Katherine Berg

• University of Toronto

As one ages, physical, cognitive, and clinical problems accumulate and the pattern of loss follows a distinct progression. The first areas requiring outside support are the Instrumental Activities of Daily Living and over time there is a need for support in performing the Activities of Daily Living. Two new functional hierarchies are presented, an...

Objective: To investigate the impact of physiotherapy (PT) and occupational therapy (OT) services on long-stay home care patients with musculoskeletal disorders. Design: Observational study. Setting: Home care programs. Participants: All long-stay home care patients between 2003 and 2008 (N=99,764) with musculoskeletal disorders who received...

To identify the structural and patient characteristics associated with better care processes in older vulnerable hospitalized patients. Retrospective study. Forty-four Geriatric Assessment Units (GAU). Patients aged 65 and older who were admitted to a GAU for a fall with trauma. Three care processes (comprehensiveness, informational continuity, com...

Objectives: The interRAI Community Rehabilitation Assessment (CRA) is a comprehensive health assessment designed to collect essential health and function information for rehabilitation care planning, benchmarking, and evaluation of clinic and home-based programs. A portion of the CRA is completed through patient self-report. The objective of this...

Purpose: To determine factors associated with improvement in urinary incontinence (UI) for long-stay postacute, complex continuing care (CCC) patients. Design: A retrospective cohort investigation of patients in a CCC setting using data obtained from the Canadian Institute for Health Information's Continuing Care Reporting System collected with...

Objectives To examine changes in urinary continence for post-acute, Complex Continuing Care hospital patients from time of admission to short-term follow-up, either in hospital or after discharge to long-term care or home with services. Design Retrospective cohort study of patients in Complex Continuing Care hospitals using clinical data collected...

Objective To examine the effect of the pandemic on and factors associated with change in home care (HC) recipients’ capacity for instrumental activities of daily living. Design Retrospective cohort study. Setting and participants HC recipients in Ontario, Canada between September 1, 2018 and August 31, 2020 who were not totally dependent on other...

Objectives To examine factors associated with distressing social decline and withdrawal during the COVID-19 pandemic for home care (HC) recipients. Design Retrospective cohort. Setting and participants HC recipients aged 18 years or older in Ontario, Canada without severe cognitive impairment with an assessment and follow-up between September 1,...

Aim To determine the predictive validity of the 1stFall algorithm in long-term care (LTC) residents across four Canadian provinces. Methods This retrospective cohort study included all clients admitted to LTC between 2006-2017 with no history of falls in the past 30 days. The outcome was occurrence of a fall and logistic regression analysis was pe...

Background: The falls literature focuses on individuals with previous falls, so little is known about individuals who have not experienced a fall in the past. Predicting falls in those without a prior event is critical for primary prevention of injuries. Identifying and intervening before the first fall may be an effective strategy for reducing th...

Purpose: We examined physiotherapists’ use of functional outcome measures in their practice to compare the frequency of use of functional outcome measures and impairment-based measures and to explore policies and practices related to the use of functional outcome measures in Colombia. Method: Eligible participants were licensed physiotherapists act...

RÉSUMÉ Chez les résidents en soins de longue durée (SLD), l’hospitalisation peut amener des complications telles que le déclin fonctionnel. L’objectif de notre étude était d’examiner l’association entre les données démographiques et de santé et le taux d’hospitalisation des résidents nouvellement admis en SLD. Nous avons mené une étude de cohorte r...

Objective To identify home care clients with substantial functional deficits who had capacity to improve and, thus, for whom recovery goals should be articulated. Design Retrospective longitudinal analysis of an international home care database. Setting and participants 523,907 persons receiving home care, having 2 assessments, on average, 8 mont...

Objectives To describe the proportion of residents receiving rehabilitation in long‐term care (LTC) homes, and scores on activities of daily living (ADL) and falls quality indicators (QIs) before and after change from fee‐for‐service to an episode of care model; and to evaluate the effect of the change on the QIs. Data Sources Secondary data were...

Background: This paper describes an integrated series of functional, clinical, and discharge post-acute care (PAC) quality indicators (QIs) and an examination of the distribution of the QIs in skilled nursing facilities (SNF) across the US. The indicators use items available in interRAI based assessments including the MDS 3.0 and are designed for...

Objectives: This study aimed to develop and validate a falls risk screening tool derived from interRAI Acute Care (AC) Assessment. Methods: For derivation and validation, two prospective cohorts were recruited from AC hospitals in Australia. The derivation cohort comprised 1418 patients from 11 hospitals. In the validation cohort, 393 patients w...

RÉSUMÉ Les résidents en soins de longue durée (SLD) ont souvent besoin de soins en réadaptation pour maintenir ou améliorer leur état physique fonctionnel. L’objectif de cet examen de portée était de décrire l’envergure des publications concernant la réadaptation physique en SLD jusqu’à ce jour, avec une emphase sur les types d’interventions en réa...

Background: According to the CDC, falls rank among the leading causes of accidental death in the United States, resulting in significant health care costs annually. In this paper we present information about everyday lifestyle decisions of the older adult that may help reduce the risk of falling. We pursued two lines of inquiry: first, we identify...

A growing number of medically complex older adults reside in long-term care (LTC) and often require physical rehabilitation (PR). While PR is effective at maintaining or improving a patient's physical function, the breadth of PR interventions evaluated in LTC, which outcomes or quality indicators (QI) can be used to evaluate PR, and what tools or m...

To describe the proportion of residents receiving occupational therapy (OT) and physical therapy (PT) and the factors associated with receiving PT in long-term care (LTC) facilities across five provinces and one territory in Canada. Using a population-based, retrospective analysis of cross-sectional data, the proportion of LTC facility residents in...

To describe the sociodemographic and clinical profile of people with traumatic brain injury (TBI) in home care, nursing homes, and complex continuing care settings in a national sample. Cross-sectional study using available Resident Assessment Instrument (RAI 2.0 and RAI Home Care [HC]) national databases in Canada from 1996 to 2011. The profile of...

Purpose : To examine the attitudes of a self-selected sample of Canadian physical therapists toward the transition from bachelor's to master's degrees and the implementation of clinical doctorate degrees in physical therapy (PT). Methods : A cross-sectional survey was conducted using a modified Dillman tailored approach. All eligible members of the...

Background Across Ontario, home care professionals collect standardized information on each client using the Resident Assessment for Home Care (RAI-HC). However, this information is not consistently shared with those professionals who provide services in the client’s home. In this pilot study, we examined the feasibility of sharing data, from the R...

Background The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus,...

Purpose: Rehabilitation is increasingly recognized as an important therapeutic intervention for people with cancer. The main objective of this study was to explore the current practice pattern and provision of oncology rehabilitation in Canada. Methods: A descriptive cross-sectional online survey was administered to Canadian facilities offering...

As in many health sectors, in home care there have been significant investments made in electronic health information systems (EHIS) and accompanying standardized assessment instruments. While the potential of these systems to enhance the quality of care has been recognized, it has yet to be fully realized in Canadian home care settings. Data on EH...

Purpose: To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario. Method: An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-car...

To investigate the construct validity of the activities of daily living (ADLs) sections of 2 major systems developed to measure functional ability in rehabilitation settings. Health assessment systems can inform care planning as well as policy decision-making on service effectiveness. Frailty, comorbidity, and heterogeneity make it difficult to acc...

Objectives: To examine the role of medication use and other factors in predicting activity restriction due to a fear of falling (AR/FF). Methods: Older adults were assessed twice with the interRAI Community Health Assessment and the Berg Balance Scale (BBS). The main outcome was limiting going outdoors due to an AR/FF. Medications were recorded by...

To assess quality-of-care processes and to examine whether care processes are associated with short-term postdischarge outcomes in older vulnerable hospitalized patients. Retrospective study. Forty-nine Geriatric Assessment Units. Patients aged 65 and older who were admitted to a Geriatric Assessment Unit for a fall with trauma. Three care processe...

To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations, including non-Medicare-paid NH stays. Online Survey of Certification and Reporting (OSCAR) data for 202 free-standing NHs, Medicare Den...

Evaluate the ability of the American and British Geriatrics Society fall prevention guideline's screening algorithm to identify and stratify future fall risk in community-dwelling older adults. Prospective cohort of community-dwelling older adults (n = 117) aged 65 to 90 years. Fall history, balance, and gait measured during a comprehensive geriatr...

Purpose: To identify modifiable risk factors associated with the transition from non-faller to faller in community-dwelling older adults. Method: A prospective study design was used. Adults aged 60 to 90 years (n=90, mean age=79.7 years, 63% male) who did not report falling in the past year were included. A comprehensive geriatric assessment was...

Despite the significance of falling, fear of falling may represent a greater pervasive concern to the health of seniors. Activity restriction, resulting from fear of falling, which may or may not develop after a fall, may lead to balance deterioration, functional decline, anxiety or reductions in social/leisure/physical activity opportunities, and,...

The purpose of this study was: (1) to identify key total joint replacement (TJR) care processes and structures from acute care and rehabilitation hospitals; (2) to determine the perceived implications of practice patterns and processes on wait times, discharge planning, transitions in care, utilization of rehabilitation services, and outcomes; and...

To compare the responsiveness of 2 major systems developed for rehabilitation settings--the FIM and the interRAI Post Acute Care (PAC) assessment--in older patients. Trained raters assessed patients with both tools at admission and discharge. Musculoskeletal (MSK) and geriatric rehabilitation units (GRUs) in 2 rehabilitation hospitals. Older adults...

Purpose: The objectives of this study were (1) to examine the effects of a 12-week exercise cessation period separating two 12-week exercise sessions on physical variables in an elderly institutionalized population and (2) to explore overall programme effectiveness. Methods: The functional mobility of 25 elderly institutionalized adults particip...

The increasing number of hospitalized elderly persons has greatly challenged decision makers to reorganize services so as to meet the needs of this clientele. Established progressively over the last 30 years, the short-term Geriatric Assessment Unit (GAU) is a specialized care program, now implemented in all the general hospital centres in Quebec....

There is growing recognition of the importance of sharing health information in home care; however, limited research exists to identify appropriate strategies, especially with home care providers. We engaged home care stakeholders from three locations in Ontario to determine facilitators, barriers, and recommendations for using health information i...

Definitions of individual QIs. This file contains the operational definition of each of the evaluated quality indicators.

Example of Third Generation Calculation of Nursing Home Quality Indicator. This document presents details on how a third generation nursing home quality indicator is calculated.

Detailed numerical results from the validation analysis. This file contains a table with the detailed results of the validation analysis.

Figure S2 Summary of validation model analyses. This file contains a figure summarizing the results of the validation analyses of the new third generation quality indicators relative to the Abt/CMS quality indicators.

Density plots of each quality indicator. This document contains a density plot for each quality indicator for each major care sector.

Table S1. Characteristics of Residents and Facilities. This file contains a table describing the characteristics of the residents and facilities used in the analysis.

Detailed numerical results from the reliability analysis. This file contains a table with the results of the reliability analysis (quarter to quarter autocorrelation) for the second and third generation quality indicators.

Figure S1 Scattergraph of autocorrelation coefficients for third and second generation quality indicators. This file contains a figure illustrating the correlation of autocorrelation coefficients for third and second generation quality indicators.

This manuscript describes a method for adjustment of nursing home quality indicators (QIs) defined using the Center for Medicaid & Medicare Services (CMS) nursing home resident assessment system, the Minimum Data Set (MDS). QIs are intended to characterize quality of care delivered in a facility. Threats to the validity of the measurement of presum...

Screening should have simple and easy-to-administer methods that identify impairments associated with future fall risk, but there is a lack of literature supporting validation for their use. The aim of this study was to evaluate the independent contribution of balance assessment on future fall risk, using 5 methods to quantify balance impairment, f...

Purpose: To identify current practice for elderly individuals who have sustained a fall-related injury and subsequently presented to the emergency department (ED) of a community-based hospital in Toronto, Ontario. Methods: A retrospective longitudinal chart review was conducted for 300 persons, 65 years of age and older, who presented to the ED...

To evaluate and summarize the evidence linking balance impairment as a risk factor for falls in community-dwelling older adults. Systematic review and meta-analysis. English language articles in MEDLINE, EMBASE, CINAHL (1988-2009), under keywords of accidental falls, aged, risk factors, and hip, radius, ulna, and humerus fractures; and bibliographi...

The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Manageme...

Summarize of the GCT items by health care professional as determined by medical and paramedical experts. Description of the content of GCT.

Unreliable GCT items by specific health care professional and among all health care professionals. Description of unreliable GCT items.

Reliability of all items of the Geriatric Care Tool by specific health care professional and among all health care professionals. Complete results of the Geriatric Care Tool intra- and inter-rater reliability.

Dimensions of quality and proposed definitions of quality indicators in each area: Access to care, Comprehensiveness, Appropriateness, Continuity and Patient-centred care. Definitions of quality indicators using reliable GCT items.

Falling constitutes a significant risk to the health and well-being of seniors. Although a number of risk factors have been established within the literature for falling, limited work has differentiated risk factors for 1-time versus recurrent or multiple fallers. The purpose of this research was to examine 2 relationships: (1) the risk factors for...

Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific. From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of p...

The International Classification of Functioning, Disability and Health (ICF) is embraced as a framework to conceptualize human functioning and disability. Health professionals choose measures to represent the domains of the framework. The ICF coding classification is an administrative system but multiple studies have linked diverse clinical assessm...

Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professio...

Falls are a significant public health concern for older adults; early identification of people at high risk for falling facilitates the provision of rehabilitation treatment to reduce future fall risk. The objective of this prospective cohort study was to examine the predictive validity of the Berg Balance Scale (BBS) for 3 types of outcomes-any fa...

To examine the frequency distributions and interrater reliability of individual items of the interRAI Acute Care instrument. Observational study of a representative sample of older inpatients; duplicate assessments conducted on a subsample by independent assessors to examine interrater reliability. Acute medical, acute geriatric and orthopedic unit...

Cost-effective methods have been developed to help busy emergency department (ED) staff cope with the growing number of older patients, including quick screening and assessment tools to identify those at high risk and note their specific needs. This survey, from a sample of key informants from all EDs (n = 111) in the province of Quebec (participat...

(1) To examine the concurrent criterion validity of the modified shuttle walk test (MSWT) by using the 6- (6MWT) and 12-minute walk test (12MWT), (2) to examine the concurrent criterion validity of the estimated maximum oxygen uptake (Vo2max) of the MSWT with actual Vo2max, and (3) to determine test-retest reliability of the MSWT in patients with c...

The purpose of the present study was to translate and adapt the Berg balance scale, an instrument for functional balance assessment, to Brazilian-Portuguese and to determine the reliability of scores obtained with the Brazilian adaptation. Two persons proficient in English independently translated the original scale into Brazilian-Portuguese and a...

This article examines various technical challenges inherent in the design, implementation, and dissemination of health care quality performance measures. Using national and state-specific Minimum Data Set data from 1999, we examined sample size, measure stability, creation of ordinal ranks, and risk adjustment as applied to aggregated facility qual...

Purpose: This article examines various technical challenges inherent in the design, implementation, and dissemination of health care quality performance measures. Design and Methods: Using national and state-specific Minimum Data Set data from 1999, we examined sample size, measure stability, creation of ordinal ranks, and risk adjustment as applie...

We summarize work done to identify and evaluate existing quality indicators (QIs) for long-term care (LTC) settings. Indicators operationally defined using routinely collected and computerized patient assessments were identified and then aggregated to characterize the performance of the nursing facility over a specific period of time. Of 143 indica...

This research investigated use of mobility equipment as a substitute for human assistance and also examined whether use of mobility equipment results in out-of-pocket cost savings associated with formal home care services. The authors analyzed data collected from 9,230 respondents to the Adult Followback Survey of the Disability Supplement to the 1...

Assessment of older people rarely includes functional domains critical for ensuring optimum outcome of treatment in acute hospital care. We report the development of a new assessment instrument, and illustrate how differences between pre-hospital and hospital admission status can be systematically evaluated using the Minimum Data Set for Acute Care...

RÉSUMÉ Avant les années 1990, la plupart des recherches portant sur l'évaluation des résultats des programmes de soins à domicile, notamment sur les efforts pour retarder le placement, maintenir le fonctionnement et assurer l'autonomie des aîné(e)s, ne reposaient pas sur des fondements théoriques. Les résultats attendus des programmes étaient rarem...

Objective: To describe the use of postacute services alone or in combination following a hospitalization for a hip fracture or stroke by Medicare beneficiaries who were relatively well and living in the community prior to the index event. Methods: Healthservice use histories were constructed using Medicare claims. Patients in the study represented...

To examine the added benefit of home health services for elderly patients with hip fracture discharged home after inpatient rehabilitation. Medicare claims from 1% of 1986 beneficiaries followed until 1992. Persons hospitalized with hip fracture at 70 years or older who had no major Medicare claims during the year before hospitalization and who wer...

The hypothesis that decreased growth hormone (GH) secretion contributes to the functional decline that occurs with aging is far from substantiated. There have been few studies addressing the distribution and correlates of IGF-I, an indicator of GH activity, in nonclinical populations. As part of a growth hormone intervention trial, we examined the...

to examine the prevalence of therapy use in nursing homes in selected countries and to describe the characteristics of nursing home residents who receive therapy. DESIGN and the design of the study is cross-sectional, using Minimum Data Set (MDS) assessments of nursing home residents. The sample includes all nursing home residents in six US states...

data using the Resident Assessment Instrument (RAI) from nursing home populations in five countries (Denmark, Iceland, Italy, Japan, USA) were assembled from 396277 residents. The distribution of a new quality of life measure, 'social engagement', embedded in the RAI and found to be reliable and valid in the USA, was examined and compared in the in...

to compare cross-nationally the sources and rates of admission and discharge in nursing homes. data on admission were used from the Minimum Data Set of the Resident Assessment Instrument as collected in a multi-nation database at the University of Michigan. Additional data containing longitudinal episodes were used from databases in the Netherlands...

The Medicare Catastrophic Coverage Act (MCCA) of 1988 altered eligibility and coverage for skilled nursing facility (SNF) care and changed Medicaid eligibility rules for nursing-home residents. Detailed data on the residents of a for-profit nursing-home chain and Medicare claims for a 1 percent sample of beneficiaries were used to examine the impac...

Individuals must be able to maintain an upright posture under a variety of conditions and to move independently. These constructs of balance and gait are fundamental components of physical functioning and should be incorporated into clinical assessment of older adults. The primary objective, therefore, is to review existing measures of functional b...