Helena Temkin‐greener
Dados Biográficos
| ID | 777611 |
|---|---|
| NOME | Helena Temkin‐greener |
| PRENOMES | Helena |
| SOBRENOME | Temkin‐greener |
| ASSINATURA | GREENER H T |
| AFILIAÇÕES | University of Rochester |
| ORCID | 0000-0001-6113-2953 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 31 |
| TOTAL DE CITAÇÕES | 17 |
| TOTAL COMO AUTOR | 31 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1981 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2023 |
| ÍNDICE H | 2 |
Association of Skilled Nursing Facility Participation in Voluntary Bundled Payments With Postacute Care Outcomes for Joint Replacement
IMPORTANCE: The Medicare Bundled Payments for Care Improvement (BPCI) model 3 of 2013 holds participating skilled nursing facilities (SNFs) responsible for all episode costs. There is limited evidence regarding SNF-specific outcomes associated with BPCI. OBJECTIVE: To examine the association between SNF BPCI participation and patient outcomes and across-facility differences in these outcomes among Medicare beneficiaries undergoing lower extremity…
Skilled Nursing Facility Participation in a Voluntary Medicare Bundled Payment Program
IMPORTANCE: Model 3 of the Bundled Payments for Care Improvement (BPCI) is an alternative payment model in which an entity takes accountability for the episode costs. It is unclear how BPCI affected the overall skilled nursing facility (SNF) financial performance and the differences between facilities with differing racial/ethnic and socioeconomic status (SES) composition of the residents. OBJECTIVE: The objective of this study was to determine a…
The Use Patterns of Medicaid Home and Community Based Services Among Medicare/Medicaid Beneficiaries With Dementia
DATA REPORT article Front. Public Health, 28 October 2021Sec. Aging and Public Health https://doi.org/10.3389/fpubh.2021.708402
Institutional Postacute Care Use May Help Reduce Readmissions for Ischemic Stroke Patients
OBJECTIVES: Readmissions for Medicare patients initially admitted for stroke are common and costly. Rehabilitation in an institutional postacute care (PAC) setting is an evidence-based component of recovery for stroke. Under current Medicare payment reforms, care coordination across hospitals and PAC providers is key to improving quality and efficiency of care. We examined the causal impact of institutional PAC use on 30-day readmission rates for…
The Effect of Medicare Shared Savings Program on Readmissions and Variations by Race/Ethnicity and Payer Status (December 9, 2020)
OBJECTIVE: Accountable care organizations in the Medicare Shared Savings Program (MSSP) in the United States attempt to reduce cost and improve quality for their patients by improving care coordination across care settings. We examined the impact of hospital participation in the MSSP on 30-day readmissions for several groups of Medicare inpatients, and by race/ethnicity and payer status. MAIN DATA SOURCE: A 2010-2016 Medicare Provider Analysis an…
Relationship of Medicare–Medicaid Dual Eligibility and Dementia With Unplanned Facility Admissions Among Medicare Home Health Care Recipients
Objective: The objective of this study was to examine the effects of dementia and Medicare-Medicaid dual eligibility on unplanned facility admission among older Medicare home health (HH) recipients. Method: This study involves a secondary analysis of data from the Outcome and Assessment Information Set (OASIS) and billing records (i.e., International Classification of Diseases, 10th Revision [ICD-10] codes) of 6,153 adults ≥ 65 years receiving HH…
Perceived Patient Safety Culture in Nursing Homes Associated With “Nursing Home Compare” Performance Indicators
BACKGROUND: The safety and quality of care provided to nursing home residents is a significant concern. Little is known whether fostering patient safety culture helps improve the safety and quality of nursing home care. METHODS: This study determined the associations of nursing home patient safety culture performance, as reported by administrators, directors of nursing, and unit leaders in a large national sample of free-standing nursing homes, w…
Impact of Nursing Home Palliative Care Teams on End-of-Life Outcomes
BACKGROUND: Deficits in end-of-life care in nursing homes (NHs) are reported, but the impact of palliative care teams (PCTeams) on resident outcomes remains largely untested. OBJECTIVE: Test the impact of PCTeams on end-of-life outcomes. RESEARCH DESIGN: Multicomponent strategy employing a randomized, 2-arm controlled trial with a difference-in-difference analysis, and a nonrandomized second control group to assess the intervention's placebo effe…
Impact of Medicare’s Nonpayment Program on Hospital-acquired Conditions
BACKGROUND: Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program. OBJECTIVE: To determine whether the Program was associa…
Prototype End-of-Life Quality Measures Based on MDS 3 Data
BACKGROUND: The Nursing Home Compare (NHC) report card does not include end-of-life (EOL) quality measures (QMs). OBJECTIVES: To develop and examine the properties of EOL QMs. SUBJECTS: A total of 39,590 nursing home decedents in 626 facilities in New York State in fiscal year 2012. DESIGN: Statistical analyses of Minimum Data Set 3 data, including multivariable regression analyses and descriptive statistics. MEASURES: Death in the hospital, numb…
Nursing Home Admissions Among Medicaid HCBS Enrollees
OBJECTIVES: Rebalancing the long-term care system between institutional care and home-based and community-based services (HCBS) has become an important policy goal of most state Medicaid programs and several provisions of the Affordable Care Act. This study estimated nursing home admission patterns by race and ethnicity in a retrospective cohort of Medicare and Medicaid dually eligible individuals who enrolled in Medicaid HCBS programs. STUDY DES…
Have Racial Disparities in Ambulatory Care Sensitive Admissions Abated Over Time
BACKGROUND: Racial disparities in access to care and access to high-quality care have been persistent over many decades. They have been documented in all areas of health care, including ambulatory care. Policy initiatives have been implemented to address disparities and close the gaps in care that minorities face. Less is known about the effectiveness of these polices. OBJECTIVES: To evaluate whether disparities in quality of ambulatory care have…
Trends in Family Ratings of Experience With Care and Racial Disparities Among Maryland Nursing Homes
BACKGROUND: Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities. METHODS: We analyzed trends of consumer ratings publicly reported for …
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…
Stability of Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders Among Long-term Nursing Home Residents
BACKGROUND: High-quality care for long-term nursing home residents should include discussions and follow-up on patients' end-of-life care wishes. Yet, recent changes to the Minimum Data Set data collection exclude this information from routine assessment of patients mandated by the Centers for Medicare & Medicaid Services, making the provision of high-quality end-of-life care less likely. We examined the stability of cardiopulmonary resuscitation…
Racial Disparities in In-hospital Death and Hospice Use Among Nursing Home Residents at the End of Life
BACKGROUND: Significant racial disparities have been reported regarding nursing home residents' use of hospital and hospice care at the end of life (EOL). OBJECTIVE: To examine whether the observed racial disparities in EOL care are due to within-facility or across-facility variations. RESEARCH DESIGN AND SUBJECTS: Cross-sectional study of 49,048 long-term care residents (9.23% black and 90.77% white) in 555 New York State nursing homes who died …
Self-Efficacy as a Mediator Between Maternal Depression and Child Hospitalizations in Low-Income Urban Families
Mother–Child Interactions and the Associations with Child Healthcare Utilization in Low-Income Urban Families
Pressure Ulcer Prevalence Among Black and White Nursing Home Residents in New York State
OBJECTIVE: The occurrence of pressure ulcers (PUs) in nursing homes is a marker for poor quality of care. We examine whether differences in PU prevalence between black and white residents are due to within- or across-facility disparities. METHODS: Minimum Data Sets (2006-2007) are linked with the Online Survey Certification and Reporting database. Long-term care residents with high risk for PUs are identified. The dependent variable is dichotomou…
Nursing Home Environment and Organizational Performance
BACKGROUND: Work environment attributes--job design, teamwork, and work effectiveness--are thought to influence nursing home (NH) quality of care. However, few studies tested these relationships empirically. OBJECTIVE: We investigated the relationship between these work environment attributes and quality of care measured by facility-level regulatory deficiencies. METHODS: Data on work environment were derived from survey responses obtained (in 20…
Measuring Work Environment and Performance in Nursing Homes
BACKGROUND: Qualitative studies of the nursing home work environment have long suggested that attributes such as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. OBJECTIVES: This study is designed to develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability …
Disenrollment From an Acute/Long-Term Managed Care Program (Pace)
BACKGROUND: The Program of All-Inclusive Care for the Elderly (PACE) is an acute/long-term managed care plan designed to care for the most frail and vulnerable Medicare beneficiaries. To our knowledge, this is a first study to examine patterns and predictors of disenrollment from PACE. OBJECTIVE: PACE, with its comprehensive delivery system, dual capitation, and a focus on the most vulnerable population, may be expected to achieve low rates of ex…
Measuring Interdisciplinary Team Performance in a Long-Term Care Setting
OBJECTIVES: The objectives of this study were to test the reliability and the validity of a survey instrument for assessing interdisciplinary team performance in long-term care settings and to measure team performance in the Program of All-Inclusive Care for the Elderly (PACE). RESEARCH DESIGN AND METHODS: The analysis is based on 1220 surveys completed by team members of 26 PACE programs. Cronbach's alphas, analysis of variance, and regression m…
Social Support and Risk-Adjusted Mortality in a Frail Older Population
OBJECTIVE: The objective of this study was to test the hypothesis that social support is an important predictor of mortality in a frail older population receiving formal long-term care services. RESEARCH DESIGN AND METHODS: The analysis is based on 3138 individuals enrolled in 28 Programs of All-Inclusive Care for the Elderly (PACE). Information about the enrollees is obtained from dataPACE. Semiparametric Cox proportional hazards models are esti…
Health Care Services Utilization at the End of Life in a Managed Care Program Integrating Acute and Long-Term Care
BACKGROUND: The period preceding death is often characterized by increased utilization of medical resources. There is an ongoing debate on the reasons for and the appropriateness of increased utilization at the end of life. OBJECTIVES: To study end-of-life practices in the PACE program and to assess the contribution of individual characteristics versus program site to the variation in use of services. RESEARCH DESIGN: Retrospective analyses of ut…
Ethnicity, gender, and utilization of mental health services in a medicaid population
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…
Determinants of hospital utilization and surgery on the Navajo Indian reservation
Surgical fertility regulation among women on the Navajo Indian reservation, 1972-1978
Changes in the rates of induced abortions, bilateral tubal ligations, and hysterectomies on the Navajo Indian Reservation have been examined for the years 1972-1978. While the incidence of abortions and tubal sterilizations is still considerably lower among Navajo women than among the total United States population of women, it has risen, especially among those in the prime of the reproductive cycle, i.e., ages 20-34. The rate of hysterectomy has…
A test of the child replacement hypothesis
Child mortality experience may affect subsequent fertility of couples by exerting the so‐called “physiological” and/or “replacement” responses. The influence of either effect should become apparent upon an examination of individual reproductive histories. The impact of infant and early childhood mortality on subsequent reproductive behavior of couples is analyzed for the presence and intensity of these effects. Historical data are derived from 1,…
Ethnicity, gender, and utilization of mental health services in a medicaid population
Spending-down to Medicaid in the Nursing Home and in the Community
Medicaid spend-down continues to be of considerable interest in public policy discussions regarding long-term care financing reforms. Yet, "measuring" of spend-down has been difficult because of data limitations. This study focuses on patterns of spend-down affecting those who become Medicaid eligible both in nursing homes and in the community. The study uses a longitudinal, person-specific, merged Medicare and Medicaid claims and eligibility fil…
Pace and the Medicare+Choice Risk-Adjusted Payment Model
This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program wo…
Health Care Services Utilization at the End of Life in a Managed Care Program Integrating Acute and Long-Term Care
BACKGROUND: The period preceding death is often characterized by increased utilization of medical resources. There is an ongoing debate on the reasons for and the appropriateness of increased utilization at the end of life. OBJECTIVES: To study end-of-life practices in the PACE program and to assess the contribution of individual characteristics versus program site to the variation in use of services. RESEARCH DESIGN: Retrospective analyses of ut…
Measuring Interdisciplinary Team Performance in a Long-Term Care Setting
OBJECTIVES: The objectives of this study were to test the reliability and the validity of a survey instrument for assessing interdisciplinary team performance in long-term care settings and to measure team performance in the Program of All-Inclusive Care for the Elderly (PACE). RESEARCH DESIGN AND METHODS: The analysis is based on 1220 surveys completed by team members of 26 PACE programs. Cronbach's alphas, analysis of variance, and regression m…
Social Support and Risk-Adjusted Mortality in a Frail Older Population
OBJECTIVE: The objective of this study was to test the hypothesis that social support is an important predictor of mortality in a frail older population receiving formal long-term care services. RESEARCH DESIGN AND METHODS: The analysis is based on 3138 individuals enrolled in 28 Programs of All-Inclusive Care for the Elderly (PACE). Information about the enrollees is obtained from dataPACE. Semiparametric Cox proportional hazards models are esti…
Disenrollment From an Acute/Long-Term Managed Care Program (Pace)
BACKGROUND: The Program of All-Inclusive Care for the Elderly (PACE) is an acute/long-term managed care plan designed to care for the most frail and vulnerable Medicare beneficiaries. To our knowledge, this is a first study to examine patterns and predictors of disenrollment from PACE. OBJECTIVE: PACE, with its comprehensive delivery system, dual capitation, and a focus on the most vulnerable population, may be expected to achieve low rates of ex…
Measuring Work Environment and Performance in Nursing Homes
BACKGROUND: Qualitative studies of the nursing home work environment have long suggested that attributes such as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. OBJECTIVES: This study is designed to develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability …
Self-Efficacy as a Mediator Between Maternal Depression and Child Hospitalizations in Low-Income Urban Families
Mother–Child Interactions and the Associations with Child Healthcare Utilization in Low-Income Urban Families
Pressure Ulcer Prevalence Among Black and White Nursing Home Residents in New York State
OBJECTIVE: The occurrence of pressure ulcers (PUs) in nursing homes is a marker for poor quality of care. We examine whether differences in PU prevalence between black and white residents are due to within- or across-facility disparities. METHODS: Minimum Data Sets (2006-2007) are linked with the Online Survey Certification and Reporting database. Long-term care residents with high risk for PUs are identified. The dependent variable is dichotomou…
Nursing Home Environment and Organizational Performance
BACKGROUND: Work environment attributes--job design, teamwork, and work effectiveness--are thought to influence nursing home (NH) quality of care. However, few studies tested these relationships empirically. OBJECTIVE: We investigated the relationship between these work environment attributes and quality of care measured by facility-level regulatory deficiencies. METHODS: Data on work environment were derived from survey responses obtained (in 20…
Racial Disparities in In-hospital Death and Hospice Use Among Nursing Home Residents at the End of Life
BACKGROUND: Significant racial disparities have been reported regarding nursing home residents' use of hospital and hospice care at the end of life (EOL). OBJECTIVE: To examine whether the observed racial disparities in EOL care are due to within-facility or across-facility variations. RESEARCH DESIGN AND SUBJECTS: Cross-sectional study of 49,048 long-term care residents (9.23% black and 90.77% white) in 555 New York State nursing homes who died …
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…
Stability of Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders Among Long-term Nursing Home Residents
BACKGROUND: High-quality care for long-term nursing home residents should include discussions and follow-up on patients' end-of-life care wishes. Yet, recent changes to the Minimum Data Set data collection exclude this information from routine assessment of patients mandated by the Centers for Medicare & Medicaid Services, making the provision of high-quality end-of-life care less likely. We examined the stability of cardiopulmonary resuscitation…
Trends in Family Ratings of Experience With Care and Racial Disparities Among Maryland Nursing Homes
BACKGROUND: Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities. METHODS: We analyzed trends of consumer ratings publicly reported for …
Nursing Home Admissions Among Medicaid HCBS Enrollees
OBJECTIVES: Rebalancing the long-term care system between institutional care and home-based and community-based services (HCBS) has become an important policy goal of most state Medicaid programs and several provisions of the Affordable Care Act. This study estimated nursing home admission patterns by race and ethnicity in a retrospective cohort of Medicare and Medicaid dually eligible individuals who enrolled in Medicaid HCBS programs. STUDY DES…
Have Racial Disparities in Ambulatory Care Sensitive Admissions Abated Over Time
BACKGROUND: Racial disparities in access to care and access to high-quality care have been persistent over many decades. They have been documented in all areas of health care, including ambulatory care. Policy initiatives have been implemented to address disparities and close the gaps in care that minorities face. Less is known about the effectiveness of these polices. OBJECTIVES: To evaluate whether disparities in quality of ambulatory care have…
Prototype End-of-Life Quality Measures Based on MDS 3 Data
BACKGROUND: The Nursing Home Compare (NHC) report card does not include end-of-life (EOL) quality measures (QMs). OBJECTIVES: To develop and examine the properties of EOL QMs. SUBJECTS: A total of 39,590 nursing home decedents in 626 facilities in New York State in fiscal year 2012. DESIGN: Statistical analyses of Minimum Data Set 3 data, including multivariable regression analyses and descriptive statistics. MEASURES: Death in the hospital, numb…
Impact of Medicare’s Nonpayment Program on Hospital-acquired Conditions
BACKGROUND: Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program. OBJECTIVE: To determine whether the Program was associa…
Impact of Nursing Home Palliative Care Teams on End-of-Life Outcomes
BACKGROUND: Deficits in end-of-life care in nursing homes (NHs) are reported, but the impact of palliative care teams (PCTeams) on resident outcomes remains largely untested. OBJECTIVE: Test the impact of PCTeams on end-of-life outcomes. RESEARCH DESIGN: Multicomponent strategy employing a randomized, 2-arm controlled trial with a difference-in-difference analysis, and a nonrandomized second control group to assess the intervention's placebo effe…
Perceived Patient Safety Culture in Nursing Homes Associated With “Nursing Home Compare” Performance Indicators
BACKGROUND: The safety and quality of care provided to nursing home residents is a significant concern. Little is known whether fostering patient safety culture helps improve the safety and quality of nursing home care. METHODS: This study determined the associations of nursing home patient safety culture performance, as reported by administrators, directors of nursing, and unit leaders in a large national sample of free-standing nursing homes, w…
Medicine (30 obras) · Geriatric Care and Nursing Homes (21 obras) · Nursing (19 obras) · Health care (16 obras) · Emergency Medicine (10 obras) · Gerontology (10 obras) · Nursing homes (10 obras) · Emergency Medicine (9 obras) · Healthcare Policy and Management (9 obras) · Medicaid (9 obras)