bluuebunny/crossref_metadata_2025_split huggingface dataset:
PATTERNS OF PERFORMANCE ON QUALITY OF CARE AMONG U.S. HOME HEALTH AGENCIES, 2015-2017
Authors: Ma Chenjuan 
Published: November 2019

Abstract
Home healthcare is a critical care source for community-dwelling older adults. As the fastest growing healthcare sector in the US, quality of home healthcare is under increasing scrutiny. The purpose of this study is to examine patterns of performance on quality of care among US home health agencies. This is a 3-year cohort study using 2015-2017 Home Health Compare data and Provider of Services (POS) Files. In the dataset, each HHA was assigned a star rating (1-5) to reflect the overall quality of care. This indicator was calculated based on two process measures (timely initiation of care and drug education) and six outcome measures (e.g., hospitalization). We examined 8,020 HHAs in the US. Over the 3-year period, the number of HHAs receiving a star rating of 4 or 5 increased from 27% in 2015, 31% in 2016, to 32% in 2017. Roughly, 32% of the HHAs received a lower star rating and another 32% received a higher star rating from 2015 to 2016. Similarly, 30% of the HHAs received a lower star rating and 29% of the HHAs received a higher star rating from 2016 to 2017. Hospital-based HHAs were less likely to receive a star rating of 4 or 5. Larger HHAs (OR 1.34; 95% CI, 1.13-1.59) and HHAs with ownership changes (OR, 1.38; 95% CI 1.20-1.59) were more likely to improve their star ratings overtime. Our finding indicates dynamic changes in the quality of care within the US home healthcare sector.
TRENDS IN HEALTHCARE COSTS AND UTILIZATION ASSOCIATED WITH HEARING LOSS DIAGNOSIS OVER 10 YEARS
Authors: Reed Nicholas , Deal Jennifer A , Lin Frank , Yeh Charlotte 
Published: November 2019

Abstract
Hearing loss affects 38 million Americans and is associated with cognitive and physical decline. Moreover, hearing loss limits communication between patients and providers. In this study, we aimed to determine whether hearing loss diagnosis impacts healthcare cost and utilization. In the OptumLabs Data Warehouse insurance claims database (January 1, 1999 to December 31, 2016) we identified cases of age-related hearing loss (i.e. excluding conductive, ototoxic-induced, surgical-related hearing losses) in adults over the age of 50 years. Hearing loss cases were propensity-matched (nearest neighbor) to persons without hearing loss on multiple socioeconomic (income, region), demographic (age, sex, race, education), and health status (comorbidity count, cancer, dementia, baseline resource utilization) indices. There were 154,414, 44,852, and 4,728 subjects, respectively, at the 2-, 5-, and 10-year follow-up time points. We used regression modeling to examine healthcare cost (total expenditures), inpatient hospitalization, length of inpatient stay, outpatient visits, 30-day readmissions, and emergency department visits. Among 4,728 matched adults, hearing loss was associated with $22,434 (95% CI $18,219-$26,648) or 46% higher total healthcare costs over a 10-year period compared to those without hearing loss. Persons with hearing loss experienced more inpatient stays (Incident Rate Ratio, 1.47; 95% CI 1.29-1.68) and were at-risk (44% higher risk) for greater 30-day hospital readmission (Relative Risk, 1.44; 95% CI 1.14-1.81) at 10-years post index date. Similar trends were observed at 2- and 5-year time points across all measures. Importantly, these pathways may be amendable to hearing treatment via amplification which warrants future research preventative strategies.
HEALTH, WORRY, AND FOOD INSECURITY IN LOW-INCOME U.S. ADULTS: AN EXPLORATION OF MIDLIFE VULNERABILITY
Authors: Miller Lisa 
Published: November 2019

Abstract
Food insecurity, defined as the inability to afford and access nutritious foods to eat, is associated with poor health, higher healthcare costs, and increased risk of mortality (Gundersen et al., 2018). Moreover, food insecurity appears to accelerate aging processes. For example, food insecurity is associated with inadequate nutrition, which expedites the loss of muscle mass, increases mobility problems, increases financial worry, and increases the risk of frailty. While a good deal is known about food insecurity in later life, far less is known about midlife, which may be a time of unexplored vulnerability. We examined food insecurity in a sample (n=17,866; 2014 NHIS) of low-income (PIR&lt;3) young, early-middle, late-middle, and older adults (18-84), focusing on health challenges (chronic conditions, functional limitations) and financial worry as predictors and whether their effects varied with age. Multinomial logistic regression was used to assess the association of predictors with food insecurity and determine whether associations differed by age group, adjusted for covariates (e.g., sex, race/ethnicity, education, social security). Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife followed by young (33.7%) and older (20.2%) adults. Age moderated the relationship between food insecurity and risk factors (p &lt; .05 for both) such that health was stronger- but financial worry was weaker- in midlife (due to higher food insecurity in low- and high- worry groups). Midlife is a period of increased vulnerability to food insecurity, particularly for those with health challenges. Research is needed to inform prevention strategies to help ensure optimal aging.
SEX DIFFERENCE IN EARLY FRAILTY TRANSITIONS, HEALTHCARE USE, AND MEDICARE PAYMENT IN OLDER MEXICAN AMERICANS
Authors: Li Chih-Ying Cynthia , Karmarkar Amol , Chou Lin-Na , Snih Soham Al , Kuo Yong-Fang , Ottenbacher Kenneth 
Published: November 2019

Abstract
This study investigated sex difference in early frailty transitions on one-year follow-up healthcare utilization and Medicare payment. We used the linked Medicare claims data and the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey, using longitudinal analyses for 789 older Mexican Americans ≥70 years old in 1998/99. Participants were divided into five transition groups: 1) remain non-frail, 2) improve (pre-frail to non-frail, frail to non-frail, frail to pre-frail), 3) remained pre-frail, 4) remained frail, 5) worse (non-frail to pre-frail, non-frail to frail, pre-frail to frail) based on their frailty status between Wave 3 (1998/99) and Wave 4 (2000/01). Main outcomes were: (a) healthcare utilization (hospitalization, emergency room admission, physician visit) and (b) Medicare payment (total and outpatient payments) from 2000/01 to 12 months after. Mean age was 78.8 (SD=5.1) and 60.3% were female in 1998/99. We found sex had significant interaction effects on one-year follow-up hospitalization and Medicare outpatient payment. Compared to the remained no-frail group, males who remained pre-frail (Odds Ratio [OR]= 3.62, 95% CI=1.18-11.2), remained frail (OR= 7.59. 95% CI= 1.74-33.1) and worse (OR=4.54, CI=1.74-11.8) had higher risk for hospitalization. Males in the worse group also had significantly higher Medicare outpatient payment (OR=2.58, CI=1.46-4.56). Same associations were not observed in females. However, both genders used similar frequency and type of outpatient services, as the top services were evaluation and management services. Our results suggested research is needed to examine balance between sex differences, frailty improvements, resources needed and total care expenditure in this population.
THE EFFECT OF DUAL ELIGIBILITY ON IMPROVEMENT IN MOBILITY: VARIATION BY PATIENTS’ PRIMARY DIAGNOSIS
Authors: Vaughan Molly W , Broyles Ila H , Ingber Melvin J , Palmer Lauren A , McMullen Tara , Anderson Karyn K , Deutsch Anne 
Published: November 2019

Abstract
Dually eligible individuals (i.e., eligible for Medicare and Medicaid) often have worse health and greater functional limitations than patients eligible for Medicare only. For dually eligible patients receiving inpatient rehabilitation services following a major illness or injury, improvement in function may be lower than for Medicare-only patients. To our knowledge, this is the first study to examine the relationship of dual eligibility on improvement in mobility for inpatient rehabilitation facility (IRF) patients by 13 primary diagnosis groups (e.g., Stroke, Amputation). Data was collected on the IRF-Patient Assessment Instrument at admission and discharge for all IRF patients discharged during 2017 (N = 428,631). A generalized linear model was run for each primary diagnosis group to examine the effect of dual eligibility on change in mobility during an IRF stay, adjusting for sociodemographic factors, clinical factors, and comorbidities. The proportion of patients who were dually eligible varied among primary diagnosis groups (9.6% for Hip/Knee Replacements, Fractures and Multiple Trauma to 21.7% for Amputation). Compared to patients who were non-dually eligible, dually eligible patients had lower improvement in mobility across all 13 diagnostic groups. The strongest effect of dual eligibility on lower improvement in mobility was among patients with hip and/or knee replacements (β: -1.99, p&lt;0.001) and patients with non-traumatic spinal cord dysfunction (β: -1.83, p&lt;0.001). This research indicates that dually eligible patients may have worse functional mobility outcomes than non-dually eligible patients for some IRF primary diagnosis groups, and these patients may need additional support after discharge.
NURSING HOME ADMINISTRATOR STRESS, SATISFACTION, AND INTENTIONS TO LEAVE
Authors: Nelson H Wayne , Yang Bo Kyum , Engineer Cyrus Y , Carter Mary W 
Published: November 2019

Abstract
Previous studies reported that high Nursing Home Administrator (NHA) turnover correlates with low staff morale and poorer care outcomes. The purpose of this study was to assess how NHA job satisfaction (JS) (in five subscales: job content, coworkers, work demands, work load, work skills, and rewards) interacts with role conflict and ambiguity, autonomy, work conflict, and influence and to estimate the odds of having NHA’s intent to quit by degree of job satisfaction. A total 208 responses were collected from the online survey in 2017 among NHAs currently working in nursing homes in 5 states. We analyzed the data using descriptive statistics and ordinal logistic regression models. The findings suggested that NHAs were generally satisfied in all JS subscales and expressed moderately high levels of autonomy, neutral levels of work conflict, role conflict and role ambiguity. NHAs with good coworker relations (adjusted odds ratio [AOR]=0.67), fair job demands (AOR=0.68) and rewards (A0R=0.8), were less likely to harbor quitting intents. Interestingly, NHAs reporting higher job skills were more likely to consider leaving nursing homes (AOR=1.46). Overall, study findings are consistent with previous JS research with the exception that higher perceived skill efficacy was found to be associated with greater likelihood of quitting in the near future. This suggests perhaps that more highly skilled NHAs may now have less tolerance for work discomfort. These findings are presented in the context of earlier studies on NHA turnover as well as likely implications of changing market conditions.
ARE TRACK-AND-TRIGGER SYSTEMS GOOD NEWS FOR RESIDENTS IN LONG-TERM CARE FACILITIES? A MULTI-METHOD EVALUATION
Authors: Barker Robert O , Russell Siân , Stocker Rachel , Liddle Jennifer , Adamson Joy , Hanratty Barbara 
Published: November 2019

Abstract
Changes in physiological measurements such as blood pressure or temperature may signal deteriorating health before it is apparent. Early warning (or track and trigger) systems provide a framework to use such measurements to identify acute illness and prompt a timely response. They are in widespread use in acute hospitals across North America and Europe, but few have been validated in community settings. Hospitals in the UK have adopted the National Early Warning Score (NEWS) which measures temperature, respiratory rate, pulse, blood pressure, oxygen saturation and conscious level. This presentation describes a multi-method evaluation of the introduction of NEWS into 47 long-term care facilities. Staff with little or no healthcare training were tasked with digital recording of the NEWS. This multi-method evaluation consisted of a survey to explore staff views (n=42), a quantitative analysis of approximately 17,000 NEWS readings, and 21 semi-structured qualitative interviews with stakeholders. Survey and interview findings suggested that use of the score increased staff confidence in communication and care. There were many challenges to implementation, including practical difficulties in measuring vital signs, competing priorities for staff and a persistent lack of shared understanding across professional boundaries. Quantitative analysis of recorded scores described an increase in use of the NEWS over time, but wide variation in uptake between different facilities. Early warning systems may enhance management of acute illness in long-term care facilities but implementation is not straightforward. This presentation will discuss will discuss findings in depth - what worked, lessons learned and implications for the future.
HEALTH-RELATED QUALITY OF LIFE AND CARDIOVASCULAR DISEASE IN ASIAN AMERICAN AND PACIFIC ISLANDER OLDER ADULTS
Authors: Doan Lan , Takata Yumie , Hooker Karen , Mendez-Luck Carolyn , Irvin and Veronica L 
Published: November 2019

Abstract
Cardiovascular disease (CVD) is the leading cause of death for Asian American (AA), Native Hawaiian, and Pacific Islander (NHPI) older adults, and AAs/NHPIs have not enjoyed decreases in CVD mortality rates, as have non-Hispanic whites (NHWs). Heterogeneity exists in the prevalence of traditional CVD risk factors for AAs/NHPIs. Health-related quality of life (HRQOL) reflect physical and mental burdens beyond clinical burdens, which may help explain discrepant CVD rates and risk factors in AAs/NHPIs. We examined HRQOL among NHW and AA/NHPI Medicare Advantage enrollees with and without a CVD (i.e., coronary artery disease, congestive heart failure, myocardial infarction, and stroke) using the Medicare Health Outcomes Survey. The sample included 655,914 older adults who were 65 years or older, self-reported as AA/NHPI or NHW, and were enrolled in Medicare Advantage plans in 2011-2015. HRQOL was measured using the Veterans RAND 12-item survey and is composed of a physical component score (PCS) and mental component score (MCS), where higher scores reflect better physical and mental health, respectively. Multivariable linear regression was used to explore HRQOL and CVD prevalence. Asian Indian, Filipino, Vietnamese, Other Asian, and NHPI subgroups had lower overall PCS, and all AA/NHPI subgroups had lower overall MCS, compared to NHWs. Among those reporting having any CVD, PCS varied by CVD outcomes and subgroups, whereas MCS was lower for all CVD outcomes and for all but one AA/NHPI subgroups (Japanese), compared to NHWs. Attention to mental health for AA/NHPI older adults could be important for the equitable realization of healthy aging.
FACTORS ASSOCIATED WITH MEANINGFUL ACTIVITIES AMONG ETHNICALLY DIVERSE OLDER ADULTS
Authors: Adeniji Dolapo O , Hong Michin 
Published: November 2019

Abstract
Objectives: With aging, there is an increased chance for older adults to experience negative health outcome and lose independence. Previous studies have shown the positive influence of engagement in physical, religious, recreational and social activities on healthy aging. This study aims to examine the factors contributing to the frequency of activity participation that helps older adults achieve the goal of staying healthy. Method: A sample (n=480) aged 60-90 with M=74.31, SD=7.65, and female 55.6 % from Well Elderly II were surveyed for the study. Hierarchical regression analysis was performed to examine factors associated with the frequency of activity participation. Age, ethnicity, education and gender controlling for meaning ascribed to activity were entered in model I. While the independent variables: social support, perceived mental and physical health and meaning ascribed for activity participation were in model II. Model II (R2=57.8%) significantly improved the prediction of the outcome variable greater than model I (R2=13.4%). Results: Results showed that age, education, ethnicity, perceived mental health, physical health, social support were significant. Of all variables the meaning attributed to activity participation (β =59.2%, &lt;.001) is the most predictor of meaningful frequency of activity participation in older adults. This implies that the meaning individuals attribute to activity participation increases their frequency of activity participation. Also, age, education, and ethnicity play important role in understanding the importance of consistency in activity participation. Implications: Meaningful activity participation should be encouraged to enable older adults increase their participation in activities that promote healthy living.
ROLE OF RELIGIOUSNESS AND SPIRITUALITY AND SOCIAL NETWORKS IN DETERMINING DEPRESSION AMONG OLDER KOREAN AMERICANS
Authors: Roh Soonhee , Lee Yeon-Shim , Park So-Young 
Published: November 2019

Abstract
Korean Americans (KAs) are one of the fastest growing minority populations in the U.S. Depression is the most common psychological problem among older KAs. While the relationship between religiousness/spirituality (R/S) and well-being in later life is an important health concern, older KAs are often affiliated with a protestant church and have the highest church participation. This study assessed the role of R/S and social networks in determining depressive symptoms and identified the best predictors of depressive symptoms. Data were drawn from a cross-sectional survey with 200 older KAs residing in New York. Best-subsets regressions were used to evaluate the best predictors of depression. Findings indicated that nearly 30% of older KAs reported experiencing mild or severe depressive symptoms. The best model fit for depression involved physical health, R/S coping skills, social networks, and annual household income. Social networks and R/S coping skills were found to be a protective factor against depressive symptoms and may be an effective tool for health care strategies in the management of depression and health-promoting behaviors. Careful assessment of R/S and social networks among older KAs may provide a more comprehensive approach to traditional, biomedically derived clinical practices by focusing on the whole person in early identification of risk factors, prognosis, and intervention for depression. Health education and intervention could be framed in ways that strengthen such psychosocial coping resources for older KAs. Facilitating social participation and mobilizing R/S resources in a wide range of personally meaningful activities may mitigate psychological distress and enhance life satisfaction.
A PRESCRIPTION FOR WELLNESS: EXERCISE REFERRALS FOR PATIENTS AT A FEDERALLY QUALIFIED HEALTH CENTER
Authors: Benavidez Gabriel , Ylitalo Kelly 
Published: November 2019

Abstract
Physical activity improves quality of life and prevents or delays chronic disease, but most adults in the United States are inactive. Consultation and planning with a health care provider, specifically with an exercise “prescription,” may increase physical activity, but utilization patterns and success of such programs are not well understood. This study assessed the initial 6 months of an exercise prescription program at a large, federally-qualified health center during 2018 whereby adult patients were referred via prescription to personalized health coaching by a fitness advisor. A census of all adults (n=512) who received an exercise prescription was combined with attendance data from the on-site exercise facility to classify patients as never attended, 1 to 3 visits, and ≥4 visits. Ordinal logistic regression was used to examine patient characteristics from the electronic health record that influenced exercise facility attendance. Only 30.2% of adults (mean age 44.7 years (SD 14.4)) completed ≥1 visit and 21.7% completed ≥4 visits. We identified no significant utilization differences by sex, race/ethnicity, body mass index, diabetes, hypertension, or coronary artery disease, but adults aged ≥60 years had almost twice the odds of ≥4 visits (OR=1.97; 95% CI: 1.18, 3.33; p=0.01) compared to younger patients. Many adult patients did not participate in the exercise prescription program, but older adults were more likely to participate. Exercise prescription programs with personalized health coaching may be useful for older adult patients receiving care at a federally-qualified health center. Future work will examine if or how exercise prescriptions impact chronic disease self-management.
EXAMINING SEX DIFFERENCES WITHIN THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND EXECUTIVE FUNCTION IN OLDER ADULTS
Authors: Losinski Genna , Hicks Hilary J , Laffer Alex , Watts Amber 
Published: November 2019

Abstract
Research has demonstrated sex-associated differences in physical activity and its benefits on cognition in older adults. The present study explored differential associations between moderate-to-vigorous physical activity (MVPA) and executive function, which is known to decline with aging. N = 53 older adults without cognitive impairment (M = 73.19 years, SD = 6.53) wore accelerometers (Actigraph GT3X+) during 7 consecutive days. Activity intensity was categorized as light, moderate, or vigorous based on Freedson Adult Vector Magnitude cutpoints. Participants completed a battery of executive function tests: Digit Symbol Substitution Test, Verbal Fluency, Trail Making Test, and Stroop Color-Word Test. A cognitive composite score was created using confirmatory factor analysis. Women had a higher mean MVPA (4.57%) than men (2.64%, t (19.04) = -2.49, p = .022). However, executive function performance did not differ by sex (t (26.20) = 1.67, p =.107). The interaction between sex and time in MVPA did not predict performance on executive function, adjusting for age and education. Older age was the only significant predictor of poorer executive function (β = -0.038, p = .003). The current sample had limited engagement in MVPA (range 0.18-10.87%). These findings suggest that the amount of engagement in MVPA in a free-living environment may not be sufficient to demonstrate sex-associated differences in executive function performance. Future studies should explore executive function performance with other intensity levels and examine other areas of cognition.