Landry's study of comorbidity and social support in elderly home care outliers

¶ … Advancement to Candidacy Methodology Critique

The dissertation by Landry (2001) entitled "A comparison of comorbidity, depression, and social support of elderly home care patients who are identified as outliers and elderly home care patients who are identified as non-outliers under the Medicare prospective payment system" used a study of 20 elderly home healthcare patients identified as outliers (i.e., atypical patients) because of specific unusual factors pertaining to their condition. "An outlier patient, in terms of the Theory of Bureaucratic Caring (Ray, 1989), is one for whom the organization provides care beyond what is technically reimbursable from the payor source of interest, creating a situation where the elements of caring are given precedent over the elements of bureaucracy" (Landry 2001: 83). A comparison group of 80 non-outliers selected at random was used as a control comparison group. Both patient groups were surveyed for their demographic characteristics and also were screened for depression using the Geriatric Depression Scale - Short Form and the Norbeck Social Support Questionnaire. Outliers were found have a greater need for primary wound care and had a higher risk for diabetes at a younger age, but had similar levels of social support to non-outliers and were not at higher risk for co-morbidity and depression. The study was primarily exploratory although it was quantitative in design.

Reference

Landry, M.T. (2001). A comparison of comorbidity, depression, and social support of elderly home care patients who are identified as outliers and elderly home care patients who are identified as non-outliers under the Medicare prospective payment system (Order No. 3012768). Available from ProQuest Dissertations & Theses Global. (304770777). Retrieved from http://search.proquest.com/docview/304770777?accountid=25340

Essay #2: Literature review essay

The structuring theory of dissertation by Landry (2001) entitled "A comparison of comorbidity, depression, and social support of elderly home care patients who are identified as outliers and elderly home care patients who are identified as non-outliers under the Medicare prospective payment system" is that of the Theory of Bureaucratic Caring which suggests "that within health care organizations, ongoing decision-making processes occur regarding the balancing of providing patient care and maintaining the financial well-being of the organization, or bureaucracy. For this to occur, the elements of caring must be synthesized with the elements of bureaucracy" (Landry 2001: 85). In this instance, the outlier patients were receiving more care than technically would be reimbursed by Medicare were had additional needs that were not subject to the current Medicare classification system of reimbursed treatments. Still, care was provided within the organizational context even though the nurses were working for a for-profit home healthcare entity. Nurses were used to evaluate patients to determine required care and although some of these patients required additional measures (most notably wound care in the case of diabetic patients), this was accepted by the nurses as a needed intervention and performed as part of their duty to care.

Reference

Landry, M.T. (2001). A comparison of comorbidity, depression, and social support of elderly home care patients who are identified as outliers and elderly home care patients who are identified as non-outliers under the Medicare prospective payment system (Order No. 3012768). Available from ProQuest Dissertations & Theses Global. (304770777). Retrieved from http://search.proquest.com/docview/304770777?accountid=25340

Essay 3: Human sciences