Changing patterns of mortality and hospitalized morbidity on the Navajo Indian Reservation.

This is the final report from the Navajo Area Indian Health Service (IHS) on mortality patterns and hospitalized morbidity on the Navajo Indian Reservation. The primary purpose of the study was to document changing causal patterns of morbidity and mortality of the Navajo in order to apprise the IHS of the types of services that are currently most needed, and of needs which may be projected in the near future. The data presented in this study was derived from three sources. The first came from the hospital discharge records of all Navajo patients seen in the IHS and IHS contract hospitals in the IHS Navajo, Phoenix, and Albuquerque Areas from 1972 to 1978. The second data set was population estimates of Navajos residing in different land management districts on the Reservation in 1975. The third set was economic data gathered from a random sample of households from each management district in 1974. The descriptive details of mortality and morbidity are presented in charts and graphic representations. The socioeconomic data were analyzed through multiple stepwise regression, and are presented in a set of regression tables. Relevant comparative and historic demographic data were drawn from the literature and presented in a series of charts and tables. The major findings of the study are as follows: 1) Navajo children\u27s physical health has improved since 1955; 2) the health of elderly patients has declined; 3) preceding observations may be explained as much by changing family, social, and economic patterns, as by any changes in the administration of Indian health care; 4) the incidences of infectious diseases has declined; 5) the instances of accidental death and injury, and mental health related problems have increased; 6) socioeconomic factors impact upon the Navajos in causal terms for most categories of disease or accident; and 7) these same factors affect the Navajo\u27s ability or inability to make themselves available to services. The authors suggest that services be expanded to provide care to the chronically ill and elderly both at home and in nursing homes. In addition, they recommend that IHS prepare to manage programs designed to provide services to children with behavioral, learning, and emotional problems. These children may be referred by families or the schools, which would require institutional linkages and community education programs. The report concludes by suggesting that the development of large scale extractive industries on the reservation increases the opportunity for occupational and environmental hazards, which may have direct impact on the health of the population

A systematic review of different models of home and community care services for older persons

<p>Abstract</p> <p>Background</p> <p>Costs and consumer preference have led to a shift from the long-term institutional care of aged older people to home and community based care. The aim of this review is to evaluate the outcomes of case managed, integrated or consumer directed home and community care services for older persons, including those with dementia.</p> <p>Methods</p> <p>A systematic review was conducted of non-medical home and community care services for frail older persons. MEDLINE, PsycINFO, CINAHL, AgeLine, Scopus and PubMed were searched from 1994 to May 2009. Two researchers independently reviewed search results.</p> <p>Results</p> <p>Thirty five papers were included in this review. Evidence from randomized controlled trials showed that case management improves function and appropriate use of medications, increases use of community services and reduces nursing home admission. Evidence, mostly from non-randomized trials, showed that integrated care increases service use; randomized trials reported that integrated care does not improve clinical outcomes. The lowest quality evidence was for consumer directed care which appears to increase satisfaction with care and community service use but has little effect on clinical outcomes. Studies were heterogeneous in methodology and results were not consistent.</p> <p>Conclusions</p> <p>The outcomes of each model of care differ and correspond to the model's focus. Combining key elements of all three models may maximize outcomes.</p

Social Relationships and Mortality Risk: A Meta-analytic Review

In a meta-analysis, Julianne Holt-Lunstad and colleagues find that individuals' social relationships have as much influence on mortality risk as other well-established risk factors for mortality, such as smoking

Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial

Background Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units. Methods INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides – non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides’ quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument – Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention. Discussion INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes. Trial registration ClinicalTrials.gov Identifier: NCT02695836 . Date of registration: 24 February 201