Bruce Leff
Biographic Data
| ID | 5534999 |
|---|---|
| NAME | Bruce Leff |
| GIVEN NAMES | Bruce |
| FAMILY NAME | Leff |
| SIGNATURE | LEFF B |
| AFFILIATIONS | Johns Hopkins University |
| ORCID | 0000-0003-1714-7458 |
| VERIFIED | Yes |
| TOTAL WORKS | 16 |
| TOTAL CITATIONS | 0 |
| AUTHOR COUNT | 16 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2008 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 0 |
Dementia care quality at home
BACKGROUND: Dementia is highly prevalent among the 7.5 million homebound older adults in the United States. Despite this high dementia prevalence, dementia care interventions and associated curricula developed to date have focused nearly exclusively on office-based primary care and have not been adapted to the unique care setting, staffing, and workflows of home-based primary care (HBPC), WHICH INCLUDES LONGITUDINAL MULTIDISCIPLINARY IN-HOME PRIM…
Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care
BACKGROUND: Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. OBJECTIVES: Develop and validate criteria that identify appropriate HBPC target populations. RESEARCH DESIGN: A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All …
Patterns of Morbidity Across the Lifespan
BACKGROUND: Classification systems to segment such patients into subgroups for purposes of care management and population analytics should balance administrative simplicity with clinical meaning and measurement precision. OBJECTIVE: To describe and empirically apply a new clinically relevant population segmentation framework applicable to all payers and all ages across the lifespan. RESEARCH DESIGN AND SUBJECTS: Cross-sectional analyses using ins…
Hospital-to-Home-Health Transition Quality (H3TQ) Index
BACKGROUND: We developed the Hospital-to-Home-Health Transition Quality (H3TQ) Index for skilled home healthcare (HH) agencies to identify threats to safe, high-quality care transitions in real time. OBJECTIVE: Assess the validity of H3TQ in a large sample across diverse communities. RESEARCH DESIGN: A survey of recently hospitalized older adults referred for skilled HH services and their HH provider at two large HH agencies in Baltimore, MD, and…
Effects of a Rehabilitation-at-Home Program Compared to Post-acute Skilled Nursing Facility Care on Safety, Readmission, and Community Dwelling Status
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…
What’s Happening at Home
BACKGROUND: Home clinical care (HCC) includes home-based medical care (HBMC-medical visits in the home) and skilled home health care (skilled nursing or therapy visits). Over 7 million older adults would benefit from HCC; however, we know surprisingly little about homebound older adults and HCC. OBJECTIVE: To describe HCC received by older adults using claims data within the OptumLabs Data Warehouse. RESEARCH DESIGN: Using administrative claims d…
Defining and Assessing Geriatric Risk Factors and Associated Health Care Utilization Among Older Adults Using Claims and Electronic Health Records
BACKGROUND: Using electronic health records (EHRs), in addition to claims, to systematically identify patients with factors associated with adverse outcomes (geriatric risk) among older adults can prove beneficial for population health management and clinical service delivery. OBJECTIVE: To define and compare geriatric risk factors derivable from claims, structured EHRs, and unstructured EHRs, and estimate the relationship between geriatric risk …
Home but still engaged
This information can be useful in designing community programs that will foster meaningful social and community engagement for older adults, which may improve their quality of life
Identifying Consistent High-cost Users in a Health Plan
BACKGROUND: High-cost users in a period may not incur high-cost utilization in the next period. Consistent high-cost users (CHUs) may be better targets for cost-saving interventions. OBJECTIVES: To compare the characteristics of CHUs (patients with plan-specific top 20% medical costs in all 4 half-year periods across 2008 and 2009) and point high-cost users (PHUs) (top users in 2008 alone), and to build claims-based models to identify CHUs. RESEA…
Prevalence, Geographic Variation, and Trends in Hospital Services Relevant to the Care of Older Adults
BACKGROUND: The availability of hospital services for older adults nationwide is not well understood. OBJECTIVE: To present the development of the Senior Care Services Scale (SCSS) through: (1) identification of hospital services relevant to the care of older adults; (2) development of a taxonomy classifying these services; and (3) description of prevalence, geographic variation, and trends in service provision in US hospitals over time. DESIGN, …
Multiple Chronic Conditions and Life Expectancy
BACKGROUND: The number of people living with multiple chronic conditions is increasing, but we know little about the impact of multimorbidity on life expectancy. OBJECTIVE: We analyze life expectancy in Medicare beneficiaries by number of chronic conditions. RESEARCH DESIGN: A retrospective cohort study using single-decrement period life tables. SUBJECTS: Medicare fee-for-service beneficiaries (N=1,372,272) aged 67 and older as of January 1, 2008…
Healthcare Task Difficulty Among Older Adults With Multimorbidity
BACKGROUND: Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden. OBJECTIVES: To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity. RESEARCH DESIGN: Cross-sectional and longitudinal secondary data analysis. SUBJECTS: Multimorbid adults aged 65 years or older from primary care clinics. MEASURES: We generated …
Who Participates in Chronic Disease Self-management (CDSM) Programs? Differences Between Participants and Nonparticipants in a Population of Multimorbid Older Adults
BACKGROUND: Self-care management is recognized as a key component of care for multimorbid older adults; however, the characteristics of those most likely to participate in Chronic Disease Self-Management (CDSM) programs and strategies to maximize participation in such programs are unknown. OBJECTIVES: To identify individual factors associated with attending CDSM programs in a sample of multimorbid older adults. RESEARCH DESIGN: Participants in th…
Physician Evaluation and Management of Medicare Home Health Patients
OBJECTIVE: The Medicare home health benefit is predicated on physician referral and involvement. In this study, we investigated (1) the frequency and (2) implications of home health patients' evaluation and management by community physicians. METHODS: The 2005 and 2006 Medicare 5% Standard Analytic Files were linked to the Outcome and Assessment Information Set to examine physician visits among 74,462 fee-for service Medicare beneficiaries with a…
Health Care Provider Evaluation of a Substitutive Model of Hospital at Home
OBJECTIVE: To evaluate Hospital at Home (HaH), a substitute for inpatient care, from the perspectives of participating providers. RESEARCH DESIGN: Multivariate general estimating equations regression analyses of a patient-specific survey of providers delivering HaH care in a prospective, nonrandomized clinical trial. SUBJECTS: Eleven physicians and 26 nurses employed in 3 Medicare-Advantage plans and 1 Veterans Administration medical center. MEAS…
Medicare Home Health Patients’ Transitions Through Acute And Post-Acute Care Settings
OBJECTIVES: To describe Medicare beneficiaries' transitions through home health care within the context of other acute and post-acute services, and to examine agreement between administrative claims and Outcome and Assessment Information Set (OASIS) measures of health services use. DATA SOURCES: The 2004 Chronic Condition Data Warehouse, including the Medicare 5% standard analytic file and OASIS. Study participants were 66,510 Medicare beneficiar…
No prominent works on this page.
Medicare Home Health Patients’ Transitions Through Acute And Post-Acute Care Settings
OBJECTIVES: To describe Medicare beneficiaries' transitions through home health care within the context of other acute and post-acute services, and to examine agreement between administrative claims and Outcome and Assessment Information Set (OASIS) measures of health services use. DATA SOURCES: The 2004 Chronic Condition Data Warehouse, including the Medicare 5% standard analytic file and OASIS. Study participants were 66,510 Medicare beneficiar…
Physician Evaluation and Management of Medicare Home Health Patients
OBJECTIVE: The Medicare home health benefit is predicated on physician referral and involvement. In this study, we investigated (1) the frequency and (2) implications of home health patients' evaluation and management by community physicians. METHODS: The 2005 and 2006 Medicare 5% Standard Analytic Files were linked to the Outcome and Assessment Information Set to examine physician visits among 74,462 fee-for service Medicare beneficiaries with a…
Health Care Provider Evaluation of a Substitutive Model of Hospital at Home
OBJECTIVE: To evaluate Hospital at Home (HaH), a substitute for inpatient care, from the perspectives of participating providers. RESEARCH DESIGN: Multivariate general estimating equations regression analyses of a patient-specific survey of providers delivering HaH care in a prospective, nonrandomized clinical trial. SUBJECTS: Eleven physicians and 26 nurses employed in 3 Medicare-Advantage plans and 1 Veterans Administration medical center. MEAS…
Who Participates in Chronic Disease Self-management (CDSM) Programs? Differences Between Participants and Nonparticipants in a Population of Multimorbid Older Adults
BACKGROUND: Self-care management is recognized as a key component of care for multimorbid older adults; however, the characteristics of those most likely to participate in Chronic Disease Self-Management (CDSM) programs and strategies to maximize participation in such programs are unknown. OBJECTIVES: To identify individual factors associated with attending CDSM programs in a sample of multimorbid older adults. RESEARCH DESIGN: Participants in th…
Multiple Chronic Conditions and Life Expectancy
BACKGROUND: The number of people living with multiple chronic conditions is increasing, but we know little about the impact of multimorbidity on life expectancy. OBJECTIVE: We analyze life expectancy in Medicare beneficiaries by number of chronic conditions. RESEARCH DESIGN: A retrospective cohort study using single-decrement period life tables. SUBJECTS: Medicare fee-for-service beneficiaries (N=1,372,272) aged 67 and older as of January 1, 2008…
Healthcare Task Difficulty Among Older Adults With Multimorbidity
BACKGROUND: Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden. OBJECTIVES: To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity. RESEARCH DESIGN: Cross-sectional and longitudinal secondary data analysis. SUBJECTS: Multimorbid adults aged 65 years or older from primary care clinics. MEASURES: We generated …
Prevalence, Geographic Variation, and Trends in Hospital Services Relevant to the Care of Older Adults
BACKGROUND: The availability of hospital services for older adults nationwide is not well understood. OBJECTIVE: To present the development of the Senior Care Services Scale (SCSS) through: (1) identification of hospital services relevant to the care of older adults; (2) development of a taxonomy classifying these services; and (3) description of prevalence, geographic variation, and trends in service provision in US hospitals over time. DESIGN, …
Home but still engaged
This information can be useful in designing community programs that will foster meaningful social and community engagement for older adults, which may improve their quality of life
Identifying Consistent High-cost Users in a Health Plan
BACKGROUND: High-cost users in a period may not incur high-cost utilization in the next period. Consistent high-cost users (CHUs) may be better targets for cost-saving interventions. OBJECTIVES: To compare the characteristics of CHUs (patients with plan-specific top 20% medical costs in all 4 half-year periods across 2008 and 2009) and point high-cost users (PHUs) (top users in 2008 alone), and to build claims-based models to identify CHUs. RESEA…
Defining and Assessing Geriatric Risk Factors and Associated Health Care Utilization Among Older Adults Using Claims and Electronic Health Records
BACKGROUND: Using electronic health records (EHRs), in addition to claims, to systematically identify patients with factors associated with adverse outcomes (geriatric risk) among older adults can prove beneficial for population health management and clinical service delivery. OBJECTIVE: To define and compare geriatric risk factors derivable from claims, structured EHRs, and unstructured EHRs, and estimate the relationship between geriatric risk …
What’s Happening at Home
BACKGROUND: Home clinical care (HCC) includes home-based medical care (HBMC-medical visits in the home) and skilled home health care (skilled nursing or therapy visits). Over 7 million older adults would benefit from HCC; however, we know surprisingly little about homebound older adults and HCC. OBJECTIVE: To describe HCC received by older adults using claims data within the OptumLabs Data Warehouse. RESEARCH DESIGN: Using administrative claims d…
Effects of a Rehabilitation-at-Home Program Compared to Post-acute Skilled Nursing Facility Care on Safety, Readmission, and Community Dwelling Status
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…
Patterns of Morbidity Across the Lifespan
BACKGROUND: Classification systems to segment such patients into subgroups for purposes of care management and population analytics should balance administrative simplicity with clinical meaning and measurement precision. OBJECTIVE: To describe and empirically apply a new clinically relevant population segmentation framework applicable to all payers and all ages across the lifespan. RESEARCH DESIGN AND SUBJECTS: Cross-sectional analyses using ins…
Hospital-to-Home-Health Transition Quality (H3TQ) Index
BACKGROUND: We developed the Hospital-to-Home-Health Transition Quality (H3TQ) Index for skilled home healthcare (HH) agencies to identify threats to safe, high-quality care transitions in real time. OBJECTIVE: Assess the validity of H3TQ in a large sample across diverse communities. RESEARCH DESIGN: A survey of recently hospitalized older adults referred for skilled HH services and their HH provider at two large HH agencies in Baltimore, MD, and…
Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care
BACKGROUND: Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. OBJECTIVES: Develop and validate criteria that identify appropriate HBPC target populations. RESEARCH DESIGN: A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All …
Dementia care quality at home
BACKGROUND: Dementia is highly prevalent among the 7.5 million homebound older adults in the United States. Despite this high dementia prevalence, dementia care interventions and associated curricula developed to date have focused nearly exclusively on office-based primary care and have not been adapted to the unique care setting, staffing, and workflows of home-based primary care (HBPC), WHICH INCLUDES LONGITUDINAL MULTIDISCIPLINARY IN-HOME PRIM…
Medicine (15 works) · Frailty in Older Adults (10 works) · Gerontology (10 works) · Family medicine (9 works) · Geriatric Care and Nursing Homes (9 works) · Gerontology (9 works) · Health care (9 works) · Chronic Disease Management Strategies (8 works) · Environmental health (5 works) · Internal Medicine (5 works)