Facility and resident characteristics associated with variation in nursing home transfers: evidence from the OPTIMISTIC demonstration project

Background: Centers for Medicare and Medicaid Services (CMS) funded demonstration project to evaluate financial incentives for nursing facilities providing care for 6 clinical conditions to reduce potentially avoidable hospitalizations (PAHs). The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) site tested payment incentives alone and in combination with the successful nurse-led OPTIMISTIC clinical model. Our objective was to identify facility and resident characteristics associated with transfers, including financial incentives with or without the clinical model. Methods: This was a longitudinal analysis from April 2017 to June 2018 of transfers among nursing home residents in 40 nursing facilities, 17 had the full clinical + payment model (1726 residents) and 23 had payment only model (2142 residents). Using CMS claims data, the Minimum Data Set, and Nursing Home Compare, multilevel logit models estimated the likelihood of all-cause transfers and PAHs (based on CMS claims data and ICD-codes) associated with facility and resident characteristics. Results: The clinical + payment model was associated with 4.1 percentage points (pps) lower risk of all-cause transfers (95% confidence interval [CI] - 6.2 to - 2.1). Characteristics associated with lower PAH risk included residents aged 95+ years (- 2.4 pps; 95% CI - 3.8 to - 1.1), Medicare-Medicaid dual-eligibility (- 2.5 pps; 95% CI - 3.3 to - 1.7), advanced and moderate cognitive impairment (- 3.3 pps; 95% CI - 4.4 to - 2.1; - 1.2 pps; 95% CI - 2.2 to - 0.2). Changes in Health, End-stage disease and Symptoms and Signs (CHESS) score above most stable (CHESS score 4) increased the risk of PAH by 7.3 pps (95% CI 1.5 to 13.1). Conclusions: Multiple resident and facility characteristics are associated with transfers. Facilities with the clinical + payment model demonstrated lower risk of all-cause transfers compared to those with payment only, but not for PAHs

The film business in the United States and Britain during the 1930s

Film was a most important product in the lives of the people during the 1930s. This paper sets out to analyse the underlying economic arrangements of the film industries of the U.S. and Britain during the decade in producing and diffusing this commodity-type to the population at large. In doing this, the paper finds a highly competitive industry that was built around showing films that audiences wanted to see, irrespective of the extent of vertical integration. It also examines the nature of the inter-relationship between the two industries and finds an asymmetry between the popularity of British films in the American market and that of American films in the British market. Our explanation for this is that the efforts of British firms on the American market were not sufficiently sustained to make a significant impact on American audiences

Digital disruption and innovation in distribution: Opportunities for research-based filmmaking in the new global screen ecology

Digital disruption manifesting through innovations in distribution is providing opportunities for the screen practices of academic, research based and independent filmmakers. Critical attention on distribution examines how digital intermediaries are changing the way filmmakers can connect their content to markets and educational audiences. In addition to enhanced prospects surrounding self-distribution, opportunities for research-based filmmaking emerging from online platforms and players continues to expand the global reach of what has traditionally been niche programming. Drawing on a range of best-practice examples from the Filmmaking Research Network (FRN) survey conducted in 2017 a collection of films are discussed in addition to three in-depth case studies tracking how the lead author’s filmmaking has responded to the digital distribution landscape