Evaluation of a Home-Based, Nurse Practitioner-led Advanced Illness Care Program.

OBJECTIVES: In the United States, people with serious illness often experience gaps and discontinuity in care. Gaps are frequently exacerbated by limited mobility, need for social support, and challenges managing multiple comorbidities. The Advanced Illness Care (AIC) Program provides nurse practitioner-led, home-based care for people with serious or complex chronic illnesses that specifically targets palliative care needs and coordinates with patients' primary care and specialty health care providers. We sought to investigate the effect of the AIC Program on hospital encounters [hospitalizations and emergency department (ED) visits], hospice conversion, and mortality. DESIGN: Retrospective nearest-neighbor matching. SETTING AND PARTICIPANTS: Patients in AIC who had ≥1 inpatient stay within the 60 days prior to AIC enrollment to fee-for-service Medicare controls at 9 hospitals within one health system. METHODS: We matched on demographic characteristics and comorbidities, with exact matches for diagnosis-related group and home health enrollment. Outcomes were hospital encounters (30- and 90-day ED visits and hospitalizations), hospice conversion, and 30- and 90-day mortality. RESULTS: We included 110 patients enrolled in the AIC Program matched to 371 controls. AIC enrollees were mean age 77.0, 40.9% male, and 79.1% white. Compared with controls, AIC enrollees had a higher likelihood of ED visits at 30 [15.1 percentage points, confidence interval (CI) 4.9, 25.3; P = .004] and 90 days (27.8 percentage points, CI 16.0, 39.6; P < .001); decreased likelihood of hospitalization at 30 days (11.4 percentage points, CI -17.7, -5.0; P < .001); and a higher likelihood of converting to hospice (22.4 percentage points, CI 11.4, 33.3; P < .001). CONCLUSIONS: The AIC Program provides care and coordination that the home-based serious illness population may not otherwise receive. IMPLICATIONS: By identifying and addressing care needs and gaps in care early, patients may avoid unnecessary hospitalizations and receive timely hospice services as they approach the end of life.

The influence of ethnicity, social class, and context on judgments about U.S. women.

In 2 studies, the authors investigated impression formation as influenced by category-based stereotypes associated with ethnicity and social class. The participants in Study I made judgments about 1 target woman, described as interested in running for office in the Parent Teacher Organization (PTO) of her children's school. The hypothetical woman was presented to the respondents along with her photograph and information about her ethnic background (Anglo-Saxon, Latina, or Jewish) and occupation (middle class or working class). In Study 2, the authors changed the context and presented a younger target woman (also varied by ethnicity and social class) to the respondents as the new girlfriend of their older brother or cousin. In both studies, judgments were assessed by the participants' responses to 45 bipolar adjectives that, in each case, yielded 8 component factors. In both hypothetical contexts, social class was a powerful trigger for a variety of negative expectations: With respect to ethnicity, the Latina women were judged to be more unsuitable for the job of PTO vice president than were the Anglo-Saxon or Jewish women. The authors discussed potential psychological and social consequences of such category-based judgments.