Robert L Kane
Dados Biográficos
| ID | 274366 |
|---|---|
| NOME | Robert L Kane |
| PRENOMES | Robert L |
| SOBRENOME | Kane |
| ASSINATURA | KANE R L |
| AFILIAÇÕES | University of Minnesota |
| ORCID | 0009-0005-8505-6218 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 72 |
| TOTAL DE CITAÇÕES | 150 |
| TOTAL COMO AUTOR | 72 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1967 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2020 |
| ÍNDICE H | 6 |
Ageing in the margins
What constitutes a ‘good place to grow old’? This study aimed to characterise salient features of built and social environments that are essential to support low-income ageing residents. Seated and mobile interviews were conducted with community-dwelling older participants (aged 55–92, mean = 71 years) in three distinct socio-economic and geographic samples of the Minneapolis (Minnesota, United States of America) metropolitan area. The interviews…
Family Caregiving in the New Normal
Racial Differences in Minnesota Nursing Home Residents’ Quality of Life
Racial differences in QOL exist on individual and aggregate levels. Individual differences are mainly explained by health status. The finding that facility racial composition predicts QOL more than individual race underscores the importance of examining NH structural characteristics and practices
Analysis of Cognitive, Functional, Health Service Use, and Cost Trajectories Prior to and Following Memory Loss
Preclinical declines in mental status and function and increases in hospital use and OOPMD are apparent prior to the formal identification of memory problems. Earlier identification of these changes might provide a basis for interventions that could alter the clinical course of dementia
Predictors of Patients’ Perceived Need for Medication to Prevent Fracture
BACKGROUND: Adherence with medications to prevent fractures is suboptimal. Patients' perceived need for medication is an important predictor of medication-use behavior. OBJECTIVE: Estimate the associations of patients' perceived need of medication for fracture prevention with objective indicators of fracture risk, patients' concerns about medications, and the quality of the patient-physician relationship. RESEARCH DESIGN: Cross-sectional medical …
Facility and Market Factors Affecting Transitions From Nursing Home to Community
BACKGROUND: Research into nursing home transitions has given limited attention to the facility or community contexts. OBJECTIVE: To identify facility and market factors affecting transitions of nursing home residents back to the community. RESEARCH DESIGN: Multilevel models were used to estimate effects of facility and market factors on facility-level community discharge rates after controlling for resident demographic, health, and functional con…
Barriers to Physical and Mental Condition Integrated Service Delivery
OBJECTIVE: To assess pragmatic challenges faced when implementing, delivering, and sustaining models of integrated mental health intervention in primary care settings. Thirty percent of primary care patients with chronic medical conditions and up to 80% of those with health complexity have mental health comorbidity, yet primary care clinics rarely include onsite mental health professionals and only one in eight patients receive evidence-based men…
The Effects of Incident and Persistent Behavioral Problems on Change in Caregiver Burden and Nursing Home Admission of Persons With Dementia
BACKGROUND: The individual contributions of behavior problems to key and related outcomes in dementia, such as nursing home admission (NHA) or caregiver burden, remain unclear. OBJECTIVES: This study sought to determine the ramifications of temporal change in individual behavior problems when accounting for increases in caregiver burden and time to NHA. Although burden is sometimes conceptualized as an antecedent to NHA, it has also emerged as a …
Perceived Need for Mental Health Care Among Community-Dwelling Older Adults
Only half of older adults with a mental disorder use mental health services, and little is known about the causes of perceived need for mental health care (MHC). We used logistic regression to examine relationships among depression, anxiety, chronic physical illness, alcohol abuse and/or dependence, sociodemographics, and perceived need among a national sample of community-dwelling individuals 65 years of age and older (the Collaborative Psychiat…
Inpatient Nursing Care Quality
Kane, Robert L. MD; Mueller, Christine RN, PhD; Shamliyan, Tatyana MD Author Information
Predicting nursing home admission in the U.S
Predictors of Institutionalization in Latinos with Dementia
The Association of Registered Nurse Staffing Levels and Patient Outcomes
OBJECTIVE: To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals. STUDY SELECTION: Twenty-eight studies reported adjusted odds ratios of patient outcomes in categories of RN-to-patient ratio, and met inclusion criteria. Information was abstracted using a standardized protocol. DATA SYNTHESIS: Random effects models assessed heterogeneity and pooled data from individual studies. Increased RN …
Geriatric Interdisciplinary Team Training Program
Geriatric interdisciplinary team training has long been a goal in health education with little progress. In 1997, the John A. Hartford Foundation funded eight programs nationally to create Geriatric Interdisciplinary Team Training (GITT) programs. Faculty trained 1,341 health professions students. The results of the evaluation, including presentation of new measures developed to assess interdisciplinary knowledge, are presented, and the implicati…
Commentary by Kane
Proxy Sources for Information on Nursing Home Residents' Quality of Life
Although staff and family proxy domain scores are significantly correlated with resident scores, the level of correlation suggests they cannot simply be substituted for resident reports of QOL. Determining how proxy reports can be used for residents who cannot be interviewed at all remains an unresolved challenge
Outcomes and Reimbursement of Inpatient Rehabilitation Facilities and Subacute Rehabilitation Programs for Medicare Beneficiaries With Hip Fracture
OBJECTIVE: We sought to assess whether outcomes and reimbursement differ for Medicare beneficiaries with hip fracture when treated in an inpatient rehabilitation facility (IRF) compared with a skilled nursing facility (SNF) subacute rehabilitation program. PARTICIPANTS: Clinical data were linked with Medicare claims for 29,793 Medicare fee-for-service beneficiaries with a recent hip fracture who completed treatment in 1996 or 1997 in rehabilitati…
The Effect of Alcoholism Treatment on Medical Care Use
OBJECTIVE: The objective of this study was to assess changes in outpatient and inpatient medical care utilization associated with outpatient and inpatient treatment of alcohol abuse by comparing alcoholics who engaged in treatment to alcoholics who presented for, but did not engage in, treatment. RESEARCH DESIGN: Claims and encounter data of 29,122 adults receiving benefits from both a behavioral managed care company and its parent medical care i…
Improving Risk Adjustment for Medicare Capitated Reimbursement Using Nonlinear Models
OBJECTIVES: This article compares a linear risk-adjusted model of medical expenditures for Medicare patients with a model that explicitly account for skewness in distribution of expenditures. METHODS: A model of expenditures and a model of the square root of expenditures, each expressed as linear combinations of risk adjusters, are estimated using data from the 1992 through 1994 Medicare Current Beneficiary Surveys. Five sets of risk adjusters ar…
Examining the Efficiency of Home Care
This article focuses on the "efficiency" or cost-effectiveness of home care. Because home care encompasses a range of services targeted to many populations, it is necessary to take cognizance of case mix and clarify its goals to assess effectiveness. Goals for home care can be thought of as meeting and/or compensating for client dependency needs or making a difference in the client's clinical trajectory. The latter implies comparing actual to exp…
Adding Values
The study suggests it is possible to sensitize case managers to the importance of assessing and acting on client values. Getting them to do so consistently, however, may require changes in the practice environment
HMO Membership and Patient Age and the Use of Specialty Care for Hospitalized Patients With Acute Stroke
BACKGROUND: The number of older patients enrolling in health maintenance organizations (HMOs) is increasing. Concerns have been raised that older patients may be targeted by HMOs for more stringent cost-containment mechanisms, including reduced access to expensive specialty care. OBJECTIVES: We investigated the relationship between membership in an HMO and the decision to consult with a neurologist or admit to a neurology ward for patients hospit…
Do Hip Replacements Improve Outcomes for Hip Fracture Patients
BACKGROUND: Hip fracture is a common problem among older Americans. Two types of procedures are available for repairing hip fractures: hip replacement and open or closed reduction with or without internal fixation. The assumption has been that hip replacement produces better functional outcomes. Although that is the common wisdom, outcome studies evaluating hip replacement for treatment of hip fracture are few and have not clearly documented its …
The Relationship between Nursing Staffing Levels and Nursing Home Outcomes
This study examined the effects of selected Minnesota nursing home attributes (size, ownership, noncompliance with a state correction order, and licensed and nonlicensed nursing hours) on specific outcomes (functional ability, discharge home, and death) for residents ages 65 and older, controlling for residents' age and previous functional ability. The functional outcome was operationalized by calculating the resident's Total Dependence Score (TD…
The Effects of Clinical Pathways for Renal Transplant on Patient Outcomes and Length of Stay
OBJECTIVES: Clinical pathways have been implemented nationwide but little is understood about their effects on efficiency of care and patient outcomes. The present study examined the effects of both development and implementation of two renal transplant pathways. METHODS: Cohorts of patients at a university hospital were compared before, during, and after the development and implementation of two renal transplant clinical pathways: isolated renal…
Issues Underlying Prevalence of 'Doctor-Shopping' Behavior
Data were collected on all persons within a sample of upper-and lower-income households who had seen physicians for illness episodes within a year prior to the interview. Forty-eight percent of upper-and 37 percent of lower-income families in the sample had changed doctors because of dissatisfaction with some aspect of the care. Factors related to tendency to shop for doctors in both upper-and lower-income groups were a lack of confidence in doct…
Is early natural menopause a biologic marker of health and aging
The relation between age at natural menopause and all-cause mortality was investigated in a sample of 5,287 White women, ages 55 to 100 years, naturally-postmenopausal, Seventh-day Adventists who had completed mailed questionnaires in 1976. The age-adjusted odds ratio of death during 1976-82 in women with natural menopause before age 40 was 1.95 (95% confidence interval = 1.24, 3.07), compared to the reference group of women reporting natural men…
Ageing in the margins
What constitutes a ‘good place to grow old’? This study aimed to characterise salient features of built and social environments that are essential to support low-income ageing residents. Seated and mobile interviews were conducted with community-dwelling older participants (aged 55–92, mean = 71 years) in three distinct socio-economic and geographic samples of the Minneapolis (Minnesota, United States of America) metropolitan area. The interviews…
A Re-Examination of Suchman's Views on Social Factors in Health Care Utilization
Reed Geertsen, Melville R. Klauber, Mark Rindflesh, Robert L. Kane, Robert Gray, A Re-Examination of Suchman's Views on Social Factors in Health Care Utilization, Journal of Health and Social Behavior, Vol. 16, No. 2 (Jun., 1975), pp. 226-237
The immediate and subsequent outcomes of nursing home care
To determine the relationship between admission status and subsequent outcomes, 563 patients discharged during 1980 from 24 nursing homes were followed through 1982. Only 28 per cent of patients were discharged to their homes. Reconstructed life histories of 529 discharges for the two-year follow-up revealed only 38 persons (7.2 per cent) were alive and at home; of these, 36 had been initially discharged to their homes. Four hundred and one perso…
The Relationship between Nursing Staffing Levels and Nursing Home Outcomes
This study examined the effects of selected Minnesota nursing home attributes (size, ownership, noncompliance with a state correction order, and licensed and nonlicensed nursing hours) on specific outcomes (functional ability, discharge home, and death) for residents ages 65 and older, controlling for residents' age and previous functional ability. The functional outcome was operationalized by calculating the resident's Total Dependence Score (TD…
Proxy Sources for Information on Nursing Home Residents' Quality of Life
Although staff and family proxy domain scores are significantly correlated with resident scores, the level of correlation suggests they cannot simply be substituted for resident reports of QOL. Determining how proxy reports can be used for residents who cannot be interviewed at all remains an unresolved challenge
State variations in Medicare expenditures
OBJECTIVES: This study examined variations in Medicare expenditures across states. METHODS: 1992 data on average Medicare expenditures per enrollee, users of services per 1000 enrollees, service use per user, and payment per unit of service were compared across states for various services. Weighted least squares regression analysis was employed to examine total Medicare expenditures per enrollee by state. RESULTS: Variation in Medicare expenditur…
Decreasing disability in the 21st century
OBJECTIVES: This study assessed the effects of reducing fatal and nonfatal health conditions on the number of functionally limited older Americans in the coming decades. METHODS: Data from the 1990 census and the Longitudinal Study of Aging were used to project the number of functionally limited older Americans from 2001 to 2049, assuming 1% biennial reductions in five conditions that shorten life expectancy (coronary artery disease, stroke, canc…
Effects of a geriatric nurse practitioner on process and outcome of nursing home care
We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. S…
Racial Differences in Minnesota Nursing Home Residents’ Quality of Life
Racial differences in QOL exist on individual and aggregate levels. Individual differences are mainly explained by health status. The finding that facility racial composition predicts QOL more than individual race underscores the importance of examining NH structural characteristics and practices
Perceived Need for Mental Health Care Among Community-Dwelling Older Adults
Only half of older adults with a mental disorder use mental health services, and little is known about the causes of perceived need for mental health care (MHC). We used logistic regression to examine relationships among depression, anxiety, chronic physical illness, alcohol abuse and/or dependence, sociodemographics, and perceived need among a national sample of community-dwelling individuals 65 years of age and older (the Collaborative Psychiat…
Geriatric Interdisciplinary Team Training Program
Geriatric interdisciplinary team training has long been a goal in health education with little progress. In 1997, the John A. Hartford Foundation funded eight programs nationally to create Geriatric Interdisciplinary Team Training (GITT) programs. Faculty trained 1,341 health professions students. The results of the evaluation, including presentation of new measures developed to assess interdisciplinary knowledge, are presented, and the implicati…
Adult foster care for the elderly in Oregon
BACKGROUND. In Oregon, adult foster care (AFC) homes, which are private residences where a live-in manager cares for one to five disabled residents, have been covered by Medicaid since 1981 and seem to offer a mainstream alternative to nursing homes. They house almost 6000 older people, two thirds of which pay privately. METHODS. In a cross-sectional study, we interviewed 400 AFC and 400 nursing home residents. Data analyses included descriptive …
"The Structure of Sophocles' "Trachiniae
carried on stage, and thereafter it is he who dominates the action. Not only is the rhythm of the drama such that husband and wife never meet; there is an extended interval during which neither character is present on stage (820-972). At this point the play's structure reveals a deep division, a gap separating the tragedy of Deianeira from the grim portrayal of Heracles in extremis. But while the presence of this gap is undeniable, it should not …
Analysis of Cognitive, Functional, Health Service Use, and Cost Trajectories Prior to and Following Memory Loss
Preclinical declines in mental status and function and increases in hospital use and OOPMD are apparent prior to the formal identification of memory problems. Earlier identification of these changes might provide a basis for interventions that could alter the clinical course of dementia
Predictors of Institutionalization in Latinos with Dementia
Examining the Efficiency of Home Care
This article focuses on the "efficiency" or cost-effectiveness of home care. Because home care encompasses a range of services targeted to many populations, it is necessary to take cognizance of case mix and clarify its goals to assess effectiveness. Goals for home care can be thought of as meeting and/or compensating for client dependency needs or making a difference in the client's clinical trajectory. The latter implies comparing actual to exp…
Adding Values
The study suggests it is possible to sensitize case managers to the importance of assessing and acting on client values. Getting them to do so consistently, however, may require changes in the practice environment
Health Perceptions
People with chronic disease often make a sharp distinction between being ill and having a serious underlying problem. This distinction is more than semantic. There is substantial danger in using, as a basis for making plans, people's ideas about their feelings about contracting diseases or entering into states of disability. The discrepancies between how people with serious health problems feel about these problems and the conceptions of those wh…
Commentary by Kane
In the patient's interest
Problems in Patient-Doctor Communications
Resident, Department of Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky ** Professor and chairman, Department of Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
Drinking Attitudes and Behavior of High-School Students in Kentucky
Of 19,929 Kentucky students who completed a questionnaire, almost half were nondrinkers, while 3% were considered heavy drinkers. The social and demographic characteristics of each of the drinking groups are described
Determination of Health Care Expectations among Navajo Consumers
A sample of 271 Navajo respondents were interviewed by Navajos to assess their attitudes toward major health problems on the reservation and problems with the health service they were receiving. Health problems identified were primarily disease states such as alcoholism and upper respiratory tract infections. Approximately one fifth of the respondents identifed environmental health problems as well. Difficulties with health services focused on pr…
Better health for aborigines
Vector Resolution
Vector resolution represents a new method for analyzing consumer data and comparing patterns for a variety of consumer services. The vectors are derived from a measurement of frequency of use and a geographic direction from the origin of the group to the point of service. Although the data presented were drawn from a probability sample survey of southern Utah rural households, the methodology may be readily applied to data derived from a variety …
Rural and Appalachian Health
The Men in the Middle
The perception of Indian health care needs are shown to be related to particular positions within the Public Health Service (PHS) structure. This study is based on interview data gathered from three groups: Navajo consumers (N = 271), Navajo PHS personnel (N = 80), and PHS non-Navajo professional staff (N = 31). The identification of health needs by the Navajo consumer is oriented toward unsolved problems in the immediate social and physical envi…
A Re-Examination of Suchman's Views on Social Factors in Health Care Utilization
Reed Geertsen, Melville R. Klauber, Mark Rindflesh, Robert L. Kane, Robert Gray, A Re-Examination of Suchman's Views on Social Factors in Health Care Utilization, Journal of Health and Social Behavior, Vol. 16, No. 2 (Jun., 1975), pp. 226-237
The Health Gap
Communication Patterns of Doctors and Their Assistants
Communication patterns between physicians and their assistants (Medex) were observed in 19 practices to describe and evaluated the nature of their relationship. Observations demonstrated that interaction around patient problems was approximately 30 minures per day and informal, with the Medex more often initiating the contact. Medex were more likely to ask for, and physicians were more likely to give, suggestions. Physicians appeared to regard th…
Adding a Medex to the Medical Mix
Three classes of Medex were followed during their preceptorship training and subsequent employment to assess the impact of adding such physician assistants on 13 private practices. The data suggest that the Medex are readily incorporated into the practice, seeing a similar spectrum of patients and generally functioning as a semicolleague. Although the Medex was almost universally a contributing addition to the practice, increasing patient volume,…
Issues Underlying Prevalence of 'Doctor-Shopping' Behavior
Data were collected on all persons within a sample of upper-and lower-income households who had seen physicians for illness episodes within a year prior to the interview. Forty-eight percent of upper-and 37 percent of lower-income families in the sample had changed doctors because of dissatisfaction with some aspect of the care. Factors related to tendency to shop for doctors in both upper-and lower-income groups were a lack of confidence in doct…
The Challenges of Community Medicine
Getting Care to Nursing-Home Patients
Data abstracted from transportation company records showed that nursing home patients made an average of 3.6 trips per year for care out of the nursing home. The bulk of this care (55 per cent) was provided at University Hospital with over a quarter provided at private physicians' offices and community health centers. On the basis of chart abstracts over half the patients had been seen within the previous month, but the quality of that visit was …
Relationship between Process and Outcome in Ambulatory Care
The outcomes of a series of some 410 acute episodes from two family practice centers were rated on the degree to which the patient regained his usual functional status and his satisfaction with the outcome and the process of care. A portion of outcomes (251) were then compared to process scores obtained using explicit criteria and the rest to implicit process ratings based on the problem-oriented record. In both instances those cases with good ou…
The effects of doctor-patient communication on satisfaction and outcome of care
The effects of doctor-patient communication on satisfaction and outcome of care
Changes in Utilization Patterns in a National Health Service Corps Community
Utilization patterns in two adjacent rural Utah counties were compared over a span of five years (1971-1976). In one, a three-physician National Health Service Corps site was established during the interval; the other went from one family physician to two during the same period. The Corps site showed an increase in physician utilization while the "control" county utilization remained unchanged. However, despite the increased utilization of physic…
Utilization Review in Nursing Homes
Comprehensive data on 3,579 patients in Baltimore nursing homes were collected by trained teams of reliable observers. The data included an implicit judgment about the level of care (LOC) deemed most appropriate for each patient. Two different approaches were used to fit the patient data to the LOC judgments: Several versions of an algorithm adapted from a utilization review scheme based on simple clinical criteria and a series of mathematical eq…
Short- and Long-Term Residents of Nursing Homes
This article analyzes reported data on length of stay of discharged patients from the 1977 National Nursing Home Survey. Assuming that patients admitted to nursing homes are one of two types, short-stayers and long-stayers, the statistically best-fitting proportions and expected lengths of stay for the two types are derived. The results are applied to statistics on characteristics of resident and discharged patients to find admission characterist…
Physicians?? Attitudes Toward Female Patients
The relative impact of a patient's sex and expressivity (expression of a personal problem) on attitudes of physicians toward patients was assessed using case simulations and questionnaires. Eight simulated cases were used that varied by presenting complaint, patient sex, and inclusion or exclusion of a personal problem. Two non-identical cases were read by each of 253 primary-care physicians, yielding 506 questionnaires for analysis. Of the physi…
Values and Long-Term Care
Assessing the Elderly
Predicting the Outcome of Primary Care
Each physician's ability to treat disease is limited by his/her ability to discriminate among patients on the basis of risk. The relationship of physician expectation of outcome (prognosis) to actual outcome and to cost were determined for 1,757 patients seeking primary care. Outcome was measured by a seven-level functional-status scale; patients who returned to their usual level of function after an acute illness were defined as having good outc…
Effect of Patient Age on Duration of Medical Encounters With Physicians
The authors analyzed the USC/DRME Practice Study data to determine if the characteristics of physician patient encounters change with patient age. The only significant change observed was a decline in encounter time for patients 65 years of age and older compared with those 45 through 64 years of age. This decrease was significant for raw data and for data weighted for the number of physicians of various types and standardized for complexity of c…
Medicine (62 obras) · Nursing (33 obras) · Psychology (31 obras) · Family medicine (22 obras) · Gerontology (22 obras) · Geriatric Care and Nursing Homes (18 obras) · Gerontology (16 obras) · Health care (13 obras) · Internal Medicine (13 obras) · Internal Medicine (13 obras)