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Pre-admission screening of nursing home applicants: Implications for home care

Home Health Care Services Quarterly 1987年第1期8卷 53-73页

作者： Iversen, Laura Himes Polich, Cynthia Longseth InterStudy's Center for Aging & Long Term Care Exelsior MN United States InterStudy United States

An increasing number of states are developing programs to evaluate nursing home applicants prior to admission. The purpose of these Pre-Admission Screening (PAS) programs is to assure that nursing home placement is needed and appropriate. Both the number and scope of these programs have grown considerably in the last decade as states attempt to reduce inappropriate placements and control nursing home costs and utilization. The increase in PAS can have a significant impact on community services as clients are diverted from nursing homes to home care. This article uses the results of a recently completed national survey of state-administered PAS programs to indicate the impact of PAS on community care. PAS was defined as an on-site assessment of the need or appropriateness of nursing home care conducted by a disinterested third party prior to nursing home admission. State administrators of Medicaid and/or PAS in all states and the District of Columbia were contacted by phone to determine whether or not their state conducted PAS. States with PAS were sent a comprehensive mail survey, and 25 of these (81%) returned a survey. Data is presented regarding the scope of PAS programs, the types of clients participating in PAS, the variety of services coordinated or funded in conjunction with PAS, the types of recommendations made by screening teams (institutional vs. home care), and how respondents felt that PAS was impacting community services. The article concludes with a discussion of these results. © 1987 Taylor & Francis Group, LLC.

关键词：数据收集合格鉴定家庭医疗保健服务/标准 Medicaid/组织和管理医护疗养所/标准病人医疗护理计划/方法美国

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Individual versus Team Case Management in Optimizing Community Care for Chronically Ill Patients with Dementia

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Journal of Aging and Health 1990年第3期2卷 357-372页

作者： Zimmer, James G. Eggert, Gerald M. Chiverton, Patricia University of Rochester School of Medicine and Dentistry United States University of Rochester School of Nursing United States

Secondary analyses of a randomized trial comparing two models of case management of community residing chronically ill elderly showed that the greatest cost savings of the more intensive neighborhood-based team model, as opposed to the centralized individual model, were in the group with dementia. Estimated costs of health care in the team group were 41% lower than costs for the control group. No differences in survivorship, functional and care need status, or in caregiver satisfaction were found, suggesting no negative effect of reduction in use. Team case managers had much smaller caseloads, made many more home visits, (with much more counseling for family support), and made more referrals for medical evaluation, respite, and day care than did case managers for the control group. © 1990, Sage Publications. All rights reserved.

关键词：日常生活活动慢性病社区卫生服务/统计学和数值数据成本及成本分析痴呆/经济学长期医疗/组织和管理模型理论纽约病人医疗护理计划/方法病人医疗小组/统计学和数值数据老年人人类

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Models to promote medical health care delivery for indigent families: computerized tracking to case management.

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Journal of health & social policy 1990年第1期2卷 21-34页

作者： Kavanagh, K.T. Tate, N.P. Boling Center for Developmental Disabilities University of Tennessee Memphis.

Poor patient/parental medical compliance is one of the most important health care issues of today. Multiple interrelated factors contribute to this problem. Of prime importance is patient/parental maturity and knowledge. Reversal of this process is undoubtably harder than prevention. The cost effectiveness of various methods of intervention is discussed in relation to a large mid-south indigent population. Computerized patient tracking is cost efficient and effectively promotes compliance in a percentage of patients. Its additional utility is the identification and triage of patients, most in need of intervention, to existing social service personnel for family-centered case management. Family-centered case management holds the best hope of reversing the many factors adversely affecting patient compliance. However, this method is costly and requires a low ratio of clients to caseworkers in order to be effective. Community-centered patient management is less costly to implement and is very useful in tightly woven communities resistant to outside intervention. However, this method often has a high client to caseworker ratio and has less utility in dealing with complex medical problems.

关键词：病案系统计算机化未参加医疗保险者/统计学和数值数据密西西比病人医疗护理计划/方法病人依从贫困区提醒者系统社会工作/人力社会工作/组织和管理社会经济因素田纳西人类

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The brokerage model of long-term care: A rose by any other name

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Home Health Care Services Quarterly 1987年第2期8卷 23-43页

作者： Arnold, Diane University of California Berkeley CA 94720 1203 Tolman Hall United States

The evolution of the organization of long-term care services in the United States has resulted in a fragmented non-system of long-term care for the elderly. The proposed solution to the crises in long-term care is to coordinate services through a pure brokerage model of service organization. The author argues that such a model cannot meet the criteria for a fully coordinated system because it does not restructure or reform the current organization of services. It is suggested that a consolidated model will restructure and reform the system. © 1987 by The Haworth Press, Inc. All rights reserved.

关键词：长期医疗/组织和管理模型理论病人医疗护理计划/方法病人医疗小组美国老年人人类

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Pastoral care planning: a process-oriented approach for mental health ministry.

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Journal of pastoral care 1991年第3期45卷 268-278页

作者： Weiss, F.S. Jackson Memorial Hospital Miami 33136. FL United States

Proposes a systematic and systemic pastoral diagnosis model based on the formulations of James W. Fowler, Stephen S. Ivy, and Wayne E. Oates. Illustrates the application of the model via a care-planning case study.

关键词：精神障碍/诊断精神障碍/心理学精神卫生服务/组织和管理模型护理学模型心理学牧师心理治疗/组织和管理病人医疗护理计划/方法病人医疗小组精神病科医院宗教和心理学美国人类

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Teaching wound care in the home

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Home Health Care Services Quarterly 1990年第3-4期11卷 157-195页

作者： Grupp, Kitty Albert, Marilyn Department of Community Health Care Systems School of Nursing University of Washington Seattle WA 98195 United States

A survey of Medicare-certified agencies in Alaska, Idaho, Montana, Oregon, and Washington identified wound care and teaching wound care as being among the highest ranked clinical problems related to earlier hospital discharges that have resulted from Medicare Diagnostic Related Groupings (DRGs). Home care nurses are treating increasingly complex wounds and are required to teach complex wound care skills to clients and caregivers. This paper provides guidelines and resources to home care nurses for teaching wound care to their elderly clients and caregivers. The process of developing and implementing a teaching plan is described through the use of the community health nursing process. Following the presentation of the process content, a sample teaching wound care plan and sample teaching handouts are presented with a list of available teaching resources about wound care. © 1990 Taylor & Francis Group, LLC.

关键词：表格和记录管理家庭医疗保健服务/组织和管理病人医疗护理计划/方法规划技术美国创伤和损伤/护理老年人人类

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Documentation of Occupational Therapy Services: A Process Model

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Canadian Journal of Occupational Therapy 1983年第5期50卷 171-175页

作者： Llorens, Lela A. Donaldson, Karen Department of Occupational Therapy San Jose State University Washington Square San Jose California 95192 � 0059 United States

This paper describes a process model of occupational therapy and the Occupational Therapy Sequential Client Care Record (OTSCCR). The OTSCCR incorporates the model and provides comprehensive documentation of occupational therapy services from referral through outcome of intervention. © 1983, Canadian Association of Occupational Therapists (CAOT). All rights reserved.

关键词：医院科室/组织和管理病案/标准模型理论职业疗法科医院/组织和管理病人医疗护理计划/方法

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Level of care: Assessment and service delivery

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Journal of Mental Health Administration 1986年第1期13卷 24-26页

作者： Herman, Samuel Creedmoor Psychiatric Center's geriatric division Queens Village NY United States

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Prescreening at-risk elders for entry into a community-based long-term care program

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Home Health Care Services Quarterly 1987年第1期8卷 75-86页

作者： Applebaum, Robert A. Wilson, Nancy L. Sociology and Scripps Gerontology Center Research Fellow at Miami University United States Instructor in Medicine at Baylor College of Medicine Texas United States

Despite the expansion of community-based service alternatives, demand for case coordinated community care continues to rise. Many programs, under pressure to target their services to the most disabled, have developed comprehensive entry criteria to determine eligibility. Their criteria generally require an in-person assessment to make the determination, but because of the volume of potential applicants, in-person assessment of each applicant has proven to be impractical. Although most programs have developed some type of screening method and a wide range of approaches are used, little research exists to validate the screening efforts. This study reports on a screening method used in the national channeling demonstration and compares the results of a telephone screen to the results of an in-person assessment. © 1987 Taylor & Francis Group, LLC.

关键词：社区卫生服务/标准合格鉴定评价研究长期医疗/标准病人医疗护理计划/方法美国老年人人类

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INITIAL KNOWLEDGE AND ATTITUDES AS PREDICTORS OF INTERVENTION EFFECTS - THE INDIVIDUAL MANAGEMENT PLAN

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PATIENT COUNSELLING AND HEALTH EDUCATION 1981年第1期3卷 30-42页

作者： GLANZ, K KIRSCHT, JP ROSENSTOCK, IM UNIV MICHIGAN SCH PUBL HLTHDEPT HLTH BEHAV & HLTH EDUCANN ARBORMI 48109

This paper addresses questions concerning the effects of patient education strategies to increase adherence to antihypertensive medical regimens. It endeavors to fill gaps in our knowledge about intervention effects that may link research findings with health care applications. Data from a community intervention study of 432 hypertensives are used to address two broad questions relating research on patient education to health care practice: Do interventions have different effects on individuals who differ with respect to initial attitudes or knowledge, and to what extent do interventions produce changes in the factors thought to mediate their effects on behavior? This investigation tests a client-oriented approach to the delivery of interventions, the Individual Management Plan (IMP). The IMP approach is based on the hypothesis that interventions will be differentially effective for individuals with varying levels of initial attitudes and knowledge thought to mediate the effects of the interventions on behavior. Analysis of variance, correlational analyses, and analysis of covariance models are used to test various aspects of this hypothesis. Analyses are performed for adherence to medication regimens, dietary sodium restrictions, and weight-loss recommendations. The results of analyses offer only minimal support for the IMP hypothesis. The state of the art and constraining factors in the study are examined to guide future applications of the IMP approach.

关键词：高血压/心理学密执安模型心理学病人医疗护理计划/方法病人依从人类

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