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Examining the Relationships between Excess Body Weight, Health and Disability
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Author(s): Vicki Freedman, Christine Himes and Saad Ahmad |
Organization(s): University of Medicine and Dentistry of New Jersey, Syracuse University and Urban Institute |
The recent rise in the prevalence of obesity and overweight in the overall U.S. population has raised many concerns about the future. In addition to concerns about the medical costs of treating obesity-related illness, an apparent correlation between obesity and disability has led to concern that the recent declines in rates of disability among the elderly may cease or reverse. In this report, the authors explore the relationship between excess weight and obesity in a series of cross sectional and longitudinal analyses in an attempt to evaluate these concerns. Using data from the 1998-2004 waves of the Health and Retirement Study, the authors find evidence that the risks of developing difficulties with activities of daily living (ADLs) does increase with the prevalence of obesity, but the effects appear to be less dramatic than the effects on the limitations in physical functioning, which can be precursors of ADL disability. Further, the authors find only a weak relationship between excess weight and the onset of difficulties with instrumental ADLs. [45 PDF pages] |
Published: May, 2008 |
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Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002
(Report)
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Author(s): Audra T. Wenzlow, Robert Schmitz and Jill Gurvey |
Organization(s): Mathematica Policy Research |
The goal of this study was to describe patterns of Medicaid nursing home utilization for each state and nationally. The authors address three specific research questions in this report: (1) What are the characteristics of people who use Medicaid nursing home services? (2) How do people who use Medicaid nursing home services become eligible for Medicaid? What proportion are long-time Medicaid enrollees entering a nursing home? What proportion are new enrollees? (3) How long do Medicaid-covered nursing home spells last and how often do individuals return to nursing homes? While addressing these questions, the authors also examine how state long-term care policies are associated with variation across states in patterns of nursing home utilization. [63 PDF pages] |
Published: January, 2008 |
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The Contribution of Self-Direction to Improving the Quality of Mental Health Services
(Report)
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Author(s): Vidhya Alakeson |
Organization(s): Office of the Assistant Secretary for Planning and Evaluation |
This report focuses on adults with severe mental illness (SMI) served by the public mental health system. It aims to identify and describe the range of self-directed care programs for this group currently being pursued by states and bring together existing evidence relating to the impact of these programs on individuals and on state resources. In doing so, it attempts to contribute to ongoing debate about effective strategies for improving the quality and outcomes of the public mental health system. It is early in the development of self-direction for individuals with SMI and the number of consumers currently served by these programs remains very small. Therefore, the findings and conclusions presented here are preliminary and further investigation will be required before definite conclusions can be drawn. [56 PDF pages] |
Published: November, 2007 |
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Advance Directives and Advance Care Planning for People with Intellectual and Physical Disabilities
(Report)
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Author(s): Gary L. Stein |
Organization(s): Yeshiva University, Wurzweiler School of Social Work |
This paper describes the current status of advance directives and advance care planning in the disability community and identifies where gaps exist in policy, practice, and research. The aim is to better assure that the needs and issues of people with disabilities are considered and integrated into new policies designed to promote effective advance care planning. This report reviews professional literature, consumer materials, and Internet sites pertaining to advance care planning, surrogate decisionmaking, and end-of-life care for people with physical and intellectual disabilities. [25 PDF pages] |
Published: October, 2007 |
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A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002
(Report)
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Author(s): Audra T. Wenzlow, Robert Schmitz and Kathy Shepperson |
Organization(s): Mathematica Policy Research |
This report examines how person-level data in the Medicaid Analytic eXtract (MAX) data system can be used to better understand Medicaid long-term care service use and expenditures, and to evaluate the utility of MAX data for further study of long-term care. In the analysis, the authors: compare expenditure and utilization-based measures of the balance of institutional and community-based long-term care services; examine Medicaid long-term care expenditures and utilization for two key groups of enrollees--young disabled enrollees and enrollees ages 65 and older; decompose community-based long-term care service expenditures by type of service; and summarize other Medicaid services used and costs incurred by long-term care users. [74 PDF pgs] |
Published: September, 2007 |
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Literature Review on Advance Directives
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Author(s): Anne Wilkinson, Neil Wenger and Lisa R. Shugarman |
Organization(s): RAND Corporation |
This report examines the empirical evidence about the degree to which advance directives and advance care planning have met their intended goals. The authors explore what the medical literature reports concerning the use of advance directives and advance care planning, disparities among groups in their use, and interventions to enhance the use and value of advance directives and advance care planning. [89 PDF pages] |
Published: June, 2007 |
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Following an Admissions Cohort: Care Management, Claim Experience and Transitions among an Admissions Cohort of Privately Insured Disabled Elders over a 16 Month Period
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Author(s): Marc A. Cohen, Jessica S. Miller and Xiaomei Shi |
Organization(s): LifePlans, Inc. |
This is the second in a series of reports based on longitudinal information collected from a sample of 1400 individuals with long-term care (LTC) insurance, who notified their insurance company that they are receiving or intend to receive paid services for which they will file or have filed a claim under their LTC policy. These individuals comprise an admissions cohort of new LTC service users. This admissions cohort has been tracked over a period of 16 months. The purpose of this report is to report on selected findings of data collected from the first four follow-up telephone interviews completed after the initial in-person baseline assessment. These interviews were conducted at four-month intervals and examine key issues related to changes in disability status, the use of care management services, individuals experience with the claims filing process, and transitions through the continuum of care. The authors also report on individuals satisfaction with providers and their experiences with their LTC insurance. [36 PDF pages] |
Published: May, 2007 |
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Gauging the Use of HCBS Supports Waivers for People with Intellectual and Developmental Disabilities: Final Project Report
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Author(s): Gary Smith, John Agosta, Jon Fortune and Janet O'Keeffe |
Organization(s): Human Services Research Institute, RTI International |
This report contains the following major sections: Methods. This section briefly describes how the information contained in this report was obtained and compiled. HCBS for People with I&DD. This section provides background information concerning the role that Medicaid HCBS waivers play in supporting people with I&DD, critical factors affecting state I&DD service systems that have spurred the implementation of supports waivers, and federal Medicaid policies that affect how states use Medicaid HCBS waivers. Overview of Supports Waivers. This section provides descriptive information about the supports waivers that are presently operating. Summary of Case Studies. This section synthesizes information gleaned from case studies of six states that operate supports waivers. Impact of Supports Waivers. This section presents observations about the impact that supports waivers appear to be having on the delivery of Medicaid waiver services to people with I&DD and identifies some of the issues that have emerged around the use of these waivers. State Supports Waiver Profiles. These profiles present detailed information about the supports waivers operated by the 17 states. Case Studies. This Appendix contains state-by-state results of the six case studies conducted by HSRI. The discussion protocols used to conduct these case studies are contained in Appendix C. [231 PDF pages] |
Published: April, 2007 |
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An Overview of the US Health System Chart Book
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Author(s): George Greenberg and Nancy DeLew |
Organization(s): In House Research |
This chart book provides data on various aspects of the US health system including public and private health care coverage, provider data, and international comparisons of the US to OECD countries. |
Published: January, 2007 |
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Toward an Evaluation of the Quality Improvement Organization Program:
(Report)
Beyond the 8th Scope of Work |
Author(s): Janet P. Sutton, Lauren Silver, Lucia Hammer, Alycia Infante |
Organization(s): NORC |
This project developed an inventory of Quality Improvement Program (QIO) activities and then proposed methodologies to evaluate Medicare's QIO in the future. The contractor gathered information from publicly available sources, from CMS data when available, and from nine site visits to a variety of QIOs. Based on the findings, NORC developed a list of potential projects to evaluate the QIO program. These were presented to a Technical Expert Panel, who provided input on their feasibility and priority. NORC used this information to prepare a report describing potential evaluation approaches. |
Published: January, 2007 |
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