William D Spector
Dados Biográficos
| ID | 5534110 |
|---|---|
| NOME | William D Spector |
| PRENOMES | William D |
| SOBRENOME | Spector |
| ASSINATURA | SPECTOR W D |
| AFILIAÇÕES | Agency for Healthcare Research and Quality |
| VERIFICADO | Não |
| TOTAL DE OBRAS | 25 |
| TOTAL DE CITAÇÕES | 125 |
| TOTAL COMO AUTOR | 25 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1989 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2017 |
| ÍNDICE H | 5 |
The Marginal Costs of Adverse Drug Events Associated With Exposures to Anticoagulants and Hypoglycemic Agents During Hospitalization
BACKGROUND: Anticoagulants and hypoglycemic agents are 2 of the most challenging drug classes for medical management in the hospital resulting in many adverse drug events (ADEs). OBJECTIVE: Estimating the marginal cost (MC) of ADEs associated with anticoagulants and hypoglycemic agents for adults in 5 patient groups during their hospital stay and the total annual ADE costs for all patients exposed to these drugs during their stay. RESEARCH DESIGN…
Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers
BACKGROUND: Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). OBJECTIVE: To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characte…
Response to Letter to the Editor Regarding the Paper “Potentially Avoidable Hospitalization for Elderly Long-stay Residents in Nursing Homes”
Evaluation of AHRQ’s On-Time Pressure Ulcer Prevention Program
BACKGROUND: Pressure ulcers present serious health and economic consequences for nursing home residents. The Agency for Healthcare Research & Quality, in partnership with the New York State Department of Health, implemented the pressure ulcer module of On-Time Quality Improvement for Long Term Care (On-Time), a clinical decision support intervention to reduce pressure ulcer incidence rates. OBJECTIVE: To evaluate the effectiveness of the On-Time …
Making Difficult Decisions
Objectives. We investigated how quality of care affects choosing a nursing home. Methods. We examined nursing home choice in California, Ohio, New York, and Texas in 2001, a period before the federal Nursing Home Compare report card was published. Thus, consumers were less able to observe clinical quality or clinical quality was masked. We modeled nursing home choice by estimating a conditional multinomial logit model. Results. In all states, con…
Potentially Avoidable Hospitalizations for Elderly Long-stay Residents in Nursing Homes
BACKGROUND: Hospitalizations of long-stay nursing home (NH) residents are common. The high estimates of potentially avoidable hospitalizations in NHs suggest that efforts to reduce avoidable hospitalizations may be effective in lowering health care expenditures as well as improving the quality of care for NH residents. OBJECTIVE: To determine the relationship between clinical risk factors, facility characteristics and State policy variables, and …
Thirty-Day, All-cause Readmissions for Elderly Patients Who Have an Injury-related Inpatient Stay
BACKGROUND: Policymakers are exploring ways to reduce readmission rates. Much attention has been given to readmissions for conditions such as heart failure, acute myocardial infarction, and pneumonia, but little attention has been given to readmissions of patients with injury-related index admissions. METHODS: This analysis is a retrospective cohort study of elderly persons who are admitted to a community hospital for a principal diagnosis of inj…
Does State Regulation of Quality Impose Costs on Nursing Homes
BACKGROUND: Government regulation is intended to enhance quality, safety, fairness, or competition in the regulated industry. Such regulation entails both direct and indirect costs. OBJECTIVES: To estimate the costs associated with the regulation of quality of the nursing home industry. SAMPLE: This study includes 11,168 free-standing nursing homes nationally, between 2004 and 2006. RESEARCH DESIGN: Data included information from the Medicare cos…
Changes in Clinical and Hotel Expenditures Following Publication of the Nursing Home Compare Report Card
BACKGROUND: Nursing Home Compare first published clinical quality measures at the end of 2002. It is a quality report card that for the first time offers consumers easily accessible information about the clinical quality of nursing homes. It led to changes in consumers' demand, increasing the relative importance of clinical versus hotel aspects of quality in their search and choice of a nursing home. OBJECTIVES: To examine the hypothesis that nur…
The Costs of Turnover in Nursing Homes
BACKGROUND: Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. OBJECTIVES: To estimate the net costs associated with turnover of direct care staff in nursing homes. DATA AND SAMPLE: Nine hundred two nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set, Medicare enrollment files, Census, and Area Resource File. RESEARCH DESIGN: We estimated total cost function…
Home Health Care Agency Staffing Patterns Before and After the Balanced Budget Act of 1997, by Rural and Urban Location
Context: The Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary. Purpose: We examine the staffing characteristics of stable Medicare‐certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies. Methods: Data were drawn from Medicare Provider of Service files a…
Does Risk Adjustment of the CMS Quality Measures for Nursing Homes Matter
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) publish a report card for nursing homes with 19 clinical quality measures (QMs). These measures include minimal risk adjustment. OBJECTIVES: To develop QMs with more extensive risk adjustment and to investigate the impact on quality rankings. RESEARCH DESIGN: Retrospective analysis of individual level data reported in the Minimum Data Set (MDS). Random effect logistic models were us…
Nursing Homes' Response to the Nursing Home Compare Report Card
These findings suggest that the Nursing Home Compare report card has the potential to positively affect nursing home quality
Effects of Nursing Home Ownership Type and Resident Payer Source on Hospitalization for Suspected Pneumonia
BACKGROUND: Whether to hospitalize residents with suspected pneumonia is a complex decision determined both by clinical and financial considerations. The decision to hospitalize may be different in for-profit and not-for-profit facilities and for different payment sources. OBJECTIVE: The objective of this study was to examine the role of proprietary status in the decision to hospitalize residents with suspected pneumonia, controlling for facility…
Development of a Risk-Adjusted Urinary Incontinence Outcome Measure of Quality for Nursing Homes
BACKGROUND: Quality of nursing home care is of ongoing concern. The availability of uniform, patient-level information-the Minimum Data Set (MDS)-offers the opportunity to assess quality based on risk-adjusted health outcomes. OBJECTIVE: To develop a risk-adjusted measure of quality based on urinary incontinence (UI) outcomes for nursing homes, derived from the MDS. RESEARCH DESIGN: A retrospective statistical analysis of individual resident leve…
Impact of Differential Item Functioning on Age and Gender Differences in Functional Disability
Comparisons of disability across sociodemographic groups need to take DIF into account. Future research should examine the causes of DIF and develop alternative question wordings that reduce DIF effects
Nursing Home Costs and Risk-Adjusted Outcome Measures of Quality
BACKGROUND: The inadequacy of quality of care in nursing homes has been and continues to be a focus of public concerns. Understanding the relationship between quality and costs can offer guidance to policies designed to encourage high quality. OBJECTIVES: To investigate the relationship between costs and quality of care in nursing homes, and to test the hypothesis that higher quality may be associated with lower costs. RESEARCH DESIGN: Statistica…
Pressure Ulcer Prevalence in Ohio Nursing Homes
Pressure ulcers remain a common medical problem in nursing homes, despite the development of clinical guidelines for prevention and treatment. Prevention involves low technology but vigilant care. If the disease progresses, infections can develop, and surgery may be necessary to prevent death. This article examines pressure ulcer correlates in a representative sample of 15,121 nursing home residents in 1994 in the state of Ohio. The prevalence of…
Combining Activities of Daily Living with Instrumental Activities of Daily Living to Measure Functional Disability
Measures of functional disability typically contain items that reflect limitations in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Combining IADL and ADL items together in the same scale would provide enhanced range and sensitivity of measurement. This article presents psychometric justification for a combined ADL/IADL scale. Data come from 2,977 disabled respondents in the 1989 National Long-Te…
Risk of Behavior Problems among Nursing Home Residents in the United States
This study identified personal risk factors associated with behavior problems among nursing home residents using data based on a national survey of nursing home residents. Data are based on the Institutional Population Component of the 1987 National Medical Expenditure Survey and include nursing home residents living in licensed facilities on January 1, 1987. Multiple regression analyses were conducted to examine characteristics of residents that…
Correlates of Disruptive Behaviors in Nursing Homes
This study reexamines factors associated with the occurrence of disruptive behaviors using a representative sample of nursing home residents in Rhode Island in 1984-1985. Four indicators of disruptive behaviors are examined using multivariate methods: evidence of any disruptive behaviors, abusive behavior, wandering, and noisiness. Results are compared with the 1989 study by Jackson et al., which was based on the same data. Findings indicate that…
The Relationship of Vision and Hearing Impairment to One-Year Mortality and Functional Decline
Impairments in hearing and vision are common for those aged 65 and older, and severe impairments may result in dependencies in daily activities. This article presents a longitudinal analysis of the risk of dying, or experiencing increased dependency in activities of daily living (ADLs) or instrumental activities of daily living (IADLs) for persons with self-rated hearing and/or visual impairment. The data are from baseline and 1-year follow-up of…
Characteristics of Nursing Homes that Affect Resident Outcomes
Although there has been increased interest in using outcomes as measures of quality, few studies have shown a link between structure or process and outcomes. In this analysis, based on approximately 2,500 residents in 80 nursing homes in Rhode Island, multivariate models estimate which aspects of care are associated with resident outcomes after controlling for resident characteristics. Outcomes, measured over a 6-month period included death, func…
Prevalence and Correlates of Disruptive Behavior in the Nursing Home
Estimates of the prevalence of disruptive behavior in the nursing home are presented based upon a representative sample of nursing home residents from intermediate care and skilled nursing facilities (ICF and SNF) in Rhode Island. Results indicate that 26.4% of residents had engaged in some form of disruptive behavior within two weeks prior to assessment. Abusiveness (physical and verbal) and noisiness were identified as the most prevalent behavi…
Reforming Nursing Home Quality Regulation
The federally-mandated nursing home survey and certification process has been criticized for focusing more on the potential of each facility to provide good care than on the demonstrated quality of care delivered or on resultant resident outcomes. This paper presents the results of an evaluation of the pilot of a new federal survey process (Patient Care and Services, PaCS) that concentrates surveyor time on the review of resident care, reduces su…
Combining Activities of Daily Living with Instrumental Activities of Daily Living to Measure Functional Disability
Measures of functional disability typically contain items that reflect limitations in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Combining IADL and ADL items together in the same scale would provide enhanced range and sensitivity of measurement. This article presents psychometric justification for a combined ADL/IADL scale. Data come from 2,977 disabled respondents in the 1989 National Long-Te…
Characteristics of Nursing Homes that Affect Resident Outcomes
Although there has been increased interest in using outcomes as measures of quality, few studies have shown a link between structure or process and outcomes. In this analysis, based on approximately 2,500 residents in 80 nursing homes in Rhode Island, multivariate models estimate which aspects of care are associated with resident outcomes after controlling for resident characteristics. Outcomes, measured over a 6-month period included death, func…
Impact of Differential Item Functioning on Age and Gender Differences in Functional Disability
Comparisons of disability across sociodemographic groups need to take DIF into account. Future research should examine the causes of DIF and develop alternative question wordings that reduce DIF effects
Nursing Homes' Response to the Nursing Home Compare Report Card
These findings suggest that the Nursing Home Compare report card has the potential to positively affect nursing home quality
The Relationship of Vision and Hearing Impairment to One-Year Mortality and Functional Decline
Impairments in hearing and vision are common for those aged 65 and older, and severe impairments may result in dependencies in daily activities. This article presents a longitudinal analysis of the risk of dying, or experiencing increased dependency in activities of daily living (ADLs) or instrumental activities of daily living (IADLs) for persons with self-rated hearing and/or visual impairment. The data are from baseline and 1-year follow-up of…
Making Difficult Decisions
Objectives. We investigated how quality of care affects choosing a nursing home. Methods. We examined nursing home choice in California, Ohio, New York, and Texas in 2001, a period before the federal Nursing Home Compare report card was published. Thus, consumers were less able to observe clinical quality or clinical quality was masked. We modeled nursing home choice by estimating a conditional multinomial logit model. Results. In all states, con…
Pressure Ulcer Prevalence in Ohio Nursing Homes
Pressure ulcers remain a common medical problem in nursing homes, despite the development of clinical guidelines for prevention and treatment. Prevention involves low technology but vigilant care. If the disease progresses, infections can develop, and surgery may be necessary to prevent death. This article examines pressure ulcer correlates in a representative sample of 15,121 nursing home residents in 1994 in the state of Ohio. The prevalence of…
Risk of Behavior Problems among Nursing Home Residents in the United States
This study identified personal risk factors associated with behavior problems among nursing home residents using data based on a national survey of nursing home residents. Data are based on the Institutional Population Component of the 1987 National Medical Expenditure Survey and include nursing home residents living in licensed facilities on January 1, 1987. Multiple regression analyses were conducted to examine characteristics of residents that…
Correlates of Disruptive Behaviors in Nursing Homes
This study reexamines factors associated with the occurrence of disruptive behaviors using a representative sample of nursing home residents in Rhode Island in 1984-1985. Four indicators of disruptive behaviors are examined using multivariate methods: evidence of any disruptive behaviors, abusive behavior, wandering, and noisiness. Results are compared with the 1989 study by Jackson et al., which was based on the same data. Findings indicate that…
Prevalence and Correlates of Disruptive Behavior in the Nursing Home
Estimates of the prevalence of disruptive behavior in the nursing home are presented based upon a representative sample of nursing home residents from intermediate care and skilled nursing facilities (ICF and SNF) in Rhode Island. Results indicate that 26.4% of residents had engaged in some form of disruptive behavior within two weeks prior to assessment. Abusiveness (physical and verbal) and noisiness were identified as the most prevalent behavi…
Prevalence and Correlates of Disruptive Behavior in the Nursing Home
Estimates of the prevalence of disruptive behavior in the nursing home are presented based upon a representative sample of nursing home residents from intermediate care and skilled nursing facilities (ICF and SNF) in Rhode Island. Results indicate that 26.4% of residents had engaged in some form of disruptive behavior within two weeks prior to assessment. Abusiveness (physical and verbal) and noisiness were identified as the most prevalent behavi…
Reforming Nursing Home Quality Regulation
The federally-mandated nursing home survey and certification process has been criticized for focusing more on the potential of each facility to provide good care than on the demonstrated quality of care delivered or on resultant resident outcomes. This paper presents the results of an evaluation of the pilot of a new federal survey process (Patient Care and Services, PaCS) that concentrates surveyor time on the review of resident care, reduces su…
Characteristics of Nursing Homes that Affect Resident Outcomes
Although there has been increased interest in using outcomes as measures of quality, few studies have shown a link between structure or process and outcomes. In this analysis, based on approximately 2,500 residents in 80 nursing homes in Rhode Island, multivariate models estimate which aspects of care are associated with resident outcomes after controlling for resident characteristics. Outcomes, measured over a 6-month period included death, func…
The Relationship of Vision and Hearing Impairment to One-Year Mortality and Functional Decline
Impairments in hearing and vision are common for those aged 65 and older, and severe impairments may result in dependencies in daily activities. This article presents a longitudinal analysis of the risk of dying, or experiencing increased dependency in activities of daily living (ADLs) or instrumental activities of daily living (IADLs) for persons with self-rated hearing and/or visual impairment. The data are from baseline and 1-year follow-up of…
Correlates of Disruptive Behaviors in Nursing Homes
This study reexamines factors associated with the occurrence of disruptive behaviors using a representative sample of nursing home residents in Rhode Island in 1984-1985. Four indicators of disruptive behaviors are examined using multivariate methods: evidence of any disruptive behaviors, abusive behavior, wandering, and noisiness. Results are compared with the 1989 study by Jackson et al., which was based on the same data. Findings indicate that…
Risk of Behavior Problems among Nursing Home Residents in the United States
This study identified personal risk factors associated with behavior problems among nursing home residents using data based on a national survey of nursing home residents. Data are based on the Institutional Population Component of the 1987 National Medical Expenditure Survey and include nursing home residents living in licensed facilities on January 1, 1987. Multiple regression analyses were conducted to examine characteristics of residents that…
Pressure Ulcer Prevalence in Ohio Nursing Homes
Pressure ulcers remain a common medical problem in nursing homes, despite the development of clinical guidelines for prevention and treatment. Prevention involves low technology but vigilant care. If the disease progresses, infections can develop, and surgery may be necessary to prevent death. This article examines pressure ulcer correlates in a representative sample of 15,121 nursing home residents in 1994 in the state of Ohio. The prevalence of…
Combining Activities of Daily Living with Instrumental Activities of Daily Living to Measure Functional Disability
Measures of functional disability typically contain items that reflect limitations in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Combining IADL and ADL items together in the same scale would provide enhanced range and sensitivity of measurement. This article presents psychometric justification for a combined ADL/IADL scale. Data come from 2,977 disabled respondents in the 1989 National Long-Te…
Nursing Home Costs and Risk-Adjusted Outcome Measures of Quality
BACKGROUND: The inadequacy of quality of care in nursing homes has been and continues to be a focus of public concerns. Understanding the relationship between quality and costs can offer guidance to policies designed to encourage high quality. OBJECTIVES: To investigate the relationship between costs and quality of care in nursing homes, and to test the hypothesis that higher quality may be associated with lower costs. RESEARCH DESIGN: Statistica…
Impact of Differential Item Functioning on Age and Gender Differences in Functional Disability
Comparisons of disability across sociodemographic groups need to take DIF into account. Future research should examine the causes of DIF and develop alternative question wordings that reduce DIF effects
Development of a Risk-Adjusted Urinary Incontinence Outcome Measure of Quality for Nursing Homes
BACKGROUND: Quality of nursing home care is of ongoing concern. The availability of uniform, patient-level information-the Minimum Data Set (MDS)-offers the opportunity to assess quality based on risk-adjusted health outcomes. OBJECTIVE: To develop a risk-adjusted measure of quality based on urinary incontinence (UI) outcomes for nursing homes, derived from the MDS. RESEARCH DESIGN: A retrospective statistical analysis of individual resident leve…
Effects of Nursing Home Ownership Type and Resident Payer Source on Hospitalization for Suspected Pneumonia
BACKGROUND: Whether to hospitalize residents with suspected pneumonia is a complex decision determined both by clinical and financial considerations. The decision to hospitalize may be different in for-profit and not-for-profit facilities and for different payment sources. OBJECTIVE: The objective of this study was to examine the role of proprietary status in the decision to hospitalize residents with suspected pneumonia, controlling for facility…
Nursing Homes' Response to the Nursing Home Compare Report Card
These findings suggest that the Nursing Home Compare report card has the potential to positively affect nursing home quality
Home Health Care Agency Staffing Patterns Before and After the Balanced Budget Act of 1997, by Rural and Urban Location
Context: The Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary. Purpose: We examine the staffing characteristics of stable Medicare‐certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies. Methods: Data were drawn from Medicare Provider of Service files a…
Does Risk Adjustment of the CMS Quality Measures for Nursing Homes Matter
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) publish a report card for nursing homes with 19 clinical quality measures (QMs). These measures include minimal risk adjustment. OBJECTIVES: To develop QMs with more extensive risk adjustment and to investigate the impact on quality rankings. RESEARCH DESIGN: Retrospective analysis of individual level data reported in the Minimum Data Set (MDS). Random effect logistic models were us…
The Costs of Turnover in Nursing Homes
BACKGROUND: Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. OBJECTIVES: To estimate the net costs associated with turnover of direct care staff in nursing homes. DATA AND SAMPLE: Nine hundred two nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set, Medicare enrollment files, Census, and Area Resource File. RESEARCH DESIGN: We estimated total cost function…
Changes in Clinical and Hotel Expenditures Following Publication of the Nursing Home Compare Report Card
BACKGROUND: Nursing Home Compare first published clinical quality measures at the end of 2002. It is a quality report card that for the first time offers consumers easily accessible information about the clinical quality of nursing homes. It led to changes in consumers' demand, increasing the relative importance of clinical versus hotel aspects of quality in their search and choice of a nursing home. OBJECTIVES: To examine the hypothesis that nur…
Does State Regulation of Quality Impose Costs on Nursing Homes
BACKGROUND: Government regulation is intended to enhance quality, safety, fairness, or competition in the regulated industry. Such regulation entails both direct and indirect costs. OBJECTIVES: To estimate the costs associated with the regulation of quality of the nursing home industry. SAMPLE: This study includes 11,168 free-standing nursing homes nationally, between 2004 and 2006. RESEARCH DESIGN: Data included information from the Medicare cos…
Thirty-Day, All-cause Readmissions for Elderly Patients Who Have an Injury-related Inpatient Stay
BACKGROUND: Policymakers are exploring ways to reduce readmission rates. Much attention has been given to readmissions for conditions such as heart failure, acute myocardial infarction, and pneumonia, but little attention has been given to readmissions of patients with injury-related index admissions. METHODS: This analysis is a retrospective cohort study of elderly persons who are admitted to a community hospital for a principal diagnosis of inj…
Making Difficult Decisions
Objectives. We investigated how quality of care affects choosing a nursing home. Methods. We examined nursing home choice in California, Ohio, New York, and Texas in 2001, a period before the federal Nursing Home Compare report card was published. Thus, consumers were less able to observe clinical quality or clinical quality was masked. We modeled nursing home choice by estimating a conditional multinomial logit model. Results. In all states, con…
Potentially Avoidable Hospitalizations for Elderly Long-stay Residents in Nursing Homes
BACKGROUND: Hospitalizations of long-stay nursing home (NH) residents are common. The high estimates of potentially avoidable hospitalizations in NHs suggest that efforts to reduce avoidable hospitalizations may be effective in lowering health care expenditures as well as improving the quality of care for NH residents. OBJECTIVE: To determine the relationship between clinical risk factors, facility characteristics and State policy variables, and …
Response to Letter to the Editor Regarding the Paper “Potentially Avoidable Hospitalization for Elderly Long-stay Residents in Nursing Homes”
Evaluation of AHRQ’s On-Time Pressure Ulcer Prevention Program
BACKGROUND: Pressure ulcers present serious health and economic consequences for nursing home residents. The Agency for Healthcare Research & Quality, in partnership with the New York State Department of Health, implemented the pressure ulcer module of On-Time Quality Improvement for Long Term Care (On-Time), a clinical decision support intervention to reduce pressure ulcer incidence rates. OBJECTIVE: To evaluate the effectiveness of the On-Time …
Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers
BACKGROUND: Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). OBJECTIVE: To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characte…
The Marginal Costs of Adverse Drug Events Associated With Exposures to Anticoagulants and Hypoglycemic Agents During Hospitalization
BACKGROUND: Anticoagulants and hypoglycemic agents are 2 of the most challenging drug classes for medical management in the hospital resulting in many adverse drug events (ADEs). OBJECTIVE: Estimating the marginal cost (MC) of ADEs associated with anticoagulants and hypoglycemic agents for adults in 5 patient groups during their hospital stay and the total annual ADE costs for all patients exposed to these drugs during their stay. RESEARCH DESIGN…
Medicine (23 obras) · Nursing (18 obras) · Geriatric Care and Nursing Homes (16 obras) · Nursing homes (16 obras) · Health care (10 obras) · Psychology (10 obras) · Business (8 obras) · Frailty in Older Adults (8 obras) · Quality (philosophy) (7 obras) · Emergency Medicine (6 obras)