Submitted & Other Publications

January 2016 – March 2016

(Alphabetic order by first author) Authors in bold are Research Center staff

2016 (as of 05/25/2016) Peer-Reviewed Publications by VNSNY Research Center Staff Ahmad, F.S., Barg, F.K., Bowles, K.H., Alexander, M., Goldberg, L.R., French B, Kangovi S, Gallagher TR, Paciotti B, Kimmel SE. (2016). Comparing perspectives of patients, caregivers, and clinicians on heart failure management. Journal of Cardiac Failure. 22(3, 210-7. Doi: 10.1016/j.cardfail.2015.10.011. PMID: 26505810. Bowles, K.H., Ratcliffe, S., Potashnik, S., Topaz, M., Holmes, J., Shih, N-W., Naylor, M.D. (in press). H3IT Special Topic: Using Electronic Case Summaries to Elicit Multi-Disciplinary Expert Knowledge about Referrals to Post-Acute Care. Applied Clinical Informatics. Diamond, E. L., Russell, D., Kryza-Lacombe, M., Bowles, K. H., Applebaum, A. J., Dennis, J., ... & Prigerson, H. G. (2016). Rates and risks for late referral to hospice in patients with primary malignant brain tumors. Neuro-Oncology. 18(10), 78-86. Dowding, D., Lichtner, V., Allcock, N., Briggs, M., James, K., Keady, J., ... & Closs, S. J. (2016). Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings. International Journal of Nursing Studies, 53, 152-162.

Feldman, P.H., McDonald, M.V., Barrón, Y., Gerber, L.M., Peng, T.R. (2016). Home-based interventions for black patients with uncontrolled hypertension: a cluster randomized controlled trial. Journal of Comparative Effectiveness Research, 5(2):155-68. Kang, Y., McHugh, MD., Chittams, J., Bowles, K.H. (2016: e-pub ahead of print). Utilizing Home Healthcare Electronic Health Records for Telehomecare Patients with Heart Failure. A Decision Tree Approach to Detect Associations with Rehospitalizations. Computers, Informatics, Nursing. Naylor, M.D., Hirschman, K.B., Hanlon, A.L., Abbott, K.M., Bowles, K.H., Foust, J., Shah,S., Zubritsky, C. (2016). Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports. Journal of the American Medical Director Association. 17(1):44-52. O’Connor, M., Murtaugh, C., Shah, S., Barrón-Vaya, Y., Bowles, K.H., Peng, T., Zhu, C., Feldman, P. (2016). Patient characteristics predicting readmission among individuals hospitalized for heart failure. Medical Care Research and Review. 73(1):3-40 Sefcik, J.S., Nock, R.H., Flores, E.J., Chase, J.D., Bradway, C., Potashnik, S., Bowles, K.H. Patient Preferences for Information on Post-Acute Care Services. (2016). Research in Gerontological Nursing. 22(1):1-8. Wilde, M.H., Crean, H.F., McMahon, J.M., McDonald, M.V., Tang, W., Brasch, J., Fairbanks, E., Shah, S. & Zhang, F. (2016). Testing a model of self-management of fluid intake in community-residing long-term indwelling urinary catheter users. Nursing Research. 65(2): 97-106.

Wilde, M. H., McMahon, J. M., Tang, W., McDonald, M. V., Brasch, J., Fairbanks, E., Shah, S. (2016). Self-care management questionnaire for long-term indwelling urinary catheter users. Neurourology and Urodynamics, 35(4):492-496.

Submitted Peer-Reviewed Publications Currently Under Review Alvarado, N., Honey, S., Greenhalgh, J., Pearman, A., Long, A., Dowding, D., Jayne, D., Cope, A., Gill, A., Kotze, A., Randell, R. How does robotic surgery impact on teamwork in the operating theatre? The views of surgeons and theatre teams. Submitted to: Social Science and Medicine. Feinberg, J., Russell, D., Mola, A., Lipman,T.H., Bowles, K.H. Developing an adapted cardiac rehabilitation training for home care clinicians :Patient perspectives, clinician knowledge & curriculum overview. Submitted to: Journal of Cardiopulmonary Rehabilitation and Prevention. Lichtner, V., Dowding, D., Allcock, N., Keady, J., Sampson, E.L., Briggs, M., Corbett, A., James, K., Lasrado, R., Swarbrick, C., Closs, S.J. The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective. Submitted to: BMC Health Services Research. Murtaugh, C., Beissner, K., Barrón, Y., Trachtenberg, M., Bach, E., Henderson, C., Sridharan, S., Reid, M.C. Pain and function in home care: A need for treatment tailoring to reduce disparities? Submitted to: Clinical Journal of Pain. Murtaugh, C., Deb, P., Zhu, C., Peng, T., Barrón, Y., Shah, S., Moore, S., Bowles, K., Kalman, J., Feldman, P., Siu, A. Reducing readmissions among heart failure patients discharged to home health care: Effectiveness of early and intensive nursing services and early physician follow-up. Submitted to: Health Services Research Randell, R., Honey, S., Alvarado, N., Pearman, A., Greenhalgh, J., Long, A., Gardner, P., Gill, A., Jayne, D., Dowding, D. Embedding surgery into routine practice and impacts on communication and decision making: A review of the experience of surgical teams. Submitted to: Cognition, Technology & Work. Smith, T., Dowding, D., Larson, E. Prevalence and Risk Factors for HIV among Elder African American and Hispanic Women Receiving Home Care. Submitted to: The Gerontologist. Other Publications by VNSNY Research Center Staff Russell, D. (2016). Book Review: Closing the gaps on efforts to improve healthcare quality at the end-of-life: A review of Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life by the Committee on Approaching Death: Addressing Key End of Life Issues. Washington, DC: National Academies Press, 2014. 638 pages.(ISBN: 978-0309303101). Published in: Death studies,40(1), 68-7.

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Authors in bold are Research Center staff

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Interviews & Profiles of the VNSNY Research Center and its Staff Poltilove, J., Feinberg, J. (2016). Train clinicians together and increase knowledge, reduce rehospitalizations. Home Health Line. Published online on 02/29/2016. Available at: http://homehealthline.decisionhealth.com/Articles/Detail.aspx?id=521494 Flannery, M. (2016) Cutting-edge research leads to more targeted and effective home health care. The Huffington Post. Published online on 03/22/2016. Available at: http://www.huffingtonpost.com/marki-flannery/cuttingedge-research-lead_b_9519064.html Peer-Reviewed Publications by VNSNY Clinical Staff with Research Staff Support

Ortiz, I. (2016). A Day in the Life of a Home Health Aide/Health Coach. Home Healthcare Now. 34(6): 340-341. Dooley, F. & McDonald, M. (2016). Recent research on medication management. Home Healthcare Now. 34(8): 450-454.

2015 Peer-Reviewed Publications by VNSNY Research Center Staff Bakallbashi, E., Vyas, A., Vaswani, N., Rosales, D., Russell, D., Dowding, D., ... & Hawkey, R. (2015). Enhancing cross-functional collaboration and effective problem solving through an innovation challenge for point-of-care providers. Journal of Nursing Administration, 45(7/8): 354-357. Best, K.M., Jarrin, O, Buttenheim, A.M., Bowles, K.H., Curley, M.A. (2015: e-published ahead of print). Innovation in creating a strategic plan for research within an academic community. Nursing Outlook. Bowles, K.H., Chittams, J., Heil, E., Topaz, M., Rickard, K., Bhasker, M., Tanzer, M., Behta, M., Hanlon, A. (2015). Successful electronic implementation of discharge referral decision support has a positive impact on 30 and 60-day readmissions. Research in Nursing and Health, 38(2): 102-114. Bowles, K.H., Dykes, P., Demeris, G. (2015). The use of health information technology to improve care and outcomes for older adults. Research in Gerontological Nursing, 8(1): 5-10. Christopher, M. A., Duhl, J., Rosati, R. J., & Sheehan, K. M. (2015). Advocacy for Vulnerable Patients: How Grassroots Organizations Can Influence Health Care Policy. The American Journal of Nursing, 115(3): 66-69.

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Authors in bold are Research Center staff

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Diamond, E. L., Russell, D., Kryza-Lacombe, M., Bowles, K. H., Applebaum, A. J., Dennis, J., ... & Prigerson, H. G. (2015: e-published ahead of print). Rates and risks for late referral to hospice in patients with primary malignant brain tumors. Neuro-Oncology. Dowding, D. (2015). Using health information technology to support evidence-based practice. Worldviews on Evidence-Based Nursing, 12(3): 129-130. Dowding, D., Lichtner, C., Allcock, N., Briggs, M., James, K., Keady, J., Lastado, R., Sampson, E.L., Swarbrick, C., Closs, S.J. (in-press). Using sense-making theories of decision making to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings: a UK multi-site study. International Journal of Nursing Studies.

Dowding D, Randell R, Gardner P, Fitzpatrick G, Dykes P, Favela J, Hamer S, Whitewood-Moores Z, Hardiker N, Borycki E, Currie L. (2015). Dashboards for improving patient care: review of the literature. International Journal of Medical Informatics, 84:87-100. Feldman, P.H., McDonald, M.V., Trachtenberg, M.A., Schoenthaler, A., Coyne, N., Teresi, J. (2015). Center for Stroke Disparities Solutions community based care transition interventions: study protocol of a randomized controlled trial. Trials, 16(1): 32-43. Greenfield, E., Oberlink, M., Sharlach, A., Neal, M., Stafford, P. (2015). Age-friendly community initiatives: Conceptual issues and key questions. The Gerontologist. 55(2): 191-198. Hechenbleikner, E., Makary, M., Smarov, D., Leung, C., Miller, J.D., Deutschendorf, A., Brotman, D.J., Holland, D.E., Bowles, K.H., Wick, E.C. (2015). Decision support tool use in colorectal surgery: what is the role? Journal of Surgical Research, 194(1): 69-76.

Lichtner, V., Dowding, D., Closs, S.J. (2015). The relative meaning of absolute numbers: the case of pain intensity scores as decision support systems for pain management of patients with dementia. BMC Medical Informatics and Decision Making. 15(1):1.

McDonald, M.V., Feldman, P.H., Barrón-Vayá, Y., Peng, T.R., Sridharan, S., Pezzin, L.E. (2015: e-published ahead of print) Outcomes of clinical decision support (CDS) and correlates of CDS use for home care patients with high medication regimen complexity: A randomized trial. Journal for the Evaluation of Clinical Practice.

Nock, R. H., Sefcik, J. S., Flores, E., Bradway, C., Potashnik, S., & Bowles, K. H. (2015). Making decisions about post-acute care following hospitalization: What do patients want to know. The Gerontologist, 55(S2), 388.

O’Connor, M., Hanlon, A., Naylor, M.D , Bowles, K.H.,. (2015) The impact of home health length of stay and number of skilled nursing visits on hospitalization among Medicare-reimbursed skilled home health beneficiaries. Research in Nursing and Health Care. 38(4), 257-67.

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Authors in bold are Research Center staff

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Pavlik, V.N., Chan, W., Hyman, D.J., Feldman, P., Ogedegbe, G., Schwartz, J.E., McDonald, M., Einhorn, P., Tobin, J. (2015) Evaluating health systems level hypertension control interventions for African-Americans: Lessons from a pooled analysis of three cluster randomized Trials. Current Hypertension Reviews, 11(2): 123-31.

Press, M.J., Gerber, L.M., Peng, T.R., Pesko, M.F., Feldman, P.H., Ouchida, K., Sridharan, S., Bao, Y., Barron, Y., Casalino, L.P. (2015). Postdischarge communication between home health nurses and physicians: measurement, quality, and outcomes. Journal of the American Geriatric Society. 63(7):1299-305.

Randell, R., Greenhalgh, J., Dowding, D. (2015: e-published ahead of print). Using realist reviews to understand how health IT works, for whom, and in what circumstances. Journal of the American Medical Informatics Association, 22(e1): e216-e217.

Randell, R., Greenhalgh, J., Wyatt, J., Gardner, P., Pearman, A., Honey, S., Dowding, D. (2015). Electronic whiteboards: review of the literature. Studies in Health Technology and Informatics, 210(1): 389-93. Randell, R., Alvarado, N., Honey, S., Greenhalgh, J., Gardner, P., Gill, A., Jayne, D., Kotze, A., Pearman, A., Dowding, D. (2015). Impact of robotic surgery on decision making: perspectives of surgical teams. Proceedings of the AMIA 2015 Annual Symposium, pp.1057-1066. Russell, D., & Bowles, K. H. (2015). Continuity in visiting nurse personnel has important implications for the patient experience. Home Health Care Management & Practice, Online First. Sockolow, P. S., Bowles, K. H., & Rogers, M. (2015). Health information technology evaluation framework (HITREF) comprehensiveness as assessed in electronic point-of-care documentation systems evaluations. Studies in health technology and informatics, 216: 406-409. Taylor, P., Crouch, S., Howell, D. A., Dowding, D. W., Johnson, M. J. (2015). Change in physiological variables in the last 2 weeks of life: An observational study of hospital in-patients with cancer. Palliative Medicine, 29(2): 120-127. Topaz, M., Kang, Y, Holland, D., Ohta, B., Rickard, K., Bowles, KH. (2015). Higher 30 day and 60 day readmissions among patients who refuse post-acute care services. American Journal of Managed Care, 21(6): 424-433. Wilde, M. H., McMahon, J. M., McDonald, M. V., Tang, W., Wang, W., Brasch, J., Fairbanks, E., Shah, S., Zhang, F., & Chen, D. (2015) Self-management intervention for long-term indwelling urinary catheter users: Randomized clinical trial. Nursing Research, 64(1): 24-34. Wilde, M. H., McMahon, J. M., Tang, W., McDonald, M. V., Brasch, J., Fairbanks, E., Shah, S. (2015: e-published ahead of print). Self-care management questionnaire for long-term indwelling urinary catheter users. Neurourology and Urodynamics.

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Authors in bold are Research Center staff

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Wilde, M.H., Liebel, D., Fairbanks, E., Wilson, P., Lash, M., Shah, S., McDonald, M.V., Brasch, J., Zhang, F., Scheid, E., McMahon, J.M. (2015) A hybrid process fidelity assessment in a home-based randomized clinical trial. Home Health Care Services Quarterly, 34(2):113-36.

Doctoral Dissertations by Staff Evans, L. (2015). An examination of the effect of vision-related factors and availability of health care resources on depression, functional status, and falls among New York City senior center attendees. PhD Thesis. The Graduate Center of the City University of New York. New York, NY. Peer-Reviewed Publications by VNSNY Clinical Staff with Research Staff Support Rocks, D. & Cooper, E. (2015). Recent research on care coordination. Home Healthcare Now, 33(2): 104-109. Other Publications by VNSNY Research Center Staff Oberlink, M., Schwarz, J., & Greenberg, B.R. (2015). Building great communities: consider an age-friendly community assessment. Grantmakers in Aging. http://www.giaging.org/documents/140707_AF_matrix_final.pdf

Interviews & Profiles of the VNSNY Research Center and its Staff Bowles, K.H. (2015). VNSNY’s Research Center: pioneering new approaches to home health care. Frontline VNSNY, 2015(March): 6. Dowding, D. (2015). VNSNY”s Dr. Dawn Dowding investigates home care issues around sexual orientation and gender identity. Frontline VNSNY, 2015(June): 3. Feinberg, J. (2015). An interview with Jodi Feinberg, RN. Frontline VNSNY, 2015 (November): 2. Murtaugh, C.M. (2015). VNSNY Researchers help develop uniform assessment tool for post-acute care settings. Frontline VNSNY, 2015(April): 7. Russell, D. (2015). Joint project with NYU Langone provides HHA health coaching to high-risk heart failure patients. Frontline VNSNY, 2015(July): 3.

2014

Peer Reviewed Publications by VNSNY Research Center Staff Coleman, S., Nelson, E.A., Keen, J., Wilson, L., McGinnis, E., Dealey, C., Stubbs, N., Muir, D., Farrin, A., Dowding, D., Schols, J.M.G.A., Cuddigan, J., Berlowitz, D., Jude, E., Vowden, P., Bader, D.L., Gefen, A.,

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Authors in bold are Research Center staff

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Oomens, C.W.J., Schoonhoven, L., Nixon, J. (2014). Developing a pressure ulcer risk factor minimum data set and risk assessment framework. Journal of Advanced Nursing, 70(10):2339-2352. Coleman, S., Nixon, J., Keen, J., Wilson, L., McGinnis, E., Dealey, C., Stubbs, N., Farrin, A., Dowding, D., Schols, J.M.G.A., Cuddigan, J., Berlowitz, D., Jude, E., Vowden, P., Schoonhoven, L., Bader, D.L., Gefen, A., Oomens, C.W.J., Nelson, E.A. (2014). A new pressure ulcer conceptual framework. Journal of Advanced Nursing, 70(10):2222-2234. Dowding, D. W., Turley, M., & Garrido, T. (2014: e-published ahead of print). Nurses' use of an integrated electronic health record: results of a case site analysis. Informatics for Health and Social Care. Fairbanks, E., Shah, S. Wilde, M.H., McDonald, M.V., Brasch, J., McMahon, J.M. (2014). Successful recruitment methods in the community for a two-site clinical trial. Applied Nursing Research, 27(4):254-257. Kurowski, D., Russell, D., Hamilton, T., Napoli, R., Rosati, R. (2014). Factors for hospitalization in a medically complex population of pediatric home care patients. Home Health Care Management Practice, 26(3):146-153. O’Connor, M., Bowles, K.H., Feldman, P., St. Pierre, M., Jarrin, O., Shah, S., Murtaugh, C.M. (2014). Frontloading and intensity of skilled home health visits: a state of the science. Home Health Care Services Quarterly, 33(3):159-175.

Parenti, N., Reggiani, M.L.B., Iannone, P., Dowding, D. (2014). A systematic review on the validity and reliability of the Manchester Triage System. International Journal of Nursing Studies, 21(7):1062-1069.

Randell, R., Greenhalgh, J., Hindmarsh, J., Dowding, D., Jayne, D., Pearman, A., Gardner, P., Croft, J., Kotze, A. (2014). Integration of robotic surgery into routine practice and impacts on communication, collaboration and decision making: a realist process evaluation protocol. Implementation Science, 9(1): 52-59. Rosati, R., Russell, D., Peng, T., Brickner, C., Kurowski, D., Christopher, M., Sheehan, K. (2014). Medicare home health payment reform may jeopardize access for clinically complex and socially vulnerable patients. Health Affairs, 33(6):946-956. Samuriwo R., Dowding D. (2014) Nurses’ pressure ulcer related judgements and decisions in clinical practice: a systematic review. International Journal of Nursing Studies, 51(12):1667-1685. Shang J, Ma C, Poghosyan L, Dowding D, Stone P. (2014). The prevalence of infections and patient risk factors in home health care: A systematic review. American Journal of Infection Control, 42(5):479-484. Vanderboom, C. E., Vincent, A., Luedtke, C. A., Rhudy, L. M., Bowles, K. H. (2014). Feasibility of interactive technology for symptom monitoring in patients with fibromyalgia. Pain Management Nursing, 15(3): 557-564.

Doctoral Dissertations by VNSNY Research Center Staff Brickner, C. (2014). Estimating the Relationship Between a Transient Effect and the Onset of An Acute Event: A Comparison of a Case Crossover Design and a Retrospective Cohort Design. PhD thesis. Rutgers University. New Brunswick, NJ.

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Other Publications by VNSNY Research Center Staff Feldman, P. (2014). The PRIDE initiative: Building the capacity and scalability of integrated managed care plans. Health Affairs Blog website. Available from: http://healthaffairs.org/blog/2014/02/13/the-pride-initiative-building-the-capacity-and-scalability-of-integrated-managed-care-plans-for-dual-eligibles/. Feldman, P. (2014). Key Attributes of high-performing integrated health plans for Medicare-Medicaid enrollees. Center for Health Care Strategies, Inc. website. Available from: http://www.chcs.org/resource/key-attributes-high-performing-integrated-health-plans-medicare-medicaid-enrollees/

Peer-Reviewed Publications by VNSNY Clinical Staff with Research Staff Support Coyne, N. & Correnti, D. (2014). Effectiveness of motivational interviewing to improve chronic condition self-management – What does the research show us? Home Healthcare Nurse, 32(1):56-62. Sealy, L. & Oliva, A. (2014). Hypertension management guidelines ppdate and research on the importance of blood pressure control. Home Healthcare Nurse, 32(10):603-609. Sunkin, A., Bach, E., Reid, M.C. (2014). The Hurt Blocker. Can a psychotherapeutic technique relieve pain in older adults? Weill Cornell Medicine, 13(2):19-20.

2013 Abramson E.L., Pfoh, E.R., Barrón, Y., Quaresimo, J., Kaushal, R. (2013). The effects of electronic prescribing by community-based providers on ambulatory medication safety. Joint Commission Journal on Quality and Patient Safety, 39(12):545-52. Bach, E., Beissner, K., Murtaugh, C., Trachtenberg, M., Reid, M.C. (2013). Implementing a cognitive-behavioral pain self-management program in home health care, Part 2: Feasibility and acceptability cohort study. J Geriatr Phys Ther., 36(3):130-137. Beissner, K., Bach, E., Murtaugh, C., Parker, S., Trachtenberg, M., Reid, M.C. (2013). Implementing a Cognitive-Behavioral Pain Self-Management Program in Home Health Care, Part 1: Program Adaptation. J Geriatr Phys Ther., 36(3):123-129. Gerber LM, Mann SJ, McDonald MV, Chiu YL, Sridharan S, Feldman PH. (2013). Diuretic use in black patients with uncontrolled hypertension. Am J Hypertens. 26(2):174-179. McDonald MV, Peng TR, Sridharan S, Foust JB, Kogan P, Pezzin LE, Feldman PH. (2013). Automating the medication complexity index. J Am Med Inform Assoc. 20(3): 499-505. Russell, D., Rosati, R. J, Peng, T. R., Barrón, Y., Andreopoulos, E. (2013). Continuity in the provider of home health aide services and the likelihood of improvement in activities of daily living. Home Health Care Management & Practice. 25(1):16-22. Ryvicker, M., Feldman, P., Chiu, Y., Gerber, L. (2013). The role of patient activation in improving blood pressure outcomes in black patients receiving home care. Med Care Res Rev, 70(6):636–652.

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Ryvicker, M., McDonald, M., Trachtenberg, M., Peng, T., Sridharan, S., Feldman, P. (2013). Can the Care Transitions Measure predict re-hospitalization risk or home health nursing use of home healthcare patients? Journal for Healthcare Quality. 35(5):32-40. Wilde, MH, McDonald, MV, Brasch, J, McMahon, JM, Fairbanks, E, Shah, S, Tang, W, Scheid, E. (2013). Long-term urinary catheter users self-care practices and problems. J Clin Nurs. 22(3-4):356–367. Peer Reviewed Publications by VNSNY Clinical Staff with CHCPR Support Abbatiello, G. & Rosenfeld, P. (2013). Research on Cognitive Impairment in Community and Home Settings. Home Healthcare Nurse, 31(2):104-10. Cutrino, A. & Santamaria, J. (2013). Research on family caregivers – understanding levels of burden and how to provide assistance. Home Healthcare Nurse, 31(6):331-337. Wilde, M.H., Zhang, F., Fairbanks, E., Shah, S., McDonald, M.V., & Brasch, J. (2013). Perceived value of a urinary catheter self-management program in the home. Home Healthcare Nurse, 31(9):465-473. Zaldivar, A. & Bohnarczyk, N. (2013). New Approaches to Delivering Primary and Preventive Care to the Older Population. Home Healthcare Nurse, 31(4):219-24.

2012 Oberlink, M. (2012). Online surveys engage older adults in community planning. In Blanchard, J.M. & Anthony, B. (Eds.) Aging in Community. Chapel Hill, NC: Second Journey Publications. Rosati, R.J. (2012). Information Management in Pelletier, L.R. & Beaudin, C.L. (Eds.), Q solutions: Essential resources for the healthcare quality professional. Glenview, IL: National Association of Healthcare Quality. Rosenfeld, P., Pyc, L., Rosati, R.J., Marren, J.M. (2012). Developing a Competency Tool for Home Health Care Nurse Managers. Home Health Care Management & Practice, 24(1):5-12. Rosenfeld, P., Russell, D. (2012). A Review of Factors Influencing Utilization of Home and Community-Based Long-Term Care: Trends and Implications to the Nursing Workforce. Policy, Politics & Nursing Practice, 13(2):72-80. DOI 10.1177/1527154412449747. Russell, D., Rosati, R., Andreopoulos, E. (2012). Continuity in the Provider of Home-Based Physical Therapy Services and Its Implications for Outcomes of Patients. Physical Therapy 92(2):1-9. Ryvicker, M., Gallo, W., Fahs, M. (2012). Environmental factors associated with primary care access among urban older adults. Social Science & Medicine, 75(5):914-921. Ryvicker, M., Peng, T., Feldman, P. (2012). Patient activation and disparate healthcare outcomes in a racially diverse sample of chronically ill older adults. Journal of Health Care for the Poor and Underserved. 23(4):1577-1589.

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Peer Reviewed Publications by VNSNY Clinical Staff with CHCPR Support Beck, C. & Chopra, S. (2012). Research on Health Related Quality of Life and Cardiac Conditions. Home Healthcare Nurse, 30(1):54-60. Dorrejo, X. & Wilson, P. (2012). Research on Culturally Tailored Interventions Aimed at Improving Chronic Disease Risk Factors and Management. Home Healthcare Nurse, 30(9):126-132. Lugo, M. & Hamilton, T. (2012). Research in Advancing Pediatric Palliative Care. Home Healthcare Nurse, 30(2):126-131.

2011 Gerber, L.M., Barrón, Y., Mongoven, J., McDonald, M., Henriquez, E., Andreopoulos, E., & Feldman, P.H. (2011). Activation among chronically-ill older adults with complex medical needs: Challenges to supporting effective self-management. Journal of Ambulatory Care Management. 34(3):290-301. Murtaugh, C., Spillman, B., & Wang, X. (2011). Lifetime risk and duration of chronic disease and disability. The Journal of Aging and Health. 23(3):554-577. Pezzin, L.E., Feldman, P.F., Mongoven, J.M., McDonald, M.V., Gerber, L.M., & Peng, T.R. (2011). Improving blood pressure control: Results of home-based post-acute care interventions. Journal of General Internal Medicine. 26(3):280-286. Rosenfeld, P., Pyc, L., Rosati, R., Marren, J. (2011). Developing a Competency Tool for Home Health Care Nurse Managers. Home Health Care Management & Practice. doi: 10.1177/1084822311416499. Russell, D., Rosati, R.J., Marren, J.M., & Rosenfeld, P. (2011). Implementing a transitional care program for high-risk heart failure patients: Findings from a community-based partnership between a certified home healthcare agency and a regional hospital. Journal for Healthcare Quality. 33(6):17-24. Russell, D., Rosati, R.J., Rosenfeld, P., & Marren, J. (2011). Continuity in home health care: Is consistency in nursing personnel associated with better patient outcomes? Journal for Healthcare Quality. 33(6):33-39. Ryvicker, M. (2011). Staff-resident interaction in the nursing home: An ethnographic study of socio-economic disparities and community contexts. Journal of Aging Studies. 25(3):295-304. Ryvicker, M., Feldman, P. H., Rosati, R. J., Sobolewski, S., Maduro, G. A. and Schwartz, T. (2011). Improving Functional Outcomes in Home Care Patients: Impact and Challenges of Disseminating a Quality Improvement Initiative. Journal for Healthcare Quality. 33(5): 28–36. doi: 10.1111/j.1945-1474.2011.00156.x. Shao, H., Peng, T.R., Bruce, M.L. & Bao, Y. (2011). Diagnosed depression among Medicare home health patients: National prevalence estimates and key characteristics. Psychiatric Services. 62(5):538-540. Silver, G., Keefer, J., & Rosenfeld, P. (2011) Assisting Patients to Age in Place: An Innovative Pilot Program Utilizing the Patent Centered Care Model (PCCM) in Home Care. Home Health Care Management & Practice July 28, 2011 1084822311411657.

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Trachtenberg, M. & Ryvicker, M. (2011). Research on transitional care: from hospital to home. Home Healthcare Nurse, 29(10):645-651. Peer Reviewed Publications by VNSNY Clinical Staff with CHCPR Support King, L. & Galuppo, J.M. (2011). Research on diabetes: Prioritization, quality of life, medication adherence, and self-efficacy. Home Healthcare Nurse, 29(5):320-325. Mandel, M. & Savoy, E. (2011). Research on supporting patients and family caregivers with palliative and end of life care. Home Healthcare Nurse, 29(3):148-154. McTernan, S.E. & Meiri, H. (2011). Research on childhood obesity prevention and intervention. Home Healthcare Nurse, 29(2):118-123.

2010 Murtaugh, C., Spillman, B. C., & Wang, X. D. (2010). Lifetime risk and duration of chronic disease and disability. J Aging Health, 23(3), 554-577. Pezzin, L. E., Feldman, P., Mongoven, J. M., McDonald, M., Gerber, L. M., & Peng, T. (2010). Improving Blood Pressure Control: Results of home-based Post-acute Care Interventions. J Gen Intern Med, 26(3), 280-286. Rosenfeld, P., Chaya, J., Lewis-Holman, S., & Davin, D. (2010). Can an ADN Internship Program Prepare New RNs for Careers in Home Health Care Nursing? Findings from an Evaluation Study at Visiting Nurse Service of New York. Home Health Care Management & Practice, 22(4), 254-261. Russell, D., Rosenfeld, P., Ames, S., & Rosati, R. J. (2010). Using technology to enhance the quality of home health care: three case studies of health information technology initiatives at the Visiting Nurse Service of New York. J Healthc Qual, 32(5), 22-29. Ryvicker, M. (2010). Staff-resident interaction in the nursing home: An ethnographic study of socio-economic disparities and community contexts. Journal of Aging Studies. Slavov, I. (2010). Dose-response analysis using generalized propensity score: An application in home health care. Alexandria, VA: American Statistical Association. Document Number _ Vladeck, F., Segek, R., Oberlink, M., Gursen, M., & Rudin, D. (2010). Health Indicators: A Proactive and Systematic Approach to Healthy Aging. Cityscape, 12(2), 67-84.

2009 CHAMP. (2009). Care Coordination, Management, and Transitions (Series C, Report 2). New York: VNSNY Center for Home Care Policy and Research. Retrieved on February 22, 2010 http://www.champ-program.org/page/68/evidence-briefs.

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CHAMP. (2009). Chronic Pain Management (Series C, Report 6). New York: VNSNY Center for Home Care Policy and Research. Retrieved on February 22, 2010 http://www.champ-program.org/page/68/evidence-briefs. CHAMP. (2009). Cognitive Function (Series C, Report 4). New York: VNSNY Center for Home Care Policy and Research. Retrieved on February 22, 2010 http://www.champ-program.org/page/68/evidence-briefs. CHAMP. (2009). Framework for Geriatric Home Health Care (Series C, Report 1). New York: VNSNY Center for Home Care Policy and Research. Retrieved on February 22, 2010 http://www.champ-program.org/page/68/evidence-briefs. CHAMP. (2009). Medication Management (Series C, Report 3) New York: VNSNY Center for Home Care Policy and Research. Retrieved on February 22, 2010 http://www.champ-program.org/page/68/evidence-briefs. CHAMP. (2009). Palliative Care and Advanced Illness Management (Series C, Report 7). New York: VNSNY Center for Home Care Policy and Research. Retrieved on February 22, 2010 http://www.champ-program.org/page/68/evidence-briefs. CHAMP. (2009). Physical Function (Series C, Report 5). New York: VNSNY Center for Home Care Policy and Research. Retrieved on February 22, 2010 http://www.champ-program.org/page/68/evidence-briefs. Feldman, P. H., McDonald, M. V., Mongoven, J. M., Peng, T. R., Gerber, L. M., & Pezzin, L. E. (2009). Home-based blood pressure interventions for blacks. Circ Cardiovasc Qual Outcomes, 2(3), 241-248. McDonald, M. V., Pezzin, L. E., Peng, T. R., & Feldman, P. H. (2009). Understanding the complexity of hypertensive African American home care patients: challenges to intervention. Ethn Dis, 19(2), 148-153. Murtaugh, C., Peng, T., Totten, A., Costello, B., Moore, S., & Aykan, H. (2009). Complexity in geriatric home healthcare. J Healthc Qual, 31(2), 34-43. Naik, D., Totten, A., & Feldman, P. H. (2009). Promoting excellence in geriatric home care: proceedings and findings from a national conference. Caring, 28(4), 32-36. Naylor, M. D., Feldman, P. H., Keating, S., Koren, M. J., Kurtzman, E. T., Maccoy, M. C., et al. (2009). Translating research into practice: transitional care for older adults. J Eval Clin Pract, 15(6), 1164-1170. Oberlink, M., & Stafford, P. B. (2009). The Indiana AdvantAge Initiative: Measuring Community Elder-Friendliness and Planning for the Future. Journal for the American Society on Aging, 33(2), 91-94. Roane, D., Danik, K., & Oberlink, M. (2009). Evaluation of a community-based geriatric mental health program. World Psychiatry, 8:Supplement(1), 275. Rosati, R. J. (2009). Evaluation of remote monitoring in home health care. In: E.C. Conley, C. Doarn & A. Hajjam-El-Hassani (Eds.) Proceedings of the International Conference on eHealth, Telemedicine and Social Medicine, eTELEMED 2009 (pp. 151 - 153). Los Alamitos, CA: IEEE Computer Society. Rosati, R. J. (2009). The history of quality measurement in home health care. Clin Geriatr Med, 25(1), 121-134, vii-viii.

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Rosati, R. J. (2009). Home healthcare quality. J Healthc Qual, 31(2), 3-4. Rosati, R. J., Marren, J. M., Davin, D. M., & Morgan, C. J. (2009). The linkage between employee and patient satisfaction in home healthcare. J Healthc Qual, 31(2), 44-53. Ryvicker, M. (2009). Preservation of self in the nursing home: Contradictory practices within two models of care. Journal of Aging Studies, 23(1), 12-23.

2008 Chaya, J., Reilly, M., Moriarity, M., Davin, D., Nero-Reid, V., & Rosenfeld, P. (2008). Preparing Newly Licensed Associate Degree Nurses to Work in Home Health Care. Home Health Care Management and Practice, 21(1), 44-53. McDonald, M. V., King, L. J., Moodie, M., & Feldman, P. H. (2008). Exploring diabetic care deficiencies and adverse events in home healthcare. J Healthc Qual, 30(6), 5-12. McDonald, M. V., & Peterson, L. E. (2008). Finding Success in Medication Management. Home Health Care Management & Practice, 20(2), 135-140. McGuire, A., Newman, A., & McTernan, S. E. (2008). Recent Research in Pediatrics: Implications for Home Health Nursing. Research Brief. Home Healthcare Nurse, 26(2), 91-95. Oberlink, M. (2008). Opportunities for Creating Livable Communities. AARP Public Policy Institute. Rosenfeld, P., & Adams, R. E. (2008). Factors associated with hospital retention of RNs in the New York City Metropolitan Area: an analysis of the 1996, 2000, and 2004 National Sample Survey of Registered Nurses. Policy Polit Nurs Pract, 9(3), 158-172. Rosenfeld, P., Taylor, E., Liu, C., & Volland, P. (2008). Articulating the Evidence Base for Effective Social Work Practices with the Elderly: Building the Case for a Geriatric Social Work Policy Agenda. Social Work and Public Health, 23(6), 23-38. Ryvicker, M., Marren, J., Sobolewski, S., Acampora, T., Flannery, M., Buff, E., et al. (2008). Spreading improvement strategies within a large home healthcare organization. J Healthc Qual, 30(2), 48-58.

2007 Boyce, P. S., & Feldman, P. (2007). ReACH National Demonstration Collaborative: Early Results of Implementation. Home Health Care Serv Q, 26(4), 105-120. Edwards, J. C., Feldman, P. H., Sangl, J., Polakoff, D., Stern, G., & Casey, D. (2007). Sustainability of partnership projects: a conceptual framework and checklist. Jt Comm J Qual Patient Saf, 33(12 Suppl), 37-47. Feldman, P., Ryvicker, M., Rosati, R., Schwartz, T., & Maduro, G. (2007). HHA Partnering Collaborative Evaluation: Practice/Policy Brief: Prepared for the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.

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Feldman, P. H., Bridges, J., & Peng, T. (2007). Team structure and adverse events in home health care. Med Care, 45(6), 553-561. Feldman, P. H., Nadash, P., & Gursen, M. D. (2007). Long-term Care. In A. R. Kovner & J. R. Knickman (Eds.), Jonas and Kovner's Health Care Delivery in the United States (9th ed.). New York: Springer Publishing Company. Foust, J. B. (2007). Discharge planning as part of daily nursing practice. Appl Nurs Res, 20(2), 72-77. Lawrence, F. P., Damron-Rodriguez, J., Rosenfeld, P., Sisco, S., & Volland, P. (2007). Strengthening Field Education in Aging through University-Community Agency Partnership: The Practicum Partnership Program. Journal of Gerontological Social Work, 50(1/2), 135-154. Murtaugh, C. M., Peng, T., Aykan, H., & Maduro, G. (2007). Risk adjustment and public reporting on home health care. Health Care Financ Rev, 28(3), 77-94. Nash, D., Andreopoulos, E., Horowitz, D., Sohler, N., & Vlahov, D. (2007). Differences among U.S. states in estimating the number of people living with HIV/AIDS: impact on allocation of federal Ryan White funding. Public Health Rep, 122(5), 644-656. Oberlink, M. (2007). Active Living for Older Adults: Using Survey Information to Make Neighborhoods Walkable and Safe. Smart Growth Online, 1-4. Oberlink, M. (2007). Issues in Creating Livable Communities for People with Disabilities: Proceedings of the Panel. National Council on Disability, 1-26. Prince, G. J., & McDonald, M. V. (2007). Research on changing practitioner and patient behavior. Home Healthc Nurse, 25(2), 89-93. Rosati, R. J., & Huang, L. (2007). Development and testing of an analytic model to identify home healthcare patients at risk for a hospitalization within the first 60 days of care. Home Health Care Serv Q, 26(4), 21-36. Rosenfeld, P. (2007). Workplace practices for retaining older hospital nurses: implications from a study of nurses with eldercare responsibilities. Policy Polit Nurs Pract, 8(2), 120-129. Rosenfeld, P., Dennis, J., Hanen, S., Henriquez, E., Schwartz, T. M., Correoso, L., et al. (2007). Are there racial differences in attitudes toward hospice care? A study of hospice-eligible patients at the Visiting Nurse Service of New York. Am J Hosp Palliat Care, 24(5), 408-416. Siegler, E. L., Murtaugh, C. M., Rosati, R. J., Schwartz, T., Razzano, R., Sobolewski, S., et al. (2007). Improving Communication at the Transition to Home Health Care: Use of an Electronic Referral System. Home Health Care Management & Practice, 19(4), 267-271. Sobolewski, S., & Foust, J. B. (2007). Research on Self-Management Support. Research Brief. Home Healthcare Nurse, 25(6), 358-361. Weiss, L., Gany, F., Rosenfeld, P., Carrasquillo, O., Sharif, I., Behar, E., et al. (2007). Access to multilingual medication instructions at New York City pharmacies. J Urban Health, 84(6), 742-754.

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2006 Feldman, P. H., Clark, A., & Bruno, L. (2006). Advancing the agenda for home healthcare quality: conference proceedings and findings. Home Healthc Nurse, 24(5), 282-289. Feldman, P. H., & McDonald, M. (2006). Clinical Guidelines and Recent Research on Hypertension and Heart Failure. Home Healthc Nurse, 24(1), 50-53. Feldman, P. H., McDonald, M., Rosati, R. J., Murtaugh, C., Kovner, C., Goldberg, J. D., et al. (2006). Exploring the utility of automated drug alerts in home healthcare. J Healthc Qual, 28(1), 29-40. Grabowski, D. C., & Ahrens, J. (2006). The cost-effectiveness of home- and community-based long-term care services: Review and synthesis of the most recent evidence (Policy Brief No. 25). New York: The Center for Home Care Policy and Research, Visiting Nurse Service of New York. Gray, B. H., Scheinmann, R., Rosenfeld, P., & Finkelstein, R. (2006). Aging without Medicare? Evidence from New York City. Inquiry, 43(3), 211-221. Oberlink, M. (2006). Livable Communities for Adults with Disabilities. Center for Home Care Policy & Research Policy Brief, 29, 1-6. Rosati, R. (2006). Focusing on Home Healthcare Quality. Journal for Healthcare Quality, 28(1), 54-55. Rudin, D. (2006). Home health care quality conferences: Promoting change through dialogue (Policy Brief No. 28). New York: The Center for Home Care Policy and Research, Visiting Nurse Service of New York. Scharpf, T. P., Colabianchi, N., Madigan, E. A., Neuhauser, D., Peng, T., Feldman, P. H., et al. (2006). Functional status decline as a measure of adverse events in home health care: an observational study. BMC Health Serv Res, 6, 162. Siegler, E. L., Murtaugh, C. M., Rosati, R. J., Clark, A., Ruchlin, H. S., Sobolewski, S., et al. (2006). Improving the transition to home healthcare by rethinking the purpose and structure of the CMS 485: first steps. Home Health Care Serv Q, 25(3-4), 27-38. Stewart, K. (2006). Perspectives on the recent decline in disability at older ages (Policy Brief No. 27). New York: The Center for Home Care Policy and Research, Visiting Nurse Service of New York. Wilson, P., & Rodgers, B. (2006). Research on falls prevention and physical activity in older adults and a notice of a new web-based quality system by the Agency for Healthcare Research and Quality. Home Healthcare Nurse, 24(10), 632-636.

2005 Ahrens, J. (2005). Homes of choice: Towards more effective linkages between housing and services: (Policy Brief No. 24). New York: The Center for Home Care Policy and Research, Visiting Nurse Service of New York. Ahrens, J. (2005). The impact of Medicare home health policy changes on Medicare beneficiaries: part II. Policy Brief (Cent Home Care Policy Res Policy Brief No. 19), 1-6.

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Ahrens, J. (2005). The need for evidence-based guidelines in home care. Home Healthc Nurse, 23(3), 147-149. Ahrens, J. (2005). The positive impact of hospice care on the surviving spouse. Home Healthc Nurse, 23(1), 53-55. Ahrens, J. (2005). Public funding for long-term care services for older people in residential care settings. Policy Brief (Cent Home Care Policy Res)(23), 1-5. Ahrens, J., & Murtaugh, C. (2005). Creating more choices for older adults: financing LTC through an integrated income and disability annuity. Policy Brief (Cent Home Care Policy Res)(21), 1-4. Berman, A., Mezey, M., Kobayashi, M., Fulmer, T., Stanley, J., Thornlow, D., et al. (2005). Gerontological nursing content in baccalaureate nursing programs: comparison of findings from 1997 and 2003. J Prof Nurs, 21(5), 268-275. Bruno, L., & Ahrens, J. (2005). Examining "operational failures" to reduce home care errors. Caring, 24(2), 34-35, 37, 39. Byers, J. F., & Rosati, R. J. (2005). Module One: Foundation, Techniques and Tools. In L. R. Pelletier & C. L. Beaudin (Eds.), Q Solutions: Essential Resources for the Healthcare Quality Professional (Vol. 27). Glenview, IL: National Association for Healthcare Quality. Byers, J. F., & Rosati, R. J. (2005). Research provides the MEAT for quality improvement. J Healthc Qual, 27(4), 2. Clark, A. (2005). Improving the delivery of care for diabetes patients with a collaborative model. Home Healthc Nurse, 23(3), 177-182. Clark, A. (2005). Measuring quality of care nationwide. Caring, 24(3), 42-45. Feldman, P. H., & Ahrens, J. (2005). Linking Housing and Long-Term Care Services for Older Adults. Center for Home Care Policy & Research Summary Report, 1-17. Feldman, P. H., Murtaugh, C. M., Pezzin, L. E., McDonald, M. V., & Peng, T. R. (2005). Just-in-time evidence-based e-mail "reminders" in home health care: impact on patient outcomes. Health Serv Res, 40(3), 865-885. Feldman, P. H., Nadash, P., & Gursen, M. D. (2005). Long-term Care. In A. R. Kovner & J. R. Knickman (Eds.), Jonas and Kovner's Health Care Delivery in the United States (8th ed.). New York: Springer Publishing Company. Kinatukara, S., Rosati, R. J., & Huang, L. (2005). Assessment of OASIS reliability and validity using several methodological approaches. Home Health Care Serv Q, 24(3), 23-38. King, L., & Ahrens, J. (2005). Toward Creating an Informatics Infrastructure in Home Health Care. Caring, 24(1), 12-18.

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McDonald, M. V., Pezzin, L. E., Feldman, P. H., Murtaugh, C. M., & Peng, T. R. (2005). Can just-in-time, evidence-based "reminders" improve pain management among home health care nurses and their patients? J Pain Symptom Manage, 29(5), 474-488. Murtaugh, C. M., Pezzin, L. E., McDonald, M. V., Feldman, P. H., & Peng, T. R. (2005). Just-in-time evidence-based e-mail "reminders" in home health care: impact on nurse practices. Health Serv Res, 40(3), 849-864. Nadash, P., & Ahrens, J. (2005). Long-term care: an overview. Policy Brief (Cent Home Care Policy Res)(22), 1-9. Nadash, P., & Ahrens, J. (2005). Managed care and long-term care: a potential solution? Policy Brief (Cent Home Care Policy Res)(20), 1-6. Nadash, P., & Ahrens, J. (2005). Strategies to support HCBS. Policy Brief (Cent Home Care Policy Res)(26), 1-6. Neder, S., Rosati, R., & Huang, L. (2005). Assessment of OASIS inter-rater reliability and validity using several methodological approaches. Home Healthcare Services Quarterly, 24(3), 23-38. Pynoos, J., Feldman, P. H., & Ahrens, J. (2005). Linking housing and services for older adults: Obstacles, options, and opportunities. In. Binghamton, NY: The Haworth Press, Inc. Rosenfeld, P. (2005). Women in green: The contributions of Hadassah nursing to immigrant and refugee health in pre-state and the early years of the state of Israel. Nurs Hist Rev, 13, 101-119. Rosenfeld, P., Kim, H., Londono, G., Kovner, C., & Mezey, M. (2005). Adult ambulatory care visits to nurses and physicians: methodological limitations of the medical expenditure panel survey data. Policy Polit Nurs Pract, 6(3), 221-228. Stone, P. W., Harrison, M. I., Feldman, P., Linzer, M., Peng, T., Roblin, D., et al. (2005). Advances in patient safety: From research to implementation. Volumes 1-4, AHRQ Publication Nos. 050021 (1-4) Rockville, MD: Agency for Healthcare Research and Quality. Stone, P. W., Harrison, M. I., Feldman, P., Linzer, M., Peng, T., Roblin, D., et al. (2005). Organizational Climate of Staff Working Conditions and Safety - An Integrative Model. Advances in Patient Safety, 2, 467-481.

2004 Ahrens, J. (2004). Home care payment changes in a post-BBA world. Caring, 23(4), 40-44. Ahrens, J. (2004). Italian study concludes "home hospitalization" benefits stroke patients. Caring, 23(8), 40-42; quiz 44-45. Clark, A., & Nadash, P. (2004). The effectiveness of a nurse-led transitional care model for patients with congestive heart failure. Home Healthc Nurse, 22(3), 160-162.

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Feldman, P. (2004). Interview with a quality leader: Penny Feldman on home healthcare quality and research. Journal for Healthcare Quality, 26(3), 31-37. Feldman, P. (2004). Penny Feldman on home healthcare quality and research. Interview by Susan V. White. J Healthc Qual, 26(3), 31-37. Feldman, P. H. (2004). Improving care for older people in the home health care setting: Challenges for practice, education and policy. National Advisory Council on Nurse Education and Practice; Fourth Report to the Secretary of Health & Human Services and the Congress. Feldman, P. H., & Ahrens, J. (Fall 2004). Leveraging resources for home- and community-based services in a time of fiscal retrenchment. Conference Report: New York: Center for Home Care Policy and Research, Visiting Nurse Service of New York. Feldman, P. H., & McDonald, M. V. (2004). Conducting translation research in the home care setting: lessons from a just-in-time reminder study. Worldviews Evid Based Nurs, 1(1), 49-59. Feldman, P. H., Oberlink, M. R., Simantov, E., & Gursen, M. D. (2004). A tale of two older Americas: Community opportunities and challenges. The AdvantAge Initiative 2003 National Survey of Adults Aged 65 and Older: New York: The Center for Home Care Policy and Research, Visiting Nurse Service of New York. Feldman, P. H., Peng, T. R., Murtaugh, C. M., Kelleher, C., Donelson, S. M., McCann, M. E., et al. (2004). A randomized intervention to improve heart failure outcomes in community-based home health care. Home Health Care Serv Q, 23(1), 1-23. Feldman, P. H., Peterson, L. E., Reische, L., Bruno, L., & Clark, A. (2004). Charting the course for home health care quality: action steps for achieving sustainable improvement: conference proceedings. Home Healthc Nurse, 22(12), 841-850. Gursen, M. D., & Ahrens, J. (2004). The key to a new home care protocol: prospective visits. Caring, 23(1), 40-44. Keepnews, D., Capitman, J. A., & Rosati, R. J. (2004). Measuring patient-level clinical outcomes of home health care. J Nurs Scholarsh, 36(1), 79-85. Nadash, P. (2004). Two models of managed long-term care: comparing PACE with a Medicaid-only plan. Gerontologist, 44(5), 644-654. Nadash, P., & Ahrens, J. (2004). Bringing managed care home to the long-term care population. Policy Brief (Cent Home Care Policy Res)(18), 1-6. National Council on Disability. (2004). Livable Communities for Adults with Disabilities. Washington, DC: A report prepared by M. Oberlink, M. Gursen, E. Simantov, & P.H. Feldman for the National Council on Disability, Document Number) Navaie-Waliser, M., Lincoln, P., Karuturi, M., & Reisch, K. (2004). Increasing job satisfaction, quality care, and coordination in home health. J Nurs Adm, 34(2), 88-92. Navaie-Waliser, M., Mersman, C., & Lincoln, P. (2004). Implementing a pediatric asthma program: enabling self-care management through education. Home Healthc Nurse, 22(9), 633-639.

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Navaie-Waliser, M., Misener, M., Mersman, C., & Lincoln, P. (2004). Evaluating the needs of children with asthma in home care: the vital role of nurses as caregivers and educators. Public Health Nurs, 21(4), 306-315. Oberlink, M., Gursen, M., Simantov, E., & Feldman, P. H. (2004). Livable communities for adults with disabilities. Washington, DC: National Council on Disability. Rosenfeld, P., Kobayashi, M., Barber, P., & Mezey, M. (2004). Utilization of nurse practitioners in long-term care: findings and implications of a national survey. J Am Med Dir Assoc, 5(1), 9-15. Rosenfeld, P., Smith, M. O., Iervolino, L., & Bowar-Ferres, S. (2004). Nurse residency program: a 5-year evaluation from the participants' perspective. J Nurs Adm, 34(4), 188-194. Simantov, E., & Oberlink, M. (2004). The great information divide: Where do older adults turn for help? Fact Sheet. New York: Center for Home Care Policy and Research, Visiting Nurse Service of New York. Accessible: http://www.vnsny.org/advantage/fact/AI_FS_Services.pdf. Simantov, E., & Oberlink, M. (2004). Housing cost burden casts a shadow over older people's future. Fact Sheet. New York: Center for Home Care Policy and Research, Visiting Nurse Service of New York. Accessible: http://www.vnsny.org/advantage/fact/AI_FS_Housing.pdf. Simantov, E., & Oberlink, M. (2004). Staying healthy, living longer: Gaps in preventive care among older adults. Fact Sheet. New York: Center for Home Care Policy and Research, Visiting Nurse Service of New York. Accessible: http://www.vnsny.org/advantage/fact/AI_FS_Care.pdf. Simantov, E., & Oberlink, M. (2004). When older adults are involved in the community, the benefits are mutual. Fact Sheet. New York: Center for Home Care Policy and Research, Visiting Nurse Service of New York. Accessible: http://www.vnsny.org/advantage/fact/AI_FS_Involvement.pdf. Vetter, M. J., Bristow, L., & Ahrens, J. (2004). A model for home care clinician and home health aide collaboration: diabetes care by nurse case managers and community health workers. Home Healthc Nurse, 22(9), 645-648.

2003 Feldman, P., & Oberlink, M. (2003). The Advantage Initiative: Developing community indicators to promote the heath and well-being of older people. Family and Community Health Journal, 26(4), 268-274. Feldman, P. H. (2003). From philosophy to practice: selected issues in financing and coordinating long-term care. J Aging Health, 15(1), 5-14. Feldman, P. H. (Summer 2003). Review: No place like home: A history of nursing and home care in the United States. Contemporary Gerontology, 9(3). Feldman, P. H., & Kane, R. L. (2003). Strengthening research to improve the practice and management of long-term care. Milbank Q, 81(2), 179-220, 171.

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Feldman, P. H., Oberlink, M., Rudin, D., Clay, J., Edwards, B., & Stafford, P. B. (2003). Best practices: Lessons for communities in supporting the health, well-being, and independence of older people. AdvantAge Initiative Website. Feldman, P. H., & Oberlink, M. R. (2003). Developing community indicators to promote the health and well-being of older people. Fam Community Health, 26(4), 268-274. McDonald, M., & Nadash, P. (2003). Effective health care: Integrating research into practice. Caring, 22(7), 52-55. Murtaugh, C. M., McCall, N., Moore, S., & Meadow, A. (2003). Trends in Medicare home health care use: 1997-2001. Health Aff (Millwood), 22(5), 146-156. Nadash, P. (2003). Adult day centers: everything you wanted to know but were afraid to ask! Caring, 22(8), 6-8. Nadash, P. (2003). Helping patients avoid repeat hospital admissions. Caring, 22(5), 52-54. Nadash, P., & Feldman, P. H. (2003). The effectiveness of a "restorative" model of care for home care patients. Home Healthc Nurse, 21(6), 421-423. Neder, S., & Nadash, P. (2003). Individualized education can improve foot care for patients with diabetes. Home Healthc Nurse, 21(12), 837-840. Peng, T. R., Navaie-Waliser, M., & Feldman, P. H. (2003). Social support, home health service use, and outcomes among four racial-ethnic groups. Gerontologist, 43(4), 503-513. Rosati, R. (2003). Creating quality improvement projects. In E. L. Siegler, S. Mirafzali & J. B. Foust (Eds.), A Guide to Hospitals and Inpatient Care. New York: Springer Publishing. Rosati, R. J., Huang, L., Navaie-Waliser, M., & Feldman, P. H. (2003). Risk factors for repeated hospitalizations among home healthcare recipients. J Healthc Qual, 25(2), 4-10; quiz 10-11. Schoen, C., Simantov, E., Gross, R., Brammli, S., & Leiman, J. (2003). Disparities in women's health and health care experiences in the United States and Israel: findings from 1998 National Women's Health Surveys. Women Health, 37(1), 49-70. Spillman, B. C., Murtaugh, C. M., & Warshawsky, M. J. (2003). Policy implications of an annuity approach to integrating long-term care financing and retirement income. J Aging Health, 15(1), 45-73.

2002 Ahrens, J., Feldman, P. H., & Frey, D. (2002). Preventing medication errors in home care. Policy Brief (Cent Home Care Policy Res)(12), 1-6. Donelan, K., Hill, C. A., Hoffman, C., Scoles, K., Feldman, P. H., Levine, C., et al. (2002). Challenged to care: informal caregivers in a changing health system. Health Aff (Millwood), 21(4), 222-231.

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Feldman, P., Nadash, P., & Gursen, M. D. (2002). Long-term Care. In A. R. Kovner & J. S. (Eds.), Jonas and Kovner's Health Care Delivery in the United States (7th ed.). New York: Springer Publishing Company. Lee, J. S., & Peng, T. (2002). A profile of Asian/Pacific Islander elders in home health care. Journal of Gerontological Social Work, 36(1/2), 171-185. Meredith, S., Feldman, P., Frey, D., Giammarco, L., Hall, K., Arnold, K., et al. (2002). Improving medication use in newly admitted home healthcare patients: a randomized controlled trial. J Am Geriatr Soc, 50(9), 1484-1491. Murtaugh, C. M., & Litke, A. (2002). Transitions through postacute and long-term care settings: patterns of use and outcomes for a national cohort of elders. Med Care, 40(3), 227-236. Nadash, P. (2002). New York State's Medicaid-only managed long-term care program. New York: The Center for Home Care Policy and Research. Navaie-Waliser, M., Feldman, P. H., Gould, D. A., Levine, C., Kuerbis, A. N., & Donelan, K. (2002). When the caregiver needs care: the plight of vulnerable caregivers. Am J Public Health, 92(3), 409-413. Navaie-Waliser, M., Spriggs, A., & Feldman, P. H. (2002). Informal caregiving: differential experiences by gender. Med Care, 40(12), 1249-1259. Peng, T. R., Navaie-Waliser, M., & Feldman, P. H. (2002). Social support, service use, and health outcomes among elders in home health care: Similarities and disparities by race/ethnicity. The Gerontologist, 43(4). Siegler, E. L., Del Monte, M. L., Rosati, R. J., & von Gunten, C. F. (2002). What role should the nephrologist play in the provision of palliative care? J Palliat Med, 5(5), 759-762.

2001 Donelson, S., Murtaugh, C., & Feldman, P., et al. (March 2001). Clarifying the definition of homebound and medical necessity using OASIS data. Final Report prepared for the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (Contract #HHS-100-99-0020). New York, NY: Center for Home Care Policy and Research, Visiting Nurse Service of NY. Feldman, P. H., Nadash, P., & Gursen, M. (2001). Improving communication between researchers and policy makers in long-term care: or, researchers are from Mars; policy makers are from Venus. Gerontologist, 41(3), 312-321. Meredith, S., Feldman, P. H., Frey, D., Hall, K., Arnold, K., Brown, N. J., et al. (2001). Possible medication errors in home healthcare patients. J Am Geriatr Soc, 49(6), 719-724. Murtaugh, C., Spillman, B. C., & Warshawsky, M. J. (2001). In sickness and in health: An annuity approach to financing long-term care and retirement income. The Journal of Risk and Insurance, 68(2), 225-253.

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Navaie-Waliser, M., Feldman, P. H., Gould, D. A., Levine, C., Kuerbis, A. N., & Donelan, K. (2001). The experiences and challenges of informal caregivers: common themes and differences among whites, blacks, and hispanics. Gerontologist, 41(6), 733-741. Passik, S. D., Kirsh, K. L., Rosenfeld, B., McDonald, M. V., & Theobald, D. E. (2001). The changeable nature of patients' fears regarding chemotherapy: implications for palliative care. J Pain Symptom Manage, 21(2), 113-120.

2000 Davidson, H., Schluger, N. W., Feldman, P. H., Valentine, D. P., Telzak, E. E., & Laufer, F. N. (2000). The effects of increasing incentives on adherence to tuberculosis directly observed therapy. Int J Tuberc Lung Dis, 4(9), 860-865. Donelson, S. M. (2000). What gets measured gets done. Rehab Manag, 13(1), 54-56. Donelson, S. M., & Feldman, P. H. (2000). How to determine if PPS will provide adequate resources for your population: one agency's experience. Home Healthc Nurse, 18(6), 363-369. Leach, C. W., Peng, T. R., & Volckens, J. (2000). Is racism dead? Comparing (expressive) means and (structural equation) models. Br J Soc Psychol, 39 ( Pt 3), 449-465. Levine, C., Kuerbis, A. N., Gould, D. A., Navaie-Waliser, M., Feldman, P. H., & Donelan, K. (2000). A survey of family caregivers in New York City: Findings and implications for the health care system. New York: The United Hospital Fund. McDonald, M., Passik, S., & Coyle, N. (2000). Addressing the Needs of the Patient Who Requests Physician-Assisted Suicide or Euthanasia. In H. M. Chochinov & W. Breitbart (Eds.), Handbook of Psychiatry in Palliative Medicine. New York, NY: Oxford University Press, Inc. Murtaugh, C., Stevenson, D., Feldman, P., & Oberlink, M. (Fall/Winter 2000). State expenditures on home and community-based care for disabled elders. Fact Sheet. New York, NY: Center for Home Care Policy and Research. Passik, S. D., Kirsh, K. L., McDonald, M. V., Ahn, S., Russak, S. M., Martin, L., et al. (2000). A pilot survey of aberrant drug-taking attitudes and behaviors in samples of cancer and AIDS patients. J Pain Symptom Manage, 19(4), 274-286. Stevenson, D., Murtaugh, C., Feldman, P., & Oberlink, M. (Fall/Winter 2000). Expanding publicly financed assisted living and other residential alternatives for disabled older persons: Issues and options. Policy Brief. New York, NY: Center for Home Care Policy and Research. Stevenson, D., Murtaugh, C., Feldman, P., & Oberlink, M. (Fall/Winter 2000). Expanding publicly financed managed long-term care programs to provide greater access to home and community-based care. Policy Brief. New York, NY: Center for Home Care Policy and Research. Warshawsky, M. J., Spillman, B. C., & Murtaugh, C. (2000). Integration of the life annuity and long-term care insurance: Theory, evidence, practice, and policy. Pension Research Council Working Paper Number 2000-11. Philadelphia, PA: The Wharton School, University of Pennsylvania.

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1999 Butler, R., Grossman, L., & Oberlink, M. (1999). Life in an Older America. New York: The Century Foundation. Feldman, P. (1999). From post-acute to chronic care: Cost and policy implications of Medicare home health expansion. In P. Katz, R. Kane & M. Mezey (Eds.), Advances in Long-Term Care. Vol. IV. New York: Springer Publications. Feldman, P. (1999). Labor market issues in home-based care. In D. Fox & C. Raphael (Eds.), Home-Based Care for a New Century. Cambridge, MA: Blackwell Publishers. Feldman, P. H. (1999). "Doing more for less": advancing the conceptual underpinnings of home-based care. J Aging Health, 11(3), 261-276. Fulmer, T., Feldman, P., Kim, T. S., Carty, B., Beers, M., Molina, M., et al. (1999). An intervention study to enhance medication compliance in community-dwelling individuals. Journal of Gerontological Nursing, 25(8), 6-14. Gardner, E. N., Murtaugh, C. M., Ray, N. F., & Thamer, M. (1999). The cost of Medicaid-covered services provided to disabled adults with neurologic disorders: implications for managed care. Am J Manag Care, 5(11), 1417-1425. McDonald, M. V., Passik, S. D., Dugan, W., Rosenfeld, B., Theobald, D. E., & Edgerton, S. (1999). Nurses' recognition of depression in their patients with cancer. Oncol Nurs Forum, 26(3), 593-599. Murtaugh, C., Sparer, M., Feldman, P., & Lee, J. S., et al. (1999). State strategies for allocating resources to home and community-based care. Final report submitted to the Robert Wood Johnson Foundation. Vogl, D., Rosenfeld, B., Breitbart, W., Thaler, H., Passik, S., McDonald, M., et al. (1999). Symptom prevalence, characteristics, and distress in AIDS outpatients. J Pain Symptom Manage, 18(4), 253-262.

1998 Breitbart, W., McDonald, M. V., Rosenfeld, B., Monkman, N. D., & Passik, S. (1998). Fatigue in ambulatory AIDS patients. J Pain Symptom Manage, 15(3), 159-167. Breitbart, W., Passik, S., McDonald, M. V., Rosenfeld, B., Smith, M., Kaim, M., et al. (1998). Patient-related barriers to pain management in ambulatory AIDS patients. Pain, 76(1-2), 9-16. Dugan, W., McDonald, M. V., Passik, S. D., Rosenfeld, B. D., Theobald, D., & Edgerton, S. (1998). Use of the Zung Self-Rating Depression Scale in cancer patients: feasibility as a screening tool. Psychooncology, 7(6), 483-493. Feldman, P. (1998). Work force issues and quality of long-term care. Commissioned by the Committee on Improving Quality in Long-Term Care, Division of Health Care Services, Institute of Medicine as a

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background document for Wunderlich, G.S., and Kohler, P., Editors; Improving the quality of long-term care, National Academy Press, 2001. Feldman, P., Gold, M., & Heiser, N. (1998). Improving the use of data in health policymaking: Lessons from RWJF’s Information for State Health Policy Program. Washington, DC: Mathematica Policy Research, Inc. Passik, S. D., Dugan, W., McDonald, M. V., Rosenfeld, B., Theobald, D. E., & Edgerton, S. (1998). Oncologists' recognition of depression in their patients with cancer. J Clin Oncol, 16(4), 1594-1600. Passik, S. D., & McDonald, M. V. (1998). Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer, 83(12 Suppl American), 2817-2820.

1997 Feldman, P. (1997). State variations in Medicare expenditures. An editorial. American Journal of Public Health, 87(10), 1595-1596. Feldman, P., & Bishop, C. (1997). Medicare home health care services. Letter to the Editor. New England Journal of Medicine, 336(3), 226. Feldman, P., Donelson, S., & Gagen, D. (1997). Evaluating outcomes in the home care setting. Monitor, Medical Outcomes Trust, Boston, MA, 2(4), 14-16. Feldman, P., Latimer, E., & Davidson, H. (1997). Reply to Hornbrook on doing policy-relevant evaluation research. Health Serv Res, 32(1), 123-125. Feldman, P., & Murtaugh, C. (1997). Medicare home health payment reform. Letter to the Editor. Health Affairs, 16(2), 260-261. Feldman, P. H., Gold, M., & Chu, K. (1997). State health policy information: what worked? Health Aff (Millwood), 16(1), 207-210. Murtaugh, C. M., Kemper, P., Spillman, B. C., & Carlson, B. L. (1997). The amount, distribution, and timing of lifetime nursing home use. Med Care, 35(3), 204-218.

1996 Feldman, P. H., Latimer, E., & Davidson, H. (1996). Medicaid-funded home care for the frail elderly and disabled: evaluating the cost savings and outcomes of a service delivery reform. Health Serv Res, 31(4), 489-508.

1995 Carlson, B. L., Kemper, P., & Murtaugh, C. (1995). Constructing a lifetime nursing home use database from a sample of discharges. Journal of Economic and Social Measurement, 21(3), 187-211.

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Freiman, M. P., & Murtaugh, C. M. (1995). Interactions between hospital and nursing home use. Public Health Rep, 110(5), 546-554; discussion 545. Lopez, G., Holliman, D., & Peng, T. (1995). Beyond zero-sum diversity: Student attitudes towards educational equity. Educational Record, 76(2,3), 55-61. Murtaugh, C. M., & Freiman, M. P. (1995). Nursing home residents at risk of hospitalization and the characteristics of their hospital stays. Gerontologist, 35(1), 35-43. Murtaugh, C. M., Kemper, P., & Spillman, B. C. (1995). Risky business: long-term care insurance underwriting. Inquiry, 32(3), 271-284. Rosati, R. (1995). Software review of "BMDP New System for Windows." Social Science Computer Review, 13, 563-567.

1994 Davidson, H., Feldman, P. H., & Crawford, S. (1994). Measuring depressive symptoms in the frail elderly. J Gerontol, 49(4), P159-164. Feldman, P. (1994). "Dead-end" work or motivating job? Prospects for frontline paraprofessional workers in long-term care. Generations, 18(3), 5-10. Feldman, P. (1994). Front-line workers in aging. Generations, 18(3). Feldman, P., Gold, M., & Chu, K. (1994). Enhancing information for state health policy formation. Health Affairs, 18(2), 236-250. Feldman, P., Sapienza, A., & Kane, N. (1994). On the home front: The job of the home aide. Generations, 18(3), 16-19. Gurin, P., Hurtado, A., & Peng, T. (1994). Group contacts and ethnicity in the social identities of Mexicanos and Chicanos. Personality and Social Psychology Bulletin, 20(5), 521-532. Hurtado, A., Gurin, P., & Peng, T. (1994). Social identities- a framework for studying the adaptations of immigrants and ethnics: The adaptations of Mexicans in the United States. Social Problems, 40(1), 133-170. Murtaugh, C. M. (1994). Discharge planning in nursing homes. Health Serv Res, 28(6), 751-769.

1993 Feldman, P. (1993). Labor market issues in home care. Harvard University, John F. Kennedy School of Government: Faculty Research Working Paper Series, R94-3. Feldman, P. H. (1993). Work life improvements for home care workers: impact and feasibility. Gerontologist, 33(1), 47-54.

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Freiman, M. P., & Murtaugh, C. M. (1993). The determinants of the hospitalization of nursing home residents. J Health Econ, 12(3), 349-359.