Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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A.3 Elder Health
A.3 Elder Health
Pages 229-241
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From page 229... ...
Next, the need for a full continuum of care for the frail elderly will become fully apparent in the next several decades, greatly expanding the demand for nursing home capacity, congregate care facilities, adult day care programs, and respite as well as other care giver support programs. The growth of capacity across this full continuum will be accelerated by the further penetration of managed care, since integrated systems of managed care will continue to drive down hospital use.
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From page 230... ...
Even within the domain of clinical activities, some critical services for sustaining elder health (e.g., annual influenza vaccination) may be the "product" of multiple providers such as the public health department or senior citizen centers, as well as the responsibility of clinical organizations.
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From page 231... ...
In these data sets or others, potential indicators include a large universe of utilization and outcomes measures expressed as annual rates per thousand Medicare- or Medicaid-eligible persons living in a geographically defined residence community, ideally divided into two age strata, 65–84 years of age and 85 and over. These might include annual rates for mortality, hospitalization, nursing home days, physician visits, myocardial infarction, stroke, hip fracture, transurethral resection of the prostate, cholecystectomy, and coronary artery bypass surgery.
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From page 232... ...
Cerebrovascular accident inpatient discharge rate TIA inpatient discharge rate Cerebrovascular disease mortality rate Cancer Mammography screening rate Breast cancer stage at diagnosis (local, regional, distant stages) Breast cancer five-year survival rate (by local, regional, distant stages at diagnosis)
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From page 233... ...
Cervical cancer mortality rate Sigmoidoscopy screening rate Colorectal cancer stage at diagnosis (local, regional, distant stages) Colorectal cancer mortality rate Lung cancer rate Lung cancer mortality rate Common Surgical Procedures Laminectomy rate Laminectomy average length of stay Appendix rupture rate Appendectomy average length of stay Negative appendectomy rate Cholecystectomy rate Percentage of cholecystectomies performed laparoscopically Cholecystectomy average length of stay Laparoscopic cholecystectomy average length of stay Hysterectomy rate Percentage of hysterectomies performed vaginally Percentage of vaginal hysterectomies laparoscopically assisted Hysterectomy average length of stay Other Adult Health Diabetes inpatient discharge rate Percentage of diabetics receiving annual retinal exam Rate of flu shots in adults > 65 Pneumonia/pleurisy inpatient discharge rate Adult asthma/bronchitis inpatient discharge rate Average length of survival for AIDS patients Mental Health and Substance Abuse Rate of outpatient follow-up after inpatient discharge Suicide rate NOTE: AMI, acute myocardial infarction; CABG, coronary artery bypass graft; ICU, intensive care unit; LBW, low birth weight; TIA, transient ischemic attack; VLBW, very low birth weight.
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From page 234... ...
, low-intensity periodic nursing or medical services (e.g., checking vital signs, blood sugar, or medication compliance; changing dressings) , and institutional services (e.g., adult day care, congregate care, senior housing with modified physical and social environments, nursing home care, respite care)
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From page 235... ...
, Area Agencies on Aging, senior citizen centers, or medical care plans operating in the community. Establishing accountability for maintaining health status would certainly be difficult, but it could be achieved if health status information were available for all and if individual organizational performance could be characterized on the basis of health status maintained in served populations (adjusted for age and gender)
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From page 236... ...
, and community long-term care services (e.g., adult day care, congregate care, senior housing with modified physical and social environments, nursing home care, respite
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From page 237... ...
Property ownership is an indirect measure of economic well-being but is a major component of the personal estate of older people in our society. Other possible approaches to assessing economic well-being might be to use Internal Revenue Service data to characterize income or bank data to measure savings, but both of these approaches seem less feasible.
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From page 238... ...
Health improvement initiatives might easily focus on any of these indicator sectors -- from long-term care capacity to improving the quality of life for frail elderly residing in nursing homes. Any of these measures take on additional meaning if they can be compared (from one community to another or to a statewide average measure)
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From page 239... ...
1995. Performance Indicators: An Overview of Private Sector, State and Federal Efforts to Assess and Document the Characteristics, Performance and Value of Health Care Delivery: Report on Field Research.
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From page 240... ...
240 TABLE A.3-2 Field Model Mapping for Sample Indicator Set: Elder Health Field Model Domain Construct Sample Indicators Data Sources Stakeholders Health Care, Reduce impact of disease Self-rated health status Community survey Health care providers Disease among the elderly (BRFSS data from Health care plans health department) , State health agencies Area Agencies on Local health agencies Aging, senior citizen Medicare centers, medical Agency on Aging care plans Community organizations Physician visits per annum Medicare Special health risk groups General public Area-adjusted average per Medicare capita medical care expenditures for the elderly Influenza vaccination Medicare Advanced-stage cancers State cancer of the breast registry, Medicare Percentage of elderly State health residing in a nursing home department on a given date surveys, census, Medicare IMPROVING HEALTH IN THE COMMUNITY
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From page 241... ...
Social Improve the quality Presence of the full Area Agency on Health care providers Environment, of life of elderly continuum of care Aging Health care plans Prosperity by providing supportive Medicare social services Library readership, voting Community survey, Local health agencies voting rolls Social service agencies Area Agency on Aging Senior citizen income and Community surveys, Business and industry A.3 ELDER HEALTH property ownership census, local Nursing homes and property tax office, caretaking possibly IRS organizations Community organizations Disease or patient organizations General public Physical Decrease hazards to Crimes against elderly Uniform crime Health care providers Environment elderly in the physical persons or residential reports, other Health care plans environment burglaries police data Medicare Local health agencies Falls among the elderly Hospital discharge Social service agencies that result in hospitalization data using Police departments ICD-9-CM E-codes, Area Agency on Aging if available Business and industry (otherwise N-codes Community for hip fractures) organizations General public NOTE: BRFSS, Behavioral Risk Factor Surveillance System; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; IRS, Internal Revenue Service.
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