Continuity of Care for Elderly Patients with Diabetes Mellitus, Hypertension, Asthma, and Chronic Obstructive Pulmonary Disease in Korea

We sought to assess continuity of care for elderly patients in Korea and to examine any association between continuity of care and health outcomes (hospitalization, emergency department visits, health care costs). This was a retrospective cohort study using the Korea National Health Insurance Claims Database. Elderly people, 65-84 yr of age, who were first diagnosed with diabetes mellitus (n=268,220), hypertension (n=858,927), asthma (n=129,550), or chronic obstructive pulmonary disease (COPD, n=131,512) in 2002 were followed up for four years, until 2006. The mean of the Continuity of Care Index was 0.735 for hypertension, 0.709 for diabetes mellitus, 0.700 for COPD, and 0.663 for asthma. As continuity of care increased, in all four diseases, the risks of hospitalization and emergency department visits decreased, as did health care costs. In the Korean health care system, elderly patients with greater continuity of care with health care providers had lower risks of hospital and emergency department use and lower health care costs. In conclusion, policy makers need to develop and try actively the program to improve the continuity of care in elderly patients with chronic diseases

What do we know about behavioral crises in dementia? A systematic review

Background: Behavioral crises in dementia are represented by a wide variety of symptoms, regularly require external intervention from professionals, and are reported as a risk factor for hospital admission. Little is known about the factors that are associated with them. Aim: To determine the factors associated with dementia-related behavioral crises. Methods: We searched MEDLINE, CINAHL, PsycINFO, EMBASE and AMED databases. An additional lateral search including reference lists was conducted. Two researchers screened all records for potential eligibility. Narrative synthesis was used to bring together the findings. Results: Out of the 5544 records identified, 24 articles (18 distinct studies) met the eligibility criteria. Aggression and agitation were the most common behaviors present at crises. Delusions, wandering / absconding and hallucinations were also key behaviors contributing to crises. Behavioral crises predominantly happened in the severe stages of dementia (according to MMSE scores), in people with dementia residing in their own homes and in long-term care, and were the catalyst for admissions to psychiatric inpatient settings, specialist-care units, long-term care settings, or for referrals to psychiatric community services. Lack of consistency in assessment of behavior, and management of agitation/aggression in dementia crises were evident. Conclusion: Interventions to reduce the likelihood of people with dementia-related behaviors reaching crisis point need to focus on both family and care home settings and incorporate aggression and agitation management. Future research should focus on determining the factors that could be addressed to prevent behavioral crises and the interventions and models of care that may help to prevent crises

Associations between feeding and development in preterm infants in the NICU and throughout the first year of life.

BACKGROUND: There is little published evidence regarding associations between feeding and development in preterm infants which could help identify infants most needing follow-up services. AIMS: To determine if preterm infant feeding and development were predictable throughout the first year of life and identify associations with maternal factors, neonatal factors, and socioeconomic measures. STUDY DESIGN: Prospective single-site study of the feeding and development of extremely and very preterm infants at three time points throughout the first year of life. SUBJECTS: Infants(NICU) discharge (DC) until 12 months corrected gestational age (CGA). OUTCOME MEASURES: Feeding and development were evaluated at NICU DC, 3 months and 12 months CGA. Maternal health, infant health, and socioeconomic measures were also recorded. RESULTS: Significant differences were found between assessments for feeding and development at each of the three time points: NICU DC (p = 0.026), 3 months CGA (p = 0.001), and 12 months CGA (p = 0.000); however, no associations were found between feeding and development at NICU DC and 12 months CGA (p = 0.137). Of the maternal factors determined to be significant, none were consistent enough as to be considered relevant. CONCLUSIONS: This study demonstrated that preterm infants with typical feeding and development at DC may go on to develop concerns in these areas, and those who scored abnormally at DC may perform typically during the first year of life. This study affirms the importance of NICU follow-up services to support feeding and development for all infants borngestation

Continuity of care and health care cost among community‐dwelling older adult veterans living with dementia

ObjectivesTo estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community‐dwelling older veterans with dementia.Data SourcesCombined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014‐2015.Study DesignFY 2014 COC was measured by the Bice‐Boxerman Continuity of Care (BBC) index on a 0‐1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long‐/short‐stay nursing home, and noninstitutional long‐term care (LTC) cost for medical (like skilled‐) and social (like unskilled‐) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders.Data CollectionCommunity‐dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N = 102 073).Principal FindingsMean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35 425. A 0.1 higher BBC resulted in (a)$4045 lower total cost; (b) $1597 lower acute inpatient cost,$119 lower ED cost, $4368 lower long‐stay nursing home cost; (c)$402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short‐stay nursing home cost.ConclusionsCOC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167831/1/hesr13541.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167831/2/hesr13541-sup-0001-Authormatrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167831/3/hesr13541_am.pd