Thesis (M.S.)--University of Michigan, 1990.

Thesis (Ph. D.)--University of Chicago, Irving B. Harris Graduate School of Public Policy Studies, December 1999. / Includes bibliographical references. Also available on the Internet.

Thesis (M.A.)--Georgia State University, 2009. / Title from title page (Digital Archive@GSU, viewed July 29, 2010) Ann Pearman, committee chair; Erin Ruel, Dennis Thompson, committee members. Includes bibliographical references (p. 73-81).

Thesis (Ph. D.)--Case Western Reserve University, 2006. / [School of Medicine] Department of Epidemiology and Biostatistics. Includes bibliographical references. Available online via OhioLINK's ETD Center.

Thesis (Ph. D.)--University of Missouri-Columbia, 2005. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "July 2005." Includes bibliographical references.

Background. The well-cited report from the Institute of Medicine stated that nearly 100,000 deaths in acute care are largely due to miscommunication. Residents in nursing homes are transported for acute care three times higher than those under the age of 65. Approximately 25 percent of these hospital transfers are avoidable. The influence of nurse-to-physician communication upon the decision to hospitalize nursing home residents is not well understood. Objective. The purpose of this study is to explore nurse-to-physician communication in the nursing home setting utilizing the Informatics Research Organizing Model (IROM) and Carrington’s Exploring Nurse-to-Nurse Communication Framework. Methods. The methodology use for this study was a qualitative descriptive (QD) design, with in-depth, one-on-one interviews of nurses and physicians with semi-structured open-ended interview questions. Communication between nurses and physicians regarding clinical events experienced by nursing home residents was digitally recorded and transcribed. Data was analyzed using natural language processing (NLP) methodology and conventional content analysis, as a means of intra-methods data triangulation. A purposive convenience sample of nurses and physicians who provide clinical care to nursing home residents at two sites was recruited. In addition to obtaining recorded communications between nurses and physicians pertaining to clinical events, these same study participants were interviewed to determine their perceptions regarding communication of the clinical events. Outcomes. Findings from this study will increase understanding of nurse-to-physician communication and its contribution to avoidable hospitalizations. Results will inform the development of an electronic interface that supports nurse-to-physician communication in the nursing home setting.

No description available.

INTRODUCTION: The Covid-19 pandemic has caused significant increases in mortality in the United States, and nursing homes were particularly impacted early in the pandemic. With questions around underreporting, limited testing, and indirect effects, it is difficult to understand the true impact of the pandemic on US mortality while only examining the deaths attributed to Covid-19. Prior analyses have looked at excess mortality, the increase in mortality over what would have been expected in 2020 if the Covid-19 pandemic had not occurred, focusing on temporal and spatial relationships between excess mortality and direct Covid-19 attributed mortality. The true impact of Covid-19 by place of death remains to be understood. Recent historical trends in mortality by place of death have shown a decreasing share of deaths occurring in hospitals while deaths in homes have increased and deaths in nursing homes have not changed significantly. OBJECTIVE: This observational study aims to characterize the impact of the Covid-19 pandemic on nursing homes in the US by examining direct Covid-19 mortality, excess mortality, and the relationship between direct and excess mortality by place of death at a state level. METHODS: Vital statistics data around mortality by place of death from CDC WONDER and the NVSS Provisional Covid-19 Deaths dataset were used along with US Census data to create a time series for US mortality by place of death from 2013 to 2020. The analysis was restricted to individuals above the age of 65 to limit fields with missing or suppressed data and stratified by 10-year age category. 2020 mortality in the absence of Covid-19 was estimated using the historical average mortality and the simple linear extrapolation of historical mortality within each age group, place of death, and state. Excess deaths were divided into those assigned to Covid-19 and those not assigned to Covid-19 and compared by place of death, age category, and state. RESULTS: 26.2% of direct Covid-19 deaths were found to occur in nursing homes, while 63.1% of Covid-19 deaths occurred in hospitals and 5.3% occurred at home. The excess mortality rate was found to be the highest at home, with 1.78 more deaths per thousand person-years occurring in 2020 in the US than would have been expected in the absence of Covid-19, despite a low direct Covid-19 mortality rate of only 0.162 deaths per thousand person-years. Excess mortality rates in nursing homes across the US were relatively low at 0.296 deaths per thousand person-years, with a direct Covid-19 mortality rate (1.29 deaths per thousand person-years) that was higher than the estimated excess mortality. Despite the high direct Covid-19 mortality compared to excess mortality in nursing homes, a regression model examining the extent to which Covid-19 mortality and historical mortality predicted 2020 mortality in nursing homes suggested that for every 100 deaths assigned to Covid-19, there were 107 more all-cause deaths in 2020. Nursing home excess mortality was found to be highest in Utah, and lowest in North Carolina and New York. CONCLUSION: This work suggests that direct Covid-19 mortality captures most of the impact of Covid-19 on mortality in US nursing homes in individuals over the age of 65. A significant difference was discovered between direct Covid-19 mortality and excess mortality in decedent’s homes, which warrants additional study. / 2022-11-23T00:00:00Z

The State of Oregon is using the Placement Information Base, PIB, as part of an assessment process to determine the type of placement needed by Medicaid clients. While used for functional assessment, PIB has not been empirically studied for its use as a screening or predictive instrument to differentiate between the need for nursing home care and community care. This dissertation addresses the question of whether PIB is suitable for use as a screening instrument for nursing home placement decisions. Both PIB's measurement and predictive capabilities are examined. Using secondary PIB data on 2287 elderly Department of Human Resources clients, four highly reliable scales were developed. Alpha coefficients range from .75 to .90. These scales were found to measure the theoretically important dimensions of Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Social functioning and Mental functioning. Ten discriminant function equations, using PIB items and scales as predictors, were developed and cross-validated to compare those elderly currently residing in the community and those currently residing in nursing homes (n = 1772). For each of the functions the predictive accuracy was at least 79 percent with the derivation sample and even higher with the cross-validation sample. Functions containing only single items predicted as well or better than those containing scales. A comparison between the discriminant function equations and three a priori decision rules accompanying the PIB indicate that each of the discriminant function equations is predictively equivalent to one of the a priori decision rules and superior to the other two. The findings of this dissertation suggest that any one of the discriminant functions or the very high probability a priori decision rule could be used as an equitable and economically feasible screening instrument for nursing home placement. The choice of a particular function or the decision rule should be guided by practical and theoretical considerations. Policy implications and suggestions for future research are discussed.

Excerpt: The conclusions by Boerlage, Masman, Hagoort, Tibboel, Baar, and Dijk (2010) were interesting, but the supports for the conclusions were weak because of a number of shortcomings. The many weaknesses would prevent the immediate adoption of those conclusions in a health care setting.