Author
Frank Stetzer
Other affiliations: University of Missouri, University of Wisconsin-Madison
Bio: Frank Stetzer is an academic researcher from University of Wisconsin–Milwaukee. The author has contributed to research in topics: Health care & Medicaid. The author has an hindex of 10, co-authored 12 publications receiving 380 citations. Previous affiliations of Frank Stetzer include University of Missouri & University of Wisconsin-Madison.
Papers
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TL;DR: Frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better healthStatus outcomes.
Abstract: Background Self-management of complex medication regimens for chronic illness is challenging for many older adults. Objectives The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. Design This study used a randomized controlled trial with three arms and longitudinal outcome measurement. Setting Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area. Methods All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months. Results After covariate and baseline health status adjustment, time × group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time × group interactions were significant for the medplanner and control group comparisons. Discussion Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.
69 citations
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TL;DR: The findings suggest that the provision of nurse-coordinated HCBS and Medicare home health services has potential to provide savings in the total cost of health care to the Medicaid program while not increasing the cost of the Medicare program.
Abstract: The objective of this study was to compare the community-based, long-term care program called Aging in Place (AIP) and nursing home care, in terms of cost to the Medicare and Medicaid programs. A retrospective cohort design was used in this study of 39 nursing home residents in the Midwest who were matched with 39 AIP participants. The AIP program consisted of a combination of Medicare home health, Medicaid home and community-based services (HCBS), and intensive nurse care coordination. Controlling for high inpatient Medicare cost in the 6 months prior and the 10 most frequently occurring chronic conditions, multiple regression was used to estimate the relationship of the AIP program on Medicare and Medicaid costs. Total Medicare and Medicaid costs were $1,591.61 lower per month in the AIP group (p < 0.01) when compared with the nursing home group over a 12-month period. The findings suggest that the provision of nurse-coordinated HCBS and Medicare home health services has potential to provide savings in the total cost of health care to the Medicaid program while not increasing the cost of the Medicare program.
62 citations
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TL;DR: Women who received PNCC services were found to have significantly better birth outcomes, including fewer low-birth-weight infants and fewer preterm infants, and fewer infants transferred to the neonatal intensive care units.
Abstract: Objective To measure the impact of a Medicaid benefit called Prenatal Care Coordination (PNCC) on healthy birth outcomes. Design A cross sectional design was used to compare the birth outcomes of infants born to women who received Medicaid and PNCC services to the birth outcomes of infants born to women who received Medicaid but did not receive PNCC services. Setting Services were provided in community based settings in Wisconsin. Participants Of the 45,406 Medicaid births in 2001 to 2002, 10,715 (23.6%) mothers received PNCC services and were considered the treatment group. Methods Secondary analyses of birth certificate and Medicaid billing data were conducted using binary logistic regression analyses to evaluate the impact of PNCC and the hours of PNCC service on birth outcomes. Results Controlling for nine covariates, women who received PNCC services were found to have significantly better birth outcomes, including fewer low‐birth‐weight infants (odds ratio [OR]=0.84; 95% CI [.777, .912]), fewer very‐low‐birth‐weight infants (OR=0.70; 95% CI [.587, .855]), fewer preterm infants (OR=0.83; 95% CI [.776, .890]), and fewer infants transferred to the neonatal intensive care units (OR=.83; 95% CI [.759, .906]).Women who received 6 or more hours of service were less likely to deliver infants with poor birth outcomes. Conclusions The use of PNCC is an effective strategy for preventing adverse birth outcomes.Strategies to further enhance PNCC's positive benefits include increased outreach and engagement with at risk pregnant women.
51 citations
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TL;DR: The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.
Abstract: background. Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported. objective. The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample. methods. This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and casefatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI. results. The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6%. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical
46 citations
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TL;DR: The annually published NIS data could be useful as a national surveillance tool for health care adverse events including HCABSIs with some modifications, and estimated the economic burden of H CABSIs on the US national economy.
44 citations
Cited by
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TL;DR: The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented.
532 citations
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TL;DR: There is a considerable gap between clinical studies using EHR data and studies using clinical IE, so a more concrete understanding of the gap is gained and potential solutions to bridge this gap are provided.
520 citations
17 Oct 2011
Abstract: OBJECTIVE
To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.
DESIGN
Case-control and cohort studies of surgical intensive care unit (SICU) patients.
SETTING
A university-affiliated Veterans Affairs medical center.
PATIENTS
Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993).
MEASUREMENTS
CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio.
RESULTS
When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence interval, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the outbreak period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients.
CONCLUSIONS
Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (i.e., nosocomial infection) needs to be critically assessed.
436 citations
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TL;DR: The global prevalence of PPD is greater than previously thought and varies dramatically by nation, and Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
Abstract: Background: Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates, and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD, and a meta-regression to identify economic, health, social or policy factors associated with national PPD prevalence. Methods: We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. Findings: 308 studies of 304,449 women from 56 countries were identified. The global pooled prevalence of PPD was 17.5% (95% CI: 16.4% - 18.6%), with significant heterogeneity across nations (Q = 17,192, p = .000, I2 = 98%), ranging from 3.10% (0.01% - 10.87%) in Singapore to 37.78% (30.95% - 44.83%) in Chile. Nations with significantly higher rates of income inequality (R2=42.78%), maternal mortality (R2=25.54%) infant mortality (R2=12.23%), total fertility rates (R2=17.14%), or women of childbearing age working > 40 hours a week (R2=24.14%) have higher rates of PPD. Together, these factors explain 77.26%% of the national variation in PPD prevalence. Interpretation: The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
314 citations
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TL;DR: This paper provides a comprehensive review of recent analytical and numerical optimization studies that present decision-support tools for designing and planning outpatient appointment systems (OAS) and provides a structure for organizing the recent literature according to various criteria.
307 citations