Publications by authors named "Mark A Unruh"
Objectives: The Program of All-Inclusive Care for the Elderly (PACE) program provides nursing home-level care to older adults living in the community. We sought to characterize provider perceptions of PACE patients' unmet palliative care needs and quantify the palliative care educational needs of multidisciplinary PACE staff members by conducting a palliative care needs assessment survey of clinical staff at 3 PACE sites.
Design: A cross-sectional survey.
Introduction: New federal minimum staffing standards aim to increase staffing in nursing homes. As the future of the new rule remains uncertain, this study compares the new standard to existing state staffing standards and examines the characteristics of nursing homes who may meet the new requirement.
Methods: We utilized the 2023 CMS Payroll-Based Journal Data to calculate staffing ratios and nurse turnover.
Importance: The number of physicians and advanced practitioners (APs) whose care is concentrated in nursing homes (often referred to as nursing home or skilled nursing facility specialists [SNFists]) has increased rapidly. Therefore, whether these clinicians provide better care is important.
Objective: To examine the association between SNFist care and outcomes of long-stay nursing home (NH) residents with Alzheimer disease and related dementias (ADRD).
Background: In the United States, the COVID-19 pandemic accelerated the adoption of telehealth in home health care (HHC), but its sustainability remains uncertain. Despite telehealth's potential benefits, including improved patient monitoring and expanded access, the lack of reimbursement and regulatory constraints may limit widespread adoption. Understanding how home health agencies (HHAs) perceive these challenges is critical for shaping future telehealth policy.
View Article and Find Full Text PDFLong-term services and supports (LTSS) in the United States have faced substantial and enduring challenges. They encompass services for persons who can no longer independently care for themselves because of cognitive decline, functional limitations, chronic illness, or the sequelae of such conditions. These services are delivered in institutional and noninstitutional settings, such as nursing homes, assisted living facilities, and home- and community-based programs.
View Article and Find Full Text PDFPhysicians Who Provide Primary Care in US Nursing Homes: Characteristics and Care Patterns.
J Am Med Dir Assoc
May 2025
Objectives: To examine practice trends and characteristics of primary care physicians providing care in US nursing homes.
Design: Retrospective cohort study using Medicare Fee-for-Service claims.
Setting And Participants: Physicians who provided primary care to long-stay nursing home residents.
Association between discontinuity in clinicians and outcomes of nursing home residents.
Health Aff Sch
November 2024
Little is known about the impact of clinician discontinuity on quality of care for nursing home residents. We examined the association between clinician discontinuity and outcomes of residents with long-term care stays up to 3 years using claims for a national 20% sample of Medicare fee-for-service beneficiaries from 2014 through 2019. We used an event study analysis that accounted for staggered treatment timing.
View Article and Find Full Text PDFObjectives: To systematically examine the evidence of the association between extreme weather events (EWEs) and adverse health outcomes among short-stay patients undergoing post-acute care (PAC) and long-stay residents in nursing homes (NHs).
Design: This is a scoping review. The findings were reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews checklist.
Importance: Clinician specialization in the care of nursing home (NH) residents or patients in skilled nursing facilities (SNFs) has become increasingly common. It is not known whether clinicians focused on NH care, often referred to as SNFists (ie, physicians, nurse practitioners, and physician assistants concentrating their practice in the NH or SNF setting), are associated with a reduced likelihood of burdensome transitions in the last 90 days of life for residents, which are a marker of poor-quality end-of-life (EOL) care.
Objective: To quantify the association between receipt of care from an SNFist and quality of EOL care for NH residents.
Article Synopsis
- About 16% of US hospice agencies are owned by private equity firms or publicly traded companies.
- The study investigates how these acquisitions affect the care settings and clinical conditions of Medicare patients in hospice care.
- Findings show that hospice agencies acquired by private equity firms or publicly traded companies had notable changes, including increased dementia diagnoses and shifts in where patients received care post-acquisition.
Nursing Homes' Use of Contract Direct Care Staff Before and During the COVID-19 Pandemic.
J Am Med Dir Assoc
October 2023
Article Synopsis
- Medical groups and health systems are worried about rising physician turnover rates that could impact patient care and access.
- Turnover rates for physicians increased from 5.3% in 2010 to 7.6% in 2018, largely due to physicians stopping practice, with variations observed across different specialties and demographics.
- Initial data from 2020 suggests no significant increase in turnover due to COVID-19, highlighting the need for ongoing monitoring using the new methods developed in this research.
Background: Despite expanded access to telehealth services for Medicare beneficiaries in nursing homes (NHs) during the COVID-19 public health emergency, information on physicians' perspectives on the feasibility and challenges of telehealth provision for NH residents is lacking.
Objective: To examine physicians' perspectives on the appropriateness and challenges of providing telehealth in NHs.
Participants: Medical directors or attending physicians in NHs.
The Role Of Real Estate Investment Trusts In Staffing US Nursing Homes.
Health Aff (Millwood)
February 2023
In 2021 real estate investment trusts (REITs) held investments in 1,806 US nursing homes. REITs are for-profit public or private corporations that invest in income-producing properties. We created a novel database of REIT investments in US nursing homes, merged it with Medicare cost report data (2013-19), and used a difference-in-differences approach within an event study framework to compare staffing before and after a nursing home received REIT investment with staffing in for-profit nursing homes that did not receive REIT investment.
View Article and Find Full Text PDFThe Association of Teamlets and Teams with Physician Burnout and Patient Outcomes.
J Gen Intern Med
May 2023
Article Synopsis
- Most general internists and family physicians work in "teamlets," which are small, consistent groups of staff and physicians designed to enhance care delivery.
- A majority (77.4%) of the surveyed physicians are involved in teamlets, with only 36.7% working in larger teams; those practicing without either experienced lower burnout rates.
- The study found no significant differences in patient outcomes or Medicare spending based on the type of team involvement, suggesting that while teamlets are common, their effectiveness in improving healthcare metrics may not be clear-cut.
Introduction: This study evaluates the performance of bariatric surgery prior to and after the implementation of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
Methods: The eras prior to (2007-2015) and after (2016-2018) the transition to MBSAQIP were compared for patients, operations and outcomes using adjusted logistic regression estimates.
Results: Thirty-day surgical (6%vs.
Background: Some generalist physicians whose training prepared them for primary care practice increasingly practice in a facility (eg, hospitals, nursing homes); however, whether this trend was accompanied by a complimentary rise in generalist physicians who focused their practice on office-based care is unknown.
Objectives: Our objective in this study was to examine trends in the prevalence of generalist physicians and physician groups that practice in a single setting.
Research Design: This was a retrospective cross-sectional study of generalist physicians trained in family medicine, internal medicine, or geriatrics.
Practice Trends and Characteristics of US Hospitalists From 2012 to 2018.
JAMA Health Forum
November 2021
This cohort study uses Medicare data to assess trends and characteristics among hospitalists who shift practice to settings outside of the hospital.
View Article and Find Full Text PDFImportance: Private equity firms have been acquiring US nursing homes; an estimated 5% of US nursing homes are owned by private equity firms.
Objective: To examine the association of private equity acquisition of nursing homes with the quality and cost of care for long-stay residents.
Design Setting And Participants: In this cohort study of 302 private equity nursing homes with 9632 residents and 9562 other for-profit homes with 249 771 residents, a novel national database of private equity nursing home acquisitions was merged with Medicare claims and Minimum Data Set assessments for the period from 2012 to 2018.
Objectives: To assess the cross-sectional relationship between prices paid to physicians by commercial insurers and the provision of low-value services.
Study Design: Observational study design using Health Care Cost Institute claims representing 3 large national commercial insurers.
Methods: The main outcome was count of 19 potential low-value services in 2014.
Article Synopsis
- The study aimed to explore how experienced physicians perceive the role and value of SNFists (physicians who mainly work in skilled nursing facilities) in nursing home care.
- Participants were 35 physicians with significant experience in nursing homes, interviewed virtually.
- Key themes emerged, highlighting issues like the lack of clear definitions for SNFists, the unique competencies required for effective practice, and the potential benefits they bring to patient care, despite challenges such as lack of billing for certain services and care continuity.
Article Synopsis
- The March 2020 lockdown in New York City led to higher COVID-19 hospitalization rates among individuals over 55 in neighborhoods with more multigenerational households.
- Analysis of data from 166 ZIP code areas showed a significant increase in hospitalizations for older residents in areas with more multigenerational populations, peaking three weeks after the lockdown.
- The study suggests that increased close contact between different age groups during the lockdown may have unintentionally heightened the risk of COVID-19 transmission among older individuals living in multigenerational settings.