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Milwaukee, WI, United States

Yoo J.W.,Center for Senior Health and Longevity | Yoo J.W.,University of Wisconsin - Madison | Choi J.B.,Yonsei University | Kim S.J.,Yonsei University | And 7 more authors.
Journal of the American Medical Directors Association | Year: 2013

Background: To identify the factors associated with stay in a skilled nursing facility (SNF) among new enrollees who did not fully participate in therapy sessions. Methods: Data (n= 36,133) were obtained from the Minimum Data Set version 2.0 in the state of Michigan in 2009. Study participants were new SNF enrollees (n= 699) who did not fully participate in therapy sessions despite their desire to return to the community. Multivariate logistic regressions were performed to identify factors contributing to remaining in a nursing home for 91 days or longer. Results: New SNF enrollees were more likely to remain in nursing home when they were depressed (odds ratio [OR]= 1.41; 95% confidence interval [CI], 1.09-2.08; P= .01), experiencing delirium (OR= 3.20; 95% CI, 1.48-5.92; P < .001), were not in pain (OR= 0.83; 95% CI, 0.60-0.95; P= .03), or in less complex care (OR= 0.57; 95% CI, 0.44-0.81; P < .01). Conclusions: A higher number of new SNF enrollees than previously reported were likely to stay in nursing homes (28.0%). Depression and delirium were associated with stay in an SNF, while pain and higher complexity of care were associated with returning to the community. © 2013 American Medical Directors Association, Inc. Source

Yoo J.W.,University of Wisconsin - Milwaukee | Jabeen S.,Aurora Senior Services | Bajwa T.,Jr. | Kim S.J.,Namseoul University | And 5 more authors.
Research in Gerontological Nursing | Year: 2015

Hospital readmission of patients discharged to skilled nursing facilities (SNFs) is common and costly with increasing public attention over the past decade, particularly in light of the new health care environment surrounding the advent of the Affordable Care Act. The purpose of the current systematic review is to critically examine prevalence, predictors, and costs of hospital readmission of SNF residents found in the medical literature. Individual resident, facility, and intervention factors predicting hospital readmission of SNF residents were studied. Despite the heterogeneity of the reviewed articles’ data sources and study designs, the existing literature asserts that hospital readmission of SNF residents is associated with individual resident and facility characteristics. Implementation of promising intervention programs can promote quality of care and reduce hospital readmission of SNF residents. © SLACK Incorporated. Source

Lee J.H.,Hanyang University | Kim S.J.,Yonsei University | Lam J.,University of Wisconsin - Madison | Kim S.,Case Western Reserve University | And 3 more authors.
Journal of Multidisciplinary Healthcare | Year: 2014

Background: Functional decline of hospitalized older adults is common and triggers health care expenditures. Physical therapy can retard the functional decline that occurs during hospitalization. This study aims to examine whether shared situational awareness (SSA) intervention may enhance the benefits of physical therapy for hospitalized older persons with a common diagnosis, heart failure. Method: An SSA intervention that involved daily multidisciplinary meetings was applied to the care of functionally declining older adults admitted to the medicine floor for heart failure. Covariates were matched between the intervention group (n=473) and control group (n=475). Both intervention and control groups received physical therapy for ≥0.5 hours per day. The following three outcomes were compared between groups: 1) disability, 2) transition to skilled nursing facility (SNF, post-acute care setting), and 3) 30-day readmission rate. Results: Disability was lower in the intervention group (28%) than in the control group (37%) (relative risk [RR] =0.74; 95% confidence interval [CI], 0.35-0.97; P=0.026), and transition to SNF was lower in the intervention group (22%) than in the control group (30%) (RR =0.77; 95% CI, 0.39-0.98; P=0.032). The 30-day readmission rate did not significantly differ between the two groups. Conclusion: SSA intervention enhanced the benefits of physical therapy for functionally declining older adults. When applied to older adults with heart failure in the form of daily multidisciplinary meetings, SSA intervention improved functional outcomes and reduced transfer to SNFs after hospitalization. © 2014 Lee et al. Source

Kim S.J.,Yonsei University | Park E.-C.,Yonsei University | Kim S.,University of Washington | Nakagawa S.,Columbia University | And 8 more authors.
Journal of the American Medical Directors Association | Year: 2014

Objectives: To assess the overall quality of life of long-stay nursing home residents with preserved cognition, to examine whether the Centers for Medicare and Medicaid Service's Nursing Home Compare 5-star quality rating system reflects the overall quality of life of such residents, and to examine whether residents' demographics and clinical characteristics affect their quality of life. Design/measurements: Quality of life was measured using the Participant Outcomes and Status Measures-Nursing Facility survey, which has 10 sections and 63 items. Total scores range from 20 (lowest possible quality of life) to 100 (highest). Setting/participants: Long-stay nursing home residents with preserved cognition (n = 316) were interviewed. Results: The average quality- of-life score was 71.4 (SD: 7.6; range: 45.1-93.0). Multilevel regression models revealed that quality of life was associated with physical impairment (parameter estimate = -0.728; P = 04) and depression (parameter estimate = -3.015; P =01) but not Nursing Home Compare's overall star rating (parameter estimate = 0.683; P =12) and not pain (parameter estimate = -0.705; P =47). Conclusion: The 5-star quality rating system did not reflect the quality of life of long-stay nursing home residents with preserved cognition. Notably, pain was not associated with quality of life, but physical impairment and depression were. © 2014 American Medical Directors Association, Inc. Source

Kim S.J.,Namseoul University | Park E.-C.,Yonsei University | Kim T.H.,Yonsei University | Yoo J.W.,University of Wisconsin - Milwaukee | And 2 more authors.
Yonsei Medical Journal | Year: 2015

Purpose: This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea. Materials and Methods: We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed. Results: The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis. Conclusion: We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending. © Yonsei University College of Medicine 2015. Source

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