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Application of a case-mix classification based on the functional autonomy of the residents for funding long-term care facilities.

https://arctichealth.org/en/permalink/ahliterature186950
Source
Age Ageing. 2003 Jan;32(1):60-6
Publication Type
Article
Date
Jan-2003
Author
Michel Tousignant
Réjean Hébert
Nicole Dubuc
France Simoneau
Linda Dieleman
Author Affiliation
Research Center on Aging, Sherbrooke Geriatric University Institute, Quebec, Canada. michel.tousignant@usherbrooke.ca
Source
Age Ageing. 2003 Jan;32(1):60-6
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - classification
Aged
Aged, 80 and over
Budgets - statistics & numerical data
Chronic Disease - classification - economics
Diagnosis-Related Groups - classification - economics
Female
Financing, Government - economics
Health Policy - economics
Health Services Needs and Demand - economics
Homes for the Aged - economics
Humans
Long-Term Care - economics
Male
National Health Programs - economics
Quebec
Abstract
increasing public costs for the care of the elderly have created fundamental changes that are redefining the basic principles of health care funding. In the past, overall institutional funding was predominantly tied to spending. In view of the limitations of this approach to funding long-term care facilities, case-mix classification tries to take into account the characteristics of the residents as a tool for predicting costs. Recently, a new case-mix classification based on the functional autonomy profile of the residents - ISO-SMAF profile - was developed in the Province of Quebec, Canada. This classification can be used to change the funding system to base it on the functional autonomy characteristics of the residents.
the main objective of this study was to apply the ISO-SMAF classification to funding long-term care facilities in one area of the Province of Quebec and to compare the results of this new funding methodology to the formal methodology.
this study used a cross-sectional design.
the population under study comprised all residents of all 11 long-term care facilities in the Eastern Townships area of Quebec. Each resident was assessed using the Functional Autonomy Measurement System. The theoretical budget was calculated based on the adjusted cost per year associated with each ISO-SMAF profile derived from a previous economic study.
the theoretical budget based on the ISO-SMAF profiles may highlight the under- or over-funding of a facility when compared to the usual funding system based predominantly on the number of beds and hours of care.
the results of this study show the feasibility of applying the new funding approach to long-term care facilities. However, implementation of the ISO-SMAF classification for funding must be supported by continued and computerised residents' medical files including the Functional Autonomy Measurement System.
PubMed ID
12540350 View in PubMed
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Assisted self-report of health-services use showed excellent reliability in a longitudinal study of older adults.

https://arctichealth.org/en/permalink/ahliterature161182
Source
J Clin Epidemiol. 2007 Oct;60(10):1040-5
Publication Type
Article
Date
Oct-2007
Author
Marie-France Dubois
Michel Raîche
Réjean Hébert
N'deye Rokhaya Gueye
Author Affiliation
Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada. marie-france.dubois@usherbrooke.ca
Source
J Clin Epidemiol. 2007 Oct;60(10):1040-5
Date
Oct-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Ambulatory Surgical Procedures - utilization
Delivery of Health Care, Integrated - utilization
Family Practice - statistics & numerical data
Female
Health Services Research
Health Services for the Aged - utilization
Health status
Hospitalization - statistics & numerical data
Humans
Longitudinal Studies
Male
Quebec
Reproducibility of Results
Self Disclosure
Abstract
Seniors use a wide variety of health services delivered by numerous practitioners and organizations. Self-report is the most accessible and cost-effective method to collect information on their use. It is thus important to demonstrate the reliability of this approach.
As part of a longitudinal study on the effect of an integrated service delivery system, participants (or their proxies) were instructed to use a calendar to record their use of health services. Every 2 months, an interviewer collected use since the last phone contact. A subsample was recontacted by the same or another interviewer to estimate test-retest and interinterviewer reliability, respectively. Data collections were compared using delta and weighted kappa as well as intraclass correlation coefficients.
Almost perfect agreement was obtained for hospitalization, day surgery, visits to general practitioners and medical specialists, help for home maintenance, and use of voluntary services. Agreement was substantial for visits to the emergency room and home help for personal care. For visits to or by nurses and other health professionals, agreement can be qualified as moderate-to-substantial.
Assisted self-report of health-services use by older adults or their proxies through bimonthly phone calls is reliable.
PubMed ID
17884599 View in PubMed
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[Autonomy insurance: An essential innovation in response to the challenges of aging].

https://arctichealth.org/en/permalink/ahliterature126785
Source
Can J Aging. 2012 Mar;31(1):1-11
Publication Type
Article
Date
Mar-2012
Author
Réjean Hébert
Author Affiliation
Université de Sherbrooke Centre de recherche sur le vieillissement, Sherbrooke. Rejean.Hebert@USherbrooke.ca
Source
Can J Aging. 2012 Mar;31(1):1-11
Date
Mar-2012
Language
French
Publication Type
Article
Keywords
Canada
Health Care Reform
Home Care Services - economics
Humans
Insurance Benefits
Long-Term Care - economics
National Health Programs - economics
Quebec
Abstract
The aging population and the epidemic of chronic diseases requires an accompanying finance reform of long-term care that will become increasingly dominant. Many countries have faced this situation and have set up a separate public funding for such care on the basis of a universal insurance covering both home care and institutions. Canada and Quebec must adopt such autonomy insurance and create a separate fund financed partly by a more judicious use of current budgets and tax credits, and also by a significant investment in home care. An autonomy support benefit could be allocated in kind to fund public services and by contract to pay for services delivered by private, voluntary, and social economy agencies. This benefit would be established following a standardized assessment of functional autonomy achieved by the case manager who will manage the services and control their quality.
PubMed ID
22355000 View in PubMed
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The big boom: what CIHR's Canadian Longitudinal Study on Aging means to the baby boomer generation and Canada's healthcare system.

https://arctichealth.org/en/permalink/ahliterature184623
Source
Hosp Q. 2003;6(3):19-20
Publication Type
Article
Date
2003

Canadian Outcomes Study in Dementia: study methods and patient characteristics.

https://arctichealth.org/en/permalink/ahliterature178462
Source
Can J Psychiatry. 2004 Jul;49(7):417-27
Publication Type
Article
Date
Jul-2004
Author
Robert Sambrook
Nathan Herrmann
Réjean Hébert
Peter McCracken
Alain Robillard
Doanh Luong
Amanda Yu
Author Affiliation
Syreon Corporation, Vancouver, British Columbia. robert.sambrook@syreon.com
Source
Can J Psychiatry. 2004 Jul;49(7):417-27
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - diagnosis - drug therapy - economics
Anti-Inflammatory Agents, Non-Steroidal - economics - therapeutic use
Canada
Cholinesterase Inhibitors - economics - therapeutic use
Cluster analysis
Diagnosis, Differential
Diagnostic and Statistical Manual of Mental Disorders
Drug Therapy - economics - statistics & numerical data
Drug Therapy, Combination
Female
Health status
Humans
Male
Mental Health Services - economics - statistics & numerical data - supply & distribution
Outcome Assessment (Health Care)
Phytotherapy - economics - statistics & numerical data
Prospective Studies
Quality Assurance, Health Care - standards
Sampling Studies
Severity of Illness Index
Vitamin E - economics - therapeutic use
Abstract
To describe the methods and patient characteristics of the Canadian Outcomes Study in Dementia (COSID).
COSID is a 3-year prospective study of dementia patients living in the community at the time of study registration. We assessed patients' cognition, behaviour, and functioning every 6 months, using the Modified Mini-Mental State Examination (3MS), the Neuropsychiatric Inventory (NPI), and the Functional Autonomy Measurement System (SMAF), respectively. We assessed caregivers, using the Zarit Burden Interview (ZBI). Additional information included the Global Deterioration Scale (GDS), patients' driving status, and clinical information including family history, dementia type, concomitant medications, and comorbid conditions. From the patient or caregiver, we collected details of inpatient and outpatient resources used by the patient and (or) caregiver.
We enrolled 766 patients from 31 Canadian sites. Overall mean age was 76.8 years, and mean age of onset was 73.1 years. Of the total patients, 98% were white, 54% were women, and 84% were diagnosed with Alzheimer's disease. Mean baseline 3MS was 66.5, NPI was 9.5, and SMAF was 18.30. Of these patients, 48% reported a GDS score of 3 (that is, moderate), 16% reported a GDS score of 4 (that is, moderately severe), and the remaining 36% reported a GDS score of 1 or 2 (that is, mild or very mild). At baseline, 83% of patients received cholinesterase inhibitors, 46% received nonsteroidal antiinflammatory drugs, 39% received vitamin E, and 25% received antidepressants. Adult day care and home help were the largest cost factors in this population, with mean monthly costs of $65 and $64, respectively. We found interesting differences in the resources used among geographic regions and care settings.
COSID is already generating valuable information about treatment patterns, outcomes, and resource use in Canadian patients with dementia. As the data mature, it will be possible to build robust models on treatment effectiveness and costs of care.
PubMed ID
15362245 View in PubMed
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Cognitive-impairment-free life expectancy for Canadian seniors.

https://arctichealth.org/en/permalink/ahliterature167627
Source
Dement Geriatr Cogn Disord. 2006;22(4):327-33
Publication Type
Article
Date
2006
Author
Marie-France Dubois
Réjean Hébert
Author Affiliation
Faculty of Medicine and Health Sciences, University of Sherbrooke, and Research Centre on Aging, Sherbrooke, Canada. Marie-France.Dubois@USherbrooke.ca
Source
Dement Geriatr Cogn Disord. 2006;22(4):327-33
Date
2006
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Canada - epidemiology
Cognition Disorders - epidemiology
Dementia - epidemiology - psychology
Female
Humans
Life expectancy
Male
Population
Sex Factors
Abstract
While cognitive impairment (CI) and dementia are among the most common morbid conditions in later life, life expectancies free from CI or dementia have been the object of much less investigation than life expectancy based on measures of physical functioning.
We estimated sex-specific CI-free life expectancy in Canada for people aged 65 and older using data from a nationwide, multicenter Canadian study on the epidemiology of dementia.
The absolute number of years with CI remains virtually constant with increasing age. Whatever the current age, senior men can expect to live 2.5-3 years of their remaining life with some form of CI and about 1.5 years of those with dementia. For women, these figures rise to 3-4 years with CI, of which 2-2.5 years are spent with dementia.
Surviving to an older age does not result in a longer average absolute period of CI. This period is associated with a significant reduction in quality of life, the use of home and institutional services, as well as psychological and physical distress for formal and informal caregivers. Results are compared to findings reported in other countries.
PubMed ID
16954687 View in PubMed
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Comparison of two functional independence scales with a participation measure in post-stroke rehabilitation.

https://arctichealth.org/en/permalink/ahliterature184260
Source
Arch Gerontol Geriatr. 2003 Sep-Oct;37(2):157-72
Publication Type
Article
Author
Johanne Desrosiers
Annie Rochette
Luc Noreau
Gina Bravo
Réjean Hébert
Catherine Boutin
Author Affiliation
Sherbrooke Geriatric University Institute, Sherbrooke, Québec J1H 4C4, Canada. johanne.desrosiers@usherbrooke.ca
Source
Arch Gerontol Geriatr. 2003 Sep-Oct;37(2):157-72
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Canada
Disability Evaluation
Female
Humans
Interpersonal Relations
Male
Stroke - physiopathology - rehabilitation
Abstract
The objectives of the study were to compare the association and responsiveness of the functional autonomy measurement system (SMAF) and functional independence measure (FIM) as outcome measures addressing functional independence in stroke patients involved in an intensive rehabilitation program and to compare their relationships with a social participation measure after rehabilitation period. One hundred and thirty-two people who had a stroke were evaluated with the SMAF and FIM during the rehabilitation period (T1: admission; T2: discharge; n=132) and twice after discharge (T3=2 weeks; n=118; T4=6 months later; n=102). At T3 and T4, a participation measure, the assessment of life habits (LIFE-H), was added. The main findings are: (1) the total scores on the SMAF and FIM are strongly correlated together (r=0.93 to 0.95; p
PubMed ID
12888229 View in PubMed
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The contribution of neuropsychiatric symptoms to the cost of dementia care.

https://arctichealth.org/en/permalink/ahliterature167624
Source
Int J Geriatr Psychiatry. 2006 Oct;21(10):972-6
Publication Type
Article
Date
Oct-2006
Author
Nathan Herrmann
Krista L Lanctôt
Robert Sambrook
Nadia Lesnikova
Réjean Hébert
Peter McCracken
Alain Robillard
Elizabeth Nguyen
Author Affiliation
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Source
Int J Geriatr Psychiatry. 2006 Oct;21(10):972-6
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Aged
Behavioral Symptoms - economics
Canada
Dementia - economics
Female
Health Care Costs - statistics & numerical data
Humans
Male
Prospective Studies
Abstract
To estimate the contribution of behavioral and psychological symptoms of dementia (BPSD) to the costs of care.
A one-year prospective study of resource utilization recorded monthly by 500 caregivers of community dwelling patients with dementia. The effect of behavior on total, direct and indirect costs of care was examined.
The total cost of care was $1,298 per month and there was a significant independent relationship between costs and BPSD. The incremental cost of a one point increase in Neuropsychiatric Inventory score was $30 per month (95% CI: $19-$41).
BPSD contribute significantly to the overall costs of dementia care. Interventions targeted at BPSD may help to reduce the staggering societal costs of this illness.
PubMed ID
16955429 View in PubMed
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Correlates of suicide in the older adult population in Quebec.

https://arctichealth.org/en/permalink/ahliterature175152
Source
Suicide Life Threat Behav. 2005 Feb;35(1):91-105
Publication Type
Article
Date
Feb-2005
Author
Michel Préville
Richard Boyer
Réjean Hébert
Gina Bravo
Monique Seguin
Author Affiliation
Université de Sherbrooke, Sherbrooke, Québec, Canada. michel.preville@usherbrooke.ca
Source
Suicide Life Threat Behav. 2005 Feb;35(1):91-105
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Aged
Depression - epidemiology
Female
Humans
Male
Middle Aged
Quebec - epidemiology
Questionnaires
Registries
Suicide - statistics & numerical data
Abstract
This study was undertaken to describe the characteristics of adults aged 60 years and over who committed suicide in Quebec in 1998-1999. In this study, 42.6% of the suicide cases presented mental disorders at the time of their death, mainly depression. Sixty-five (65.3%) percent of the suicide cases would have been considered as having a mental health disorder if sub-threshold depression cases were included. Only 27.7% of the cases did not express any idea of death during the 6-month period preceding their suicide. One interesting finding was that 53.5% of the suicide cases consulted a general practitioner or specialist during the 2-week period preceding their death. Our results showed that only 8.1% had a severe level of functional limitations at the time of their death. This result leads us to interpret with caution the conclusion of some studies suggesting that physical frailty is a major causal factor associated with suicide among the elderly.
PubMed ID
15843326 View in PubMed
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35 records – page 1 of 4.