Publications

Long-Term Care Policy after Covid-19 - Solving the Nursing Home Crisis

A descriptive paper covering how COVID19 has further destabilized nursing homes and offering suggestions for how to improve long term care post-pandemic.

Werner R, Hoffman A, Coe NB: Long-Term Care Policy after Covid-19 - Solving the Nursing Home Crisis (Perspective) New England Journal of Medicine 383(10): 903-905, Sep 2020.

Health Care Leader Perspectives on State Government–Sponsored Accountable Care for Public Employees

Most studies of accountable care organizations (ACOs) have focused on contracts with commercial payers, Medicare, or Medicaid. This study contributes to the literature by describing implementation of an ACO for public employees, contracted by a state government under a federally funded State Innovation Model grant.

Albertson E, Wood SJ, Coe NB, Conrad DA: Health Care Leader Perspectives on State Government-Sponsored Accountable Care for Public Employees. American Journal of Accountable Care 8(3), Sept 2020.

Dementia Is Associated With Earlier Mortality for Men and Women in the United States

Sociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. The study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Methods: Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, the authors identified a retrospective cohort of adults with at least one International Classification of Diseases—ninth revision—Clinical Modification (ICD-9-CM) dementia diagnosis code (n = 3,714). For each case, the authors randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year (n = 9,531), and assigned comparators the diagnosis date of their matched case. The authors estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.

White L, Fishman P, Basu A, Crane PK, Larson EB, Coe NB. Dementia Is Associated With Earlier Mortality for Men and Women in the United States. Gerontology and Geriatric Medicine, 2020 Aug.

Primary Care Utilization and Expenditures in Traditional Medicare and Medicare Advantage, 2007-2016

Achieving effective, high-quality primary care for Medicare beneficiaries is a national priority as it encourages health promotion and maintenance, potentially reducing intensity of acute care services. Currently, there is ample data documenting intensity of primary care services, including rates of utilization and expenditures, for beneficiaries in fee-for-service Traditional Medicare (TM). However, less is known about the beneficiaries enrolled in Medicare Advantage (MA) plans, which now include 33% of the Medicare population. As managed care’s goal is to control costs while maintaining a high quality, MA plans may encourage greater primary care than is the case in TM. We examined whether this is the case by assessing primary care utilization and expenditures among beneficiaries in MA and TM.

Park S, Figueroa JF, Fishman P, Coe NB: Primary Care Utilization and Expenditures in Traditional Medicare and Medicare Advantage, 2007-2016. Journal of General Internal Medicine 35(8): 2480-2481, Aug 2020.

Informal And Formal Home Care For Older Adults With Disabilities Increased, 2004–16

Rates of informal home care use among older adults with disabilities increased from 2004 to 2016, such that in 2016 almost three-quarters of these adults received informal home care. Informal care remains the most common source of home care, even though formal home care use grew at almost twice the rate, with a 6-percentage-point increase to 36.9 percent in 2016.

Van Houtven CH, Taggert E, Konetzka RT, Coe NB: Informal and Formal Home Care Both Increased Between 2004 and 2016, Potentially Reducing Unmet Needs of Older Adults (Data Watch). Health Affairs. August 2020.

Essential Long-Term Care Workers Commonly Hold Second Jobs and Double- or Triple-Duty Caregiving Roles

Long-term care (LTC) facilities are particularly dangerous places for the spread of COVID-19 given that they house vulnerable high-risk populations. Transmission-based precautions to protect residents, employees, and families alike must account for potential risks posed by LTC workers’ second jobs and unpaid care work. This observational study describes the prevalence of their (1) second jobs, and (2) unpaid care work for dependent children and/or adult relatives (double- and triple-duty caregiving) overall and by occupational group (registered nurses [RNs], licensed practical nurses [LPNs], or certified nursing assistants [CNAs]). The data used was a descriptive secondary analysis of data collected as part of the final wave of the Work, Family, and Health Study. Findings show that LTC workers commonly hold second jobs along with double- and triple-duty caregiving roles. To slow the spread of COVID-19, both the paid and unpaid activities of these employees warrant consideration in the identification of appropriate clinical, policy, and informal supports.

Van Houtven CH, DePasquale N, Coe NB: Essential Long-Term Care Workers Commonly Hold Second Jobs and Double- or Triple-Duty Caregiving Roles. Journal of the American Geriatrics Society 68(8): 1657-1660, Aug 2020.

Living Arrangements of Older Adults and COVID risk: It is not just Nursing Homes

Descriptive article covering the risk of COVID transmission in assisted living, independent living, and continuing care retirement communities.

 

 

Van Houtven CH, Coe NB: Living Arrangements of Older Adults and COVID risk: It is not just Nursing Homes (Letter to the Editor). Journal of the American Geriatrics Society 68(7): 1398-1399, Jul 2020.

Washington's Privatization of Liquor: Effects on Household Alcohol Purchases from Initiative 1183

Washington Initiative 1183 (I-1183), a 2012 law that privatized liquor retail sales and distribution in Washington State, USA, has had two opposing effects on liquor purchases: it has increased access to liquor and imposed new fees on retailers and distributors. This study aimed to estimate the effect of I-1183 on monthly alcohol purchases during the post-I-1183 period (June 2012-December 2014) compared with the pre-I-1183 period (January 2010-May 2012).

Barnett SB, Coe NB, Harris JR, Basu A: Washington's Privatization of Liquor: Effects on Household Alcohol Purchases from Initiative 1183. Addiction 115(4): 681-689, Apr 2020.

RE-AIM Evaluation Plan for Washington State Innovation Models Project

The State of Washington received a State Innovation Models (SIM) $65 million award from the federal Centers for Medicare & Medicaid Services to improve population health and quality of care and reduce the growth of health care costs in the entire state, which has over 7 million residents. SIM is a "complex intervention" that implements several interacting components in a complex, decentralized health system to achieve goals, which poses challenges for evaluation. Our purpose is to present the state-level evaluation methods for Washington's SIM, a 3-year intervention (2016-2018). We apply the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework to structure our evaluation. We create a conceptual model and a plan to use multiple and mixed methods to study SIM performance in the RE-AIM components from a statewide, population-based perspective.

Grembowski DE, Conrad DA, Naranjo D, Wood S, Coe NB, Kwan-Gett T, Baseman J: RE-AIM Evaluation Plan for Washington's State Innovation Models (SIM) Project. Quality Management in Health Care 29(2): 81-94, Apr/June 2020.

 

 

 

 

 

 

 

 

 

 

Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias

The purpose of this study was to determine differences in health care utilization, care satisfaction, and health status for Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries with and without Alzheimer’s Disease and Related Dementias (ADRD). A cohort study was conducted of MA and TM beneficiaries with and without ADRD from all publicly available years of the Medicare Current Beneficiary Survey between 2010 and 2016. To address advantageous selection into MA plans, county-level MA enrollment rate was used as an instrument. Data were analyzed between July 2019 and December 2019. Compared with TM beneficiaries, MA beneficiaries had lower health care utilization without compromising care satisfaction and health status. This difference was more pronounced among beneficiaries with ADRD. These findings suggest that MA plans may be delivering health care more efficiently than TM, especially for beneficiaries with ADRD.

Park S, White L, Fishman P, Larson EB, Coe NB: Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias. JAMA Network Open 3(3), Mar 2020.