.2%) discontinued LTOT. The discontinuers vs continuers had lower adjusted risk of worsening pain (relative risk 0.65, 95% CI 0.59–0.74, <em>P</em> &lt; .001) and lower adjusted rates of opioid use disorder (rate ratio 0.76, 95% CI 0.64–0.90, <em>P</em> &lt; .001) and opioid overdose (rate ratio 0.33, 95% CI 0.21–0.52, <em>P</em> &lt; .001) at the 1-year follow-up, with no difference in physical function and depressive symptoms or rates of pain-related hospitalizations and emergency department visits.</div></div><div><h3>Conclusions and Implications</h3><div>Discontinuing vs continuing LTOT was associated with lower risk of worsening pain, opioid use disorder, and opioid overdose, with nondifferential risks of the other studied outcomes. Discontinuing vs continuing LTOT may confer benefits that outweigh risks among older LTC cancer survivors.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105522"},"PeriodicalIF":4.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the Use of Medicare Home Health Care among Congregate Living Residents","authors":"Jun Li PhD ,&nbsp;Bo Zheng MPA ,&nbsp;Brian McGarry PhD","doi":"10.1016/j.jamda.2025.105498","DOIUrl":"10.1016/j.jamda.2025.105498","url":null,"abstract":"<div><h3>Objective</h3><div>To examine trends in home health care (HHC) use in congregate living and compare characteristics of HHC use between Medicare patients in congregate living and those in other home settings.</div></div><div><h3>Design</h3><div>Retrospective cohort study describing HHC use, in and outside of congregate living, using national Medicare claims, assessment, and administrative data (2014-2019). We compared HHC use by setting, on HHC quality, planned visit quantity, referral source (post-acute or community-initiated), and recertifications. We additionally examined whether HHC patterns across settings differed by patient dual eligibility and race-ethnicity.</div></div><div><h3>Setting and Participants</h3><div>Traditional Medicare (TM) and Medicare Advantage (MA) HHC patients aged 67 and older in congregate living or elsewhere.</div></div><div><h3>Methods</h3><div>Multivariable regressions.</div></div><div><h3>Results</h3><div>15.9% of HHC episodes in 2018-2019 were in congregate living, which increased 20.5% between 2014 and 2019. TM patients in congregate living were 4.4% (2.3 ppt, 95% CI: 1.7, 2.9) more likely to use high-quality agencies, had 8.7% (0.7 visits, 95% CI: 0.7, 0.8) more planned visits, were 27.6% (14.9 ppt, 95% CI: 14.7, 15.1) more likely to have community-initiated referrals, and 9.9% (3.2 ppt, 95% CI: 2.9, 3.5) more likely to be recertified compared with TM patients in other settings; differences were similar between settings among MA enrollees. Compared with their counterparts, dually eligible and racial-ethnic minoritized populations in congregate living were 2.6% (−1.5 ppt, 95% CI: −2.2, −0.8%) and 1.6% less likely (−0.9 ppt, 95% CI: −1.6, −0.3%) to use high-quality agencies, respectively, and dually eligible patients in congregate living had 6% fewer planned visits (−0.64 visits, 95% CI: −0.72, −55); these differences persisted across settings.</div></div><div><h3>Conclusion and Implications</h3><div>Congregate living may have facilitated access to higher quality and quantity of HHC, but inequitably. Further research is needed to determine the value of high-frequency community-initiated HHC referrals in congregate living.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105498"},"PeriodicalIF":4.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}