Reports from the field-Medicaid/Medicare issues
Study finds nutrition tool predicts future problems
The DETERMINE nutrition health screening tool developed by the Nutrition Screening Initiative in Washington, DC, identifies high-risk older adults who without treatment are likely to have disability or depression within one year, according to a recent study in the Journal of the American Geriatric Society.
Researchers found that when used as a secondary screening instrument, the DETERMINE checklist correctly identified in advance 68.8% of high-risk seniors who would become disabled and 65% of high-risk seniors who would have 12 or more depressive symptoms a year later. They noted that a battery of assessment tools, which includes the physical functioning of the sickness impact scale, geriatric depression scale, and general health scores, also could predict future disability and depression, but it would require answering a combined 76 questions and place a greater burden on both patients and health care providers than the 10-question DETERMINE checklist. (For more details and a copy of the checklist, see Case Management Advisor, July 1999, pp. 100-104 and insert.)
[Also see: Boult C, Beate Krike U, Flood Urdanigarin K, et al. The validity of a nutritional status as a marker for future disability and depressive symptoms among high-risk older adults. JAGS 1999; 47:995-999. A free copy of the checklist also can be obtained, as can a copy of the study, by sending a self-addressed, stamped envelope or e-mail message to Nutrition Screening Initiative, 1010 Wisconsin Ave. N.W., Suite 800, Washington, DC 20007. E-mail: [email protected].]
Special units, more docs reduce risk of hospitalization
Anywhere from 13% to 63% of nursing home residents are hospitalized each year. These inpatient admissions are not only costly but often cause relocation stress in the elderly and increase the risk of hospital-acquired infections. A recent study found that elderly adults who live in nursing homes with special care units, more physicians, and physician extenders such as nurse practitioners or physician assistants are less likely to be hospitalized than residents of nursing homes without those resources.
Researchers analyzed 1993 data from 10 states on 2,080 residents in 253 nursing homes. They looked at the effect facility characteristics, such as whether a facility had a special care unit, on inpatient admission rates while controlling for resident characteristics known to affect the decision to hospitalize, such as advanced age and co-morbidities. The study found that residents in facilities with special care units were 30% less likely to be hospitalized. Other findings include:
• No correlation was found between nursing staff levels and hospitalization, but residents of facilities with greater than the median full-time equivalent physicians per 100 beds were 21% less likely to be hospitalized.
• The presence of physician extenders in the nursing home reduced the risk of hospitalization by 41%.
[See: Intrator O, Castle NG, Mor V. Facility characteristics associated with hospitalization of nursing home residents. Medical Care 1999; 37:228-237.]
Study finds self-reported health status predicts utilization
The answer to a single question about general health status strongly predicts a person's use of health care services, according to a recent study in the journal Effective Clinical Practice.
Researchers asked patients participating in a Medicare beneficiaries study to rate their health as excellent, very good, good, fair, or poor. They found that a patient's response to that single question accurately predicted the use of health care services over the next 12 months.
Results include:
• 18% of patients rated their health as excellent and had an age and sex-adjusted annual health care expenditure of $1,656.
• 7% rated their health as poor and had an age and sex-adjusted annual health care expenditure of $8,743.
• Those who rated their health as poor had 675 hospitalizations per 1,000, compared with 136 per 1,000 for those who rated their health as excellent.
[See: Bierman AS, Bubolz TA, Fisher ES, et al. How well does a single question about health predict the financial health of Medicare managed care plans? Effec Clini Practice 1999; 2:55-56.]
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