Accountable Care Organizations in California: Promise and Performance

California has more accountable care organizations (ACOs) than any other state in the country, with particularly rapid growth over the past two years. This report introduces new evidence that ACOs improve the quality of care, increase patient satisfaction, and may reduce costs

Can Preschoolers be Health Messengers to Promote Breast Health among Chinese Americans?

Women’s limited knowledge about breast cancer screening (BCS), combined with differences in Eastern and Western disease prevention concepts, may contribute to late-stage breast cancer diagnosis among minorities. Children can be conduits of knowledge transfer to adults. This pilot study tested the use of a culturally-tailored theatrical preschool performance in increasing Chinese American women’s knowledge of BCS guidelines. Chinese preschool children relayed BCS guidelines through a culturally-tailored theatrical performance. Data were collected from 177 Chinese American women (84% foreign-born) who completed pre- and post-performance surveys. Findings suggested that promoting BCS guidelines through a culturally-tailored preschool theatrical performance significantly increased participants’ knowledge of the guidelines. Interventions involving young children as change agents to deliver simple health messages such as BCS guidelines are feasible and promising to increase knowledge and desired behavioral change within the target population. Further empirical investigations are warranted in larger randomized controlled trials

Functional disability in late-middle-aged and older adults admitted to a safety-net hospital.

ObjectivesTo determine the prevalence of preadmission functional disability in late-middle-aged and older safety-net inpatients and to identify characteristics associated with functional disability by age.DesignCross-sectional analysis.SettingSafety-net hospital in San Francisco, California.ParticipantsEnglish-, Spanish-, and Chinese-speaking community-dwelling individuals aged 55 and older admitted to a safety-net hospital with anticipated return to the community (N = 699).MeasurementsAt hospital admission, participants reported their need for help performing five activities of daily living (ADLs) and seven instrumental activities of daily living (IADLs) 2 weeks before admission. ADL disability was defined as needing help performing one or more ADLs and IADL disability as needing help performing two or more IADLs. Participant characteristics were assessed, including sociodemographic characteristics, health status, health-related behaviors, and health-seeking behaviors.ResultsOverall, 28.3% of participants reported that they had an ADL disability 2 weeks before admission, and 40.4% reported an IADL disability. The prevalence of preadmission ADL disability was 28.9% of those aged 55 to 59, 20.7% of those aged 60 to 69, and 41.2% of those aged 70 and older (P < .001). The prevalence of IADL disability had a similar distribution. The characteristics associated with functional disability differed according to age; in participants aged 55 to 59, African Americans had a higher odds of ADL and IADL disability, whereas in participants aged 60 to 69 and aged 70 and older, inadequate health literacy was associated with functional disability.ConclusionPreadmission functional disability is common in individuals aged 55 and older admitted to a safety-net hospital. Late-middle-aged individuals admitted to safety-net hospitals may benefit from models of acute care currently used for older adults that prevent adverse outcomes associated with functional disability

Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital.

BackgroundLittle is known about hospitalization-associated disability (HAD) in older adults who receive care in safety-net hospitals.ObjectivesTo describe HAD and to examine its association with age in adults aged 55 and older hospitalized in a safety-net hospital.DesignSecondary post hoc analysis of a prospective cohort from a discharge intervention trial, the Support from Hospital to Home for Elders.SettingMedicine, cardiology, and neurology inpatient services of San Francisco General Hospital, a safety-net hospital.ParticipantsA total of 583 participants 55 and older who spoke English, Spanish, or Chinese. We determined the incidence of HAD 30 days post-hospitalization and ORs for HAD by age group.MeasurementsThe outcome measure was death or HAD at 30 days after hospital discharge. HAD is defined as a new or additional disability in one or more activities of daily living (ADL) that is present at hospital discharge compared to baseline. Participants' functional status at baseline (2 weeks prior to admission) and 30 days post-discharge was ascertained by self-report of ADL function.ResultsMany participants (75.3 %) were functionally independent at baseline. By age group, HAD occurred as follows: 27.4 % in ages 55-59, 22.2 % in ages 60-64, 17.4 % in ages 65-69, 30.3 % in ages 70-79, and 61.7 % in ages 80 or older. Compared to the youngest group, only the adjusted OR for HAD in adults over 80 was significant, at 2.45 (95 % CI 1.17, 5.15).ConclusionsIn adults at a safety-net hospital, HAD occurred in similar proportions among adults aged 55-59 and those aged 70-79, and was highest in the oldest adults, aged ≥ 80. In safety-net hospitals, interventions to reduce HAD among patients 70 years and older should consider expanding age criteria to adults as young as 55

Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital.

BackgroundLittle is known about hospitalization-associated disability (HAD) in older adults who receive care in safety-net hospitals.ObjectivesTo describe HAD and to examine its association with age in adults aged 55 and older hospitalized in a safety-net hospital.DesignSecondary post hoc analysis of a prospective cohort from a discharge intervention trial, the Support from Hospital to Home for Elders.SettingMedicine, cardiology, and neurology inpatient services of San Francisco General Hospital, a safety-net hospital.ParticipantsA total of 583 participants 55 and older who spoke English, Spanish, or Chinese. We determined the incidence of HAD 30 days post-hospitalization and ORs for HAD by age group.MeasurementsThe outcome measure was death or HAD at 30 days after hospital discharge. HAD is defined as a new or additional disability in one or more activities of daily living (ADL) that is present at hospital discharge compared to baseline. Participants' functional status at baseline (2 weeks prior to admission) and 30 days post-discharge was ascertained by self-report of ADL function.ResultsMany participants (75.3 %) were functionally independent at baseline. By age group, HAD occurred as follows: 27.4 % in ages 55-59, 22.2 % in ages 60-64, 17.4 % in ages 65-69, 30.3 % in ages 70-79, and 61.7 % in ages 80 or older. Compared to the youngest group, only the adjusted OR for HAD in adults over 80 was significant, at 2.45 (95 % CI 1.17, 5.15).ConclusionsIn adults at a safety-net hospital, HAD occurred in similar proportions among adults aged 55-59 and those aged 70-79, and was highest in the oldest adults, aged ≥ 80. In safety-net hospitals, interventions to reduce HAD among patients 70 years and older should consider expanding age criteria to adults as young as 55