Orna Intrator
Biographic Data
| ID | 1731550 |
|---|---|
| NAME | Orna Intrator |
| GIVEN NAMES | Orna |
| FAMILY NAME | Intrator |
| SIGNATURE | INTRATOR O |
| AFFILIATIONS | Brown University |
| ORCID | 0000-0002-4173-0662 |
| VERIFIED | Yes |
| TOTAL WORKS | 20 |
| TOTAL CITATIONS | 34 |
| AUTHOR COUNT | 20 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1994 |
| LATEST PUBLICATION YEAR | 2024 |
| H-INDEX | 3 |
Sex differences in unmet needs between male and female older Veterans
Aging Veterans face complex needs across multiple domains. However, the needs of older female Veterans and the degree to which unmet needs differ by sex are unknown. We analyzed responses to the HERO CARE survey from 7,955 Veterans aged 55 years and older (weighted N = 490,148), 93.9% males and 6.1% females. We evaluated needs and unmet needs across the following domains: activities of daily living (ADLs), instrumental ADLs (IADLs), health manage…
Trajectories and Transitions in Service Use Among Older Veterans at High Risk of Long-Term Institutional Care
BACKGROUND: We aimed to identify combinations of long-term services and supports (LTSS) Veterans use, describe transitions between groups, and identify factors influencing transition. METHODS: We explored LTSS across a continuum from home to institutional care. Analyses included 104,837 Veterans Health Administration (VHA) patients 66 years and older at high-risk of long-term institutional care (LTIC). We conduct latent class and latent transitio…
Fall-related Injuries and Opioid Administration Among Veterans With Dementia in US Department of Veterans Affairs Community Living Centers
OBJECTIVES: Opioid use is associated with fall-related injuries (FRI) among older adults, especially those with dementia. We examined FRI following changes in national opioid safety initiatives over 3 regulatory periods [preinitiatives baseline (period 1): October 2012 to June 2013; post-Veteran Affairs (VA) opioid safety initiative (period 2): January 2014 to November 2015; post-VA and CDC opioid prescribing guidelines (period 3): March 2017 to …
Developing a Machine Learning Risk-adjustment Method for Hospitalizations and Emergency Department Visits of Nursing Home Residents With Dementia
BACKGROUND: Long-stay nursing home (NH) residents with Alzheimer disease and related dementias (ADRD) are at high risk of hospital transfers. Machine learning might improve risk-adjustment methods for NHs. OBJECTIVES: The objective of this study was to develop and compare NH risk-adjusted rates of hospitalizations and emergency department (ED) visits among long-stay residents with ADRD using Extreme Gradient Boosting (XGBoost) and logistic regres…
Effects of a Rehabilitation-at-Home Program Compared to Post-acute Skilled Nursing Facility Care on Safety, Readmission, and Community Dwelling Status: A Matched Cohort Analysis
OBJECTIVES: To evaluate the effectiveness and safety of Rehabilitation-at-Home (RaH), which provides high-frequency, multidisciplinary post-acute rehabilitative services in patients' homes. DESIGN: Comparative effectiveness analysis. SETTING AND PARTICIPANTS: Medicare Fee-For-Service patients who received RaH in a Center for Medicare and Medicaid Innovation Center Demonstration during 2016-2017 (N=173) or who received Medicare Skilled Nursing Fac…
Rural-Urban Differences in Nursing Home Risk-adjusted Rates of Emergency Department Visits: A Decomposition Analysis
BACKGROUND: Higher risk-adjusted rate of emergency department (ED) visits might reflect poor quality of nursing home (NH) care; however, existing evidence is limited regarding rural-urban differences in ED rates of NHs, especially for long-stay residents. OBJECTIVES: To determine and quantify sources of rural-urban differences in NH risk-adjusted rates of any ED visit, ED without hospitalization or observation stay (outpatient ED), and potentiall…
Construction and Validation of Risk-adjusted Rates of Emergency Department Visits for Long-stay Nursing Home Residents
BACKGROUND: Long-stay nursing home (NH) residents are at high risk of having emergency department (ED) visits, but current knowledge regarding risk-adjusted ED rates is limited. OBJECTIVES: To construct and validate 3 quarterly risk-adjusted rates of long-stay residents' ED use: any ED visit, ED visits without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED). RESEARCH DESIGN: The authors calculated q…
Benchmarking Site of Death and Hospice Use: A Case Study of Veterans Cared by Department of Veterans Affairs Home-based Primary Care
OBJECTIVE: The objective of this study was to examine site of death and hospice use, identifying potential disparities among veterans dying in Department of Veterans Affairs (VA) Home Based Primary Care (VA-HBPC). METHODS: Administrative data (2008, 2012, and 2016) were compiled using the VA Residential-History-File which tracks health care service location, daily. Outcomes were site of death [home, nursing home (NH), hospital, inpatient hospice]…
Can Continuity of Care Reduce Hospitalization Among Community-dwelling Older Adult Veterans Living With Dementia
BACKGROUND: Hospitalization is a difficult experience, especially for patients with dementia. Understanding whether better continuity of care (COC) reduces hospitalizations can indicate interventions that might help curb hospitalizations. OBJECTIVE: To estimate the causal impact of COC on hospitalizations and different reasons for hospitalization among community-dwelling older veterans with dementia. RESEARCH DESIGN: Population-based observationa…
Nursing Home Chain Affiliation and Its Impact on Specialty Service Designation for Alzheimer Disease
Specialty care units (SCUs) in nursing homes (NHs) grew in popularity during the 1990s to attract residents while national policies and treatment paradigms changed. Alzheimer disease has consistently been the dominant form of SCU. This study explored the extent to which chain affiliation, which is common among NHs, affected SCU bed designation. Using data from the Online Survey Certification and Reporting (OSCAR) from 1996 through 2010 with 207 4…
The Impact of Chain Standardization on Nursing Home Staffing
BACKGROUND: Standardization in production is common in multientity chain organizations. Although chains are prominent in the nursing home sector, standardization in care has not been studied. One way nursing home chains may standardize is by controlling the level and mix of staffing in member homes. OBJECTIVES: To examine the extent to which standardization occurred in staffing, its relative presence across different types of chains, and whether …
Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care
BACKGROUND: In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. OBJECTIVES: To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with…
Obesity and Pressure Ulcers Among Nursing Home Residents
OBJECTIVES: To examine the prevalence of obesity and its relationship with pressure ulcers among nursing home (NH) populations, and whether such relationship varies with certified nursing assistant (CNA) level in NHs. DATA AND STUDY POPULATION: The 1999-2009 nationwide Minimum Data Sets were linked with Online Survey of Certification and Reporting records. We identified newly admitted NH residents who became long-stayers and followed them up to 1…
Determinants of performance failure in the nursing home industry
Spousal Caregiving in Late Midlife Versus Older Ages: Implications of Work and Family Obligations
Late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by spouses; however, they may be particularly vulnerable to unmet need for care. As the baby boom generation ages, retirement ages increase, and federal safety nets weaken, people with health problems at older ages may soon find themselves in the same caregiving predicament as those in late middle age
Medicaid Payment Rates, Case-Mix Reimbursement, and Nursing Home Staffing—1996-2004
OBJECTIVE: We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. METHODS: We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according…
The effects of introducing prospective payments to general hospitals on length of stay, quality of care, and hospitals' income: The early experience of Israel
Postacute Care Following Stroke or Hip Fracture: Single Services and Combinations Used by Medicare Beneficiaries (1987-1992)
Resource use and assessment of patient outcomes should be examined across the continuum of postacute care and in the months beyond to examine the relative effectiveness of different combinations of care
Facility Characteristics Associated With Hospitalization of Nursing Home Residents: Results of a National Study
OBJECTIVES: To test the effect of facility characteristics on the probability of hospitalization of nursing home residents, controlling for resident characteristics and the competing risk of death. RESEARCH DESIGN: Study data were derived from the evaluation of the implementation of the Resident Assessment Instrument, the Minimum Data Set (MDS) in 1993. The data consisted of 2080 residents in 253 NHs as well as the annual On-Line Survey Certifica…
The outcomes of patients newly admitted to nursing homes after hip fracture
OBJECTIVES. The outcomes of elderly, hospitalized patients discharged to nursing homes after hip fracture were examined. METHODS. For 2624 hip fracture patients admitted to any of 43 proprietary nursing homes between 1984 and 1988, admission assessments were examined in relation to 1-month outcomes. RESULTS. Mean patient age was 82 +/- 7 y; 85% of the sample were female. Within 1 month after discharge, 24% had returned home, 12% had been rehospit…
Spousal Caregiving in Late Midlife Versus Older Ages: Implications of Work and Family Obligations
Late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by spouses; however, they may be particularly vulnerable to unmet need for care. As the baby boom generation ages, retirement ages increase, and federal safety nets weaken, people with health problems at older ages may soon find themselves in the same caregiving predicament as those in late middle age
Determinants of performance failure in the nursing home industry
The outcomes of patients newly admitted to nursing homes after hip fracture
OBJECTIVES. The outcomes of elderly, hospitalized patients discharged to nursing homes after hip fracture were examined. METHODS. For 2624 hip fracture patients admitted to any of 43 proprietary nursing homes between 1984 and 1988, admission assessments were examined in relation to 1-month outcomes. RESULTS. Mean patient age was 82 +/- 7 y; 85% of the sample were female. Within 1 month after discharge, 24% had returned home, 12% had been rehospit…
Postacute Care Following Stroke or Hip Fracture: Single Services and Combinations Used by Medicare Beneficiaries (1987-1992)
Resource use and assessment of patient outcomes should be examined across the continuum of postacute care and in the months beyond to examine the relative effectiveness of different combinations of care
The effects of introducing prospective payments to general hospitals on length of stay, quality of care, and hospitals' income: The early experience of Israel
The outcomes of patients newly admitted to nursing homes after hip fracture
OBJECTIVES. The outcomes of elderly, hospitalized patients discharged to nursing homes after hip fracture were examined. METHODS. For 2624 hip fracture patients admitted to any of 43 proprietary nursing homes between 1984 and 1988, admission assessments were examined in relation to 1-month outcomes. RESULTS. Mean patient age was 82 +/- 7 y; 85% of the sample were female. Within 1 month after discharge, 24% had returned home, 12% had been rehospit…
Postacute Care Following Stroke or Hip Fracture: Single Services and Combinations Used by Medicare Beneficiaries (1987-1992)
Resource use and assessment of patient outcomes should be examined across the continuum of postacute care and in the months beyond to examine the relative effectiveness of different combinations of care
Facility Characteristics Associated With Hospitalization of Nursing Home Residents: Results of a National Study
OBJECTIVES: To test the effect of facility characteristics on the probability of hospitalization of nursing home residents, controlling for resident characteristics and the competing risk of death. RESEARCH DESIGN: Study data were derived from the evaluation of the implementation of the Resident Assessment Instrument, the Minimum Data Set (MDS) in 1993. The data consisted of 2080 residents in 253 NHs as well as the annual On-Line Survey Certifica…
The effects of introducing prospective payments to general hospitals on length of stay, quality of care, and hospitals' income: The early experience of Israel
Spousal Caregiving in Late Midlife Versus Older Ages: Implications of Work and Family Obligations
Late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by spouses; however, they may be particularly vulnerable to unmet need for care. As the baby boom generation ages, retirement ages increase, and federal safety nets weaken, people with health problems at older ages may soon find themselves in the same caregiving predicament as those in late middle age
Medicaid Payment Rates, Case-Mix Reimbursement, and Nursing Home Staffing—1996-2004
OBJECTIVE: We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. METHODS: We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according…
Determinants of performance failure in the nursing home industry
Obesity and Pressure Ulcers Among Nursing Home Residents
OBJECTIVES: To examine the prevalence of obesity and its relationship with pressure ulcers among nursing home (NH) populations, and whether such relationship varies with certified nursing assistant (CNA) level in NHs. DATA AND STUDY POPULATION: The 1999-2009 nationwide Minimum Data Sets were linked with Online Survey of Certification and Reporting records. We identified newly admitted NH residents who became long-stayers and followed them up to 1…
Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care
BACKGROUND: In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. OBJECTIVES: To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with…
Nursing Home Chain Affiliation and Its Impact on Specialty Service Designation for Alzheimer Disease
Specialty care units (SCUs) in nursing homes (NHs) grew in popularity during the 1990s to attract residents while national policies and treatment paradigms changed. Alzheimer disease has consistently been the dominant form of SCU. This study explored the extent to which chain affiliation, which is common among NHs, affected SCU bed designation. Using data from the Online Survey Certification and Reporting (OSCAR) from 1996 through 2010 with 207 4…
The Impact of Chain Standardization on Nursing Home Staffing
BACKGROUND: Standardization in production is common in multientity chain organizations. Although chains are prominent in the nursing home sector, standardization in care has not been studied. One way nursing home chains may standardize is by controlling the level and mix of staffing in member homes. OBJECTIVES: To examine the extent to which standardization occurred in staffing, its relative presence across different types of chains, and whether …
Construction and Validation of Risk-adjusted Rates of Emergency Department Visits for Long-stay Nursing Home Residents
BACKGROUND: Long-stay nursing home (NH) residents are at high risk of having emergency department (ED) visits, but current knowledge regarding risk-adjusted ED rates is limited. OBJECTIVES: To construct and validate 3 quarterly risk-adjusted rates of long-stay residents' ED use: any ED visit, ED visits without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED). RESEARCH DESIGN: The authors calculated q…
Benchmarking Site of Death and Hospice Use: A Case Study of Veterans Cared by Department of Veterans Affairs Home-based Primary Care
OBJECTIVE: The objective of this study was to examine site of death and hospice use, identifying potential disparities among veterans dying in Department of Veterans Affairs (VA) Home Based Primary Care (VA-HBPC). METHODS: Administrative data (2008, 2012, and 2016) were compiled using the VA Residential-History-File which tracks health care service location, daily. Outcomes were site of death [home, nursing home (NH), hospital, inpatient hospice]…
Can Continuity of Care Reduce Hospitalization Among Community-dwelling Older Adult Veterans Living With Dementia
BACKGROUND: Hospitalization is a difficult experience, especially for patients with dementia. Understanding whether better continuity of care (COC) reduces hospitalizations can indicate interventions that might help curb hospitalizations. OBJECTIVE: To estimate the causal impact of COC on hospitalizations and different reasons for hospitalization among community-dwelling older veterans with dementia. RESEARCH DESIGN: Population-based observationa…
Rural-Urban Differences in Nursing Home Risk-adjusted Rates of Emergency Department Visits: A Decomposition Analysis
BACKGROUND: Higher risk-adjusted rate of emergency department (ED) visits might reflect poor quality of nursing home (NH) care; however, existing evidence is limited regarding rural-urban differences in ED rates of NHs, especially for long-stay residents. OBJECTIVES: To determine and quantify sources of rural-urban differences in NH risk-adjusted rates of any ED visit, ED without hospitalization or observation stay (outpatient ED), and potentiall…
Fall-related Injuries and Opioid Administration Among Veterans With Dementia in US Department of Veterans Affairs Community Living Centers
OBJECTIVES: Opioid use is associated with fall-related injuries (FRI) among older adults, especially those with dementia. We examined FRI following changes in national opioid safety initiatives over 3 regulatory periods [preinitiatives baseline (period 1): October 2012 to June 2013; post-Veteran Affairs (VA) opioid safety initiative (period 2): January 2014 to November 2015; post-VA and CDC opioid prescribing guidelines (period 3): March 2017 to …
Developing a Machine Learning Risk-adjustment Method for Hospitalizations and Emergency Department Visits of Nursing Home Residents With Dementia
BACKGROUND: Long-stay nursing home (NH) residents with Alzheimer disease and related dementias (ADRD) are at high risk of hospital transfers. Machine learning might improve risk-adjustment methods for NHs. OBJECTIVES: The objective of this study was to develop and compare NH risk-adjusted rates of hospitalizations and emergency department (ED) visits among long-stay residents with ADRD using Extreme Gradient Boosting (XGBoost) and logistic regres…
Effects of a Rehabilitation-at-Home Program Compared to Post-acute Skilled Nursing Facility Care on Safety, Readmission, and Community Dwelling Status: A Matched Cohort Analysis
OBJECTIVES: To evaluate the effectiveness and safety of Rehabilitation-at-Home (RaH), which provides high-frequency, multidisciplinary post-acute rehabilitative services in patients' homes. DESIGN: Comparative effectiveness analysis. SETTING AND PARTICIPANTS: Medicare Fee-For-Service patients who received RaH in a Center for Medicare and Medicaid Innovation Center Demonstration during 2016-2017 (N=173) or who received Medicare Skilled Nursing Fac…
Sex differences in unmet needs between male and female older Veterans
Aging Veterans face complex needs across multiple domains. However, the needs of older female Veterans and the degree to which unmet needs differ by sex are unknown. We analyzed responses to the HERO CARE survey from 7,955 Veterans aged 55 years and older (weighted N = 490,148), 93.9% males and 6.1% females. We evaluated needs and unmet needs across the following domains: activities of daily living (ADLs), instrumental ADLs (IADLs), health manage…
Trajectories and Transitions in Service Use Among Older Veterans at High Risk of Long-Term Institutional Care
BACKGROUND: We aimed to identify combinations of long-term services and supports (LTSS) Veterans use, describe transitions between groups, and identify factors influencing transition. METHODS: We explored LTSS across a continuum from home to institutional care. Analyses included 104,837 Veterans Health Administration (VHA) patients 66 years and older at high-risk of long-term institutional care (LTIC). We conduct latent class and latent transitio…
Medicine (20 works) · Geriatric Care and Nursing Homes (13 works) · Nursing (13 works) · Nursing homes (11 works) · Gerontology (9 works) · Family medicine (8 works) · Frailty in Older Adults (8 works) · Health care (8 works) · Internal Medicine (8 works) · Business (7 works)