67 research outputs found
Caregiving Immediately After Stroke: A Study of Uncertainty in Caregivers of Older Adults
BACKGROUND: Caregivers of stroke survivors experience high rates of mental and physical morbidity. Stroke has sudden onset, and the outcome is not immediately known. Uncertainties surrounding the new caregiving role may not only necessitate major changes in the lives of family caregivers but also contribute to negative health outcomes for the caregiver.
PURPOSE: The purposes of this study were to describe caregiver uncertainty across the early weeks after a family member\u27s stroke and to explore characteristics of caregivers and stroke survivors associated with that uncertainty.
METHODS: A prospective, longitudinal exploratory observational study was conducted with a convenience sample of 40 caregivers and older adult (≥65 years) stroke survivors recruited from urban acute care settings in the mid-Atlantic region. Caregivers were enrolled by 2 weeks poststroke (T1) and revisited 4 weeks later (T2). Uncertainty was measured usingthe Mishel Uncertainty in Illness Scale for Family Members. An unadjusted linear mixed model was computed to examine significant associations between each caregiver or stroke survivor characteristic and repeated measures of uncertainty.
RESULTS: Uncertainty at T1 (83.73 ± 23.47) was higher than reported in other caregiver populations and remained high 6 weeks poststroke (T2: 85.23 ± 23.94). Each of the following characteristics was independently associated with greater caregiver uncertainty: caregivers\u27 older age (p = .019), being a spouse (p = .01), higher stress (p \u3c .001), more depressive symptoms (p = .001), more comorbidities (p = .035), and poorer coping capacity (p = .002) and stroke survivors\u27 recurrent stroke (p = .034), poorer functional status (p = .009), and insurance type (p = .008).
CONCLUSIONS: Caregivers experienced persistently high uncertainty during the first 6 weeks poststroke. Better understanding of uncertainty, its associated characteristics, and its outcomes may help clinicians identify caregivers at highest risk who may benefit from targeted interventions
Recommended from our members
Predictors of Payer Mix and Financial Performance Among Safety Net Hospitals Prior to the Affordable Care Act.
Objective: To use audited hospital financial statements to identify predictors of payer
mix and financial performance in safety net hospitals prior to the Affordable Care Act.
Data Sources/Setting: We analyzed the 2010 financial statements of 98 large urban
safety net hospital systems in 34 states, supplemented with data on population
demographics, hospital features, and state policies.
Study Design: We used multivariate regression to identify independent predictors of
three outcomes: 1) Medicaid-reliant payer mix (hospitals for which at least 25% of
hospitals days are paid for by Medicaid); 2) Safety net revenue-to-cost ratio (Medicaid
and Medicare Disproportionate Share Hospital payments and local government transfers,
divided by charity care costs and Medicaid payment shortfall); and 3) Operating margin.
Principal Findings: Medicaid-reliant payer mix was positively associated with more
inclusive state Medicaid eligibility criteria and more minority patients. More inclusive
Medicaid eligibility and higher Medicaid reimbursement rates positively predicted safety
net revenue-to-cost ratio. University governance was the strongest positive predictor of
operating margin.
Conclusions: Safety net hospital financial performance varied considerably. Academic
hospitals had higher operating margins, while more generous Medicaid eligibility and
reimbursement policies improved hospitals’ ability to recoup costs. Institutional and state
policies may outweigh patient demographics in the financial health of safety net hospitals
Student writers at work and in the company of other writers: The Bedford prizes
New Yorkxxvi, 739 p.; 23 cm
- …