Seattle-Denver Center of Innovation (COIN)

COIN Investigators & Staff

COIN Investigators

Cari R. Levy, MD, PhD

Title: Core Investigator
Physician

Contact: Cari.Levy@va.gov

Location: Denver

University of Colorado webpage

 

Research Interests

See Dr. Levy's Dimensions profile that includes: publications, grants, datasets, patents and clinical trials

I am an internist with board certification in Geriatrics and Hospice and Palliative Medicine and a PhD in Clinical Sciences. I am also a Certified Medical Director. My research focuses on innovative models of long-term care delivery and optimizing palliative care delivery to frail older adult populations.
I was inspired in childhood by my grandfather and great-grandmother to improve the way we care for those who are aging and suffering from serious illness. My grandfather was a Navy Veteran and my relationship to him has always connected me to Veterans.
As the world population ages, I hope my work inspires and informs new models of care that allow older adults to age well in the setting of their choice.

The following images visualize Dr. Levy's work. The word cloud is drawn from publication titles. The research collaboration map shows research relationships (click the image to enlarge):

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Grants & Funding

Preferences Elicited and Respected for Seriously-Ill Veterans through Enhanced Decision-Making (PERSIVED)

This program aims to promote Veteran choice and deliver goal-concordant care by consistently conducting goals-of-care conversations and documenting Veterans’ preferences for care in actionable, portable medical orders.
Our program focuses on two groups of Veterans at high risk for receiving non-beneficial, unwanted care:
— Those enrolled in home-based primary care programs and
— Those receiving Veterans Health Administration (VA)-paid care in community nursing homes.
Our interdisciplinary team will use two implementation strategies:
1) audit with feedback and action planning and
2) facilitation will focus on coaching clinical champions, who will work with VA and non-VA clinicians to document Veterans’ preferences in durable, portable orders that can be honored across settings.
This program will improve the care and outcomes for seriously ill Veterans by addressing the VA’s modernization priorities of committing to zero harm and reducing unwanted variation in care delivery.
Funder: Veterans Administration
NIH website
Publications of note:
— PERSIVED QUERI Program
— Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration
— Applying the Tailored Implementation in Chronic Diseases framework to inform implementation of the Preferences Elicited and Respected for Seriously Ill Veterans through enhanced decision-making program in the United States Veterans Health Administration
— Health Services Research & Development Impacts

Medical Foster Homes: A Safe, Cost Effective Substitute for Nursing Homes?

The VA Medical Foster Home Program is an unprecedented initiative to care for Veterans who are nursing home eligible but prefer to receive care in a private home with qualified caregivers. The study will conduct interviews and available data to understand why Veterans choose care in a private medical foster home instead of a nursing home. How characteristics of Veterans differ by the site of care, program attributes that support their decision, and whether the program is safe and cost-effective.
Understanding Veteran characteristics associated with successful enrollment can lead to medical foster home staff improving enrollment efficiency and identifying types of Veterans not currently served by the program who would benefit from the program.
Dissemination of project results to a broad audience ranging from front-line staff to national policymakers will improve recruitment strategies and ensure that medical foster homes are a safe and cost-effective alternative to nursing home care.
Funder: Veterans Administration
NIH website
Publications of note:
— The Veterans Health Administration’s Medical Foster Home Program: Where Heroes Meet (Older) Angels
— Launching Medical Foster Home Programs: Key Components to Growing This Alternative to Nursing Home Placement
— Fostering Excellence: An Examination of High-Enrollment VHA Medical Foster Home Programs
— A qualitative evaluation of a new community living model: medical foster home placement

Are Veterans' Outcomes Better when VHA Purchases High-Quality Nursing Home Care?

As a result of the Veterans Choice Act, the Veterans Health Administration (VHA) is purchasing more care in the community. While studies are underway to learn how the Choice Act is improving access to care for Veterans, systematic measurement of the quality of care VHA is purchasing due to the Choice Act has yet to be available.
However, we can learn more about what leads to purchasing high-quality care from the Community Nursing Home Program. VHA has purchased this type of care in the community for 51 years. Over the last decade, expenditures on community nursing home care have grown from $227 to $861 million.
This project will describe the quality and costs of community nursing home care purchased by VHA compared to that available in the community, understand if outcomes are better in high-quality nursing homes, and identify what incentives and conditions lead to purchasing high-quality care for Veterans. Results will lead to the creation of a toolkit to inform program policy revisions and VHA-purchased care.
Funder: Veterans Affairs
NIH website
Publications of note:
— Purchasing High-Quality Community Nursing Home Care: A Will to Work With VHA Diminished by Contracting Burdens
— Antipsychotic initiation and new diagnoses excluded from quality‐measure reporting among Veterans in community nursing homes contracted by the Veterans Health Administration in the United States

A Conference for Patient Centered Post-Acute Care

The Patient-Centered Post-Acute Care Conference aims to bring together providers, patients, researchers, policymakers, and corporate representatives to discuss, innovate and collaborate regarding how to best provide high-quality care for older adults needing post-acute care services. This series of 3 conferences aims to build networks and foster collaboration in the highly diverse and fragmented post-acute care industry.
Funder: National Institute on Aging
NIH website
Publications of note:
— "What Would It Take to Transform Post-Acute Care?" 2019 Conference Proceedings on Re-envisioning Post-Acute Care

Notice of Intent to Fund - HSR&D QUERI Palliative Care as a Standard of Care in Parkinson’s Disease

Funder: Veterans Administration

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Recent Publications

2023

Cole CS, Roydhouse J, Fink RM, Ozkaynak M, Carpenter JG, Plys E, Wan S, Levy CR. Identifying Nursing Home Residents With Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties. J Am Med Dir Assoc. 2023 Apr 5:S1525-8610(23)00235-9. doi: 10.1016/j.jamda.2023.02.112. Epub ahead of print.
PMID: 37030323
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Resnick B, Vellega A, Levy C. The Interdisciplinary Care Team Approach in Long-Term Care: Where are We and Where do We Need to Go? J Am Med Dir Assoc. 2023 Apr;24(4):407-409. doi: 10.1016/j.jamda.2023.02.003.
PMID: 37005056
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Cornell PY, Magid KH, Corneau E, Haverhals LM, Levy C. Decline in Veterans' Admissions to Nursing Homes During COVID-19: Fewer Beds, More Fear, and Finding Alternative Care Settings. J Am Med Dir Assoc. 2023 Jan 5:S1525-8610(22)00999-9. doi: 10.1016/j.jamda.2022.12.021. Epub ahead of print. PMCID: PMC9812817.
PMID: 36708741
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2022

McConnell ES, Xue TM, Levy CR. Veterans Health Administration Models of Community-Based Long-Term Care: State of the Science. J Am Med Dir Assoc. 2022 Nov 9:S1525-8610(22)00794-0. doi: 10.1016/j.jamda.2022.10.012. Epub ahead of print.
PMID: 36370751
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Wyte-Lake T, Levy C, Hovsepian S, Mudoh Y, Schmitz C, Dobalian A. COVID-19 vaccine adoption and hesitancy among older Veterans. BMC Public Health. 2022 Aug 11;22(1):1532. doi: 10.1186/s12889-022-13882-7. PMCID: PMC9366126.
PMID: 35953851
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Plys E, Levy C. Depression within the First Year of Relocation to Residential Care/Assisted Living: Where You Come From Matters. J Appl Gerontol. 2022 Aug 5:7334648221117524. doi: 10.1177/07334648221117524. Epub ahead of print.
PMID: 35930794
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Ersek M, Sales A, Keddem S, Ayele R, Haverhals LM, Magid KH, Kononowech J, Murray A, Carpenter JG, Foglia MB, Potter L, McKenzie J, Davis D, Levy C. Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration. Implement Sci Commun. 2022 Jul 20;3(1):78. doi: 10.1186/s43058-022-00321-2. PMCID: PMC9296899.
PMID: 35859140
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Plys E, Levy CR, Brenner LA, Vranceanu AM. Let's Integrate! The Case for Bringing Behavioral Health to Nursing Home-Based Post-Acute and Subacute Care. J Am Med Dir Assoc. 2022 Jul 2:S1525-8610(22)00462-5. doi: 10.1016/j.jamda.2022.06.004. Epub ahead of print.
PMID: 35792146
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Haverhals LM, Manheim CE, Katz M, Levy CR. Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program. Geriatrics (Basel). 2022 Jun 15;7(3):66. doi: 10.3390/geriatrics7030066. PMCID: PMC9223204.
PMID: 35735771
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Magid KH, Galenbeck E, Haverhals LM, Cornell PY, Moyo P, Mochel AL, Corneau E, Rudolph JL, Mor V, Levy C. Purchasing High-Quality Community Nursing Home Care: A Will to Work With VA Diminished by Contracting Burdens. J Am Med Dir Assoc. 2022 Apr 13:S1525-8610(22)00238-9. doi: 10.1016/j.jamda.2022.03.007. Epub ahead of print.
PMID: 35429454
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Sloane PD, Portelli Tremont JN, Brasel KJ, Dhesi J, Hewitt J, Joseph BA, Ko FC, Kow AWC, Lagoo-Deenadelayan SA, Levy CR, Louie RJ, McConnell ES, Neuman MD, Partridge J, Rosenthal RA. Surgery and Geriatric Medicine: Toward Greater Integration and Collaboration. J Am Med Dir Assoc. 2022 Apr;23(4):525-527. doi: 10.1016/j.jamda.2022.02.015. PMID: .
PMID: 35379455.
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Presley CJ, Kaur K, Han L, Soulos PR, Zhu W, Corneau E, O'Leary JR, Chao H, Shamas T, Rose MG, Lorenz KA, Levy CR, Mor V, Gross CP. Aggressive End-of-Life Care in the Veterans Health Administration versus Fee-for-Service Medicare among Patients with Advanced Lung Cancer. J Palliat Med. 2022 Mar 30. doi: 10.1089/jpm.2021.0436. Epub ahead of print.
PMID: 35363053.
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Carpenter JG, Scott WJ, Kononowech J, Foglia MB, Haverhals LM, Hogikyan R, Kolanowski A, Landis-Lewis Z, Levy C, Miller SC, Periyakoil VJ, Phibbs CS, Potter L, Sales A, Ersek M. Evaluating implementation strategies to support documentation of veterans' care preferences. Health Serv Res. 2022 Mar 8. doi: 10.1111/1475-6773.13958. Epub ahead of print.
PMID: 35261022.
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Med Dir Assoc. 2022 Mar;23(3):323-327. doi: 10.1016/j.jamda.2022.01.001.
PMID: 35219503.
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Levy C, Zimmerman S, Mor V, Gifford D, Greenberg SA, Klinger JH, Lieblich C, Linnebur S, McAllister A, Nazir A, Pace D, Stone R, Resnick B, Sloane PD, Ouslander J, Gaugler JE. Pragmatic Trials in Long-Term Care: Implementation and Dissemination Challenges and Opportunities. J Am Geriatr Soc. 2022 Feb 23. doi: 10.1111/jgs.17698. Epub ahead of print.
PMID: 35195281.
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Geriatr Soc. 2022 Feb 23. doi: 10.1111/jgs.17697. Epub ahead of print.
PMID: 35195278.
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Levy C, Zimmerman S, Mor V, Gifford D, Greenberg SA, Klinger JH, Lieblich C, Linnebur S, McAllister A, Nazir A, Pace D, Stone R, Resnick B, Sloane PD, Ouslander J, Gaugler JE. Pragmatic trials in long-term care: Challenges, opportunities, recommendations. Geriatr Nurs. 2022 Feb 23:S0197-4572(22)00036-2. doi: 10.1016/j.gerinurse.2022.02.006. Epub ahead of print.
PMID: 35219533.
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic trials and improving long-term care: Recommendations from a national institutes of health conference. Geriatr Nurs. 2022 Feb 23:S0197-4572(22)00038-6. doi: 10.1016/j.gerinurse.2022.02.008. Epub ahead of print.
PMID: 35219536.
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Haverhals LM, Magid KH, Blanchard KN, Levy CR. Veterans Health Administration Staff Perceptions of Overseeing Care in Community Nursing Homes During COVID-19. Gerontol Geriatr Med. 2022 Feb 15;8:23337214221080307. doi: 10.1177/23337214221080307. PMCID: PMC8855220.
PMID: 35187203.
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Magid KH, Galenbeck E, Hazelwood J, Shanbhag P, Joucovsky AL, Levy CR, Lum HD. Sharing Space to Age in Community: A Mixed-Methods Study of Homeshare Organizations. J Aging Soc Policy. 2022 Feb 6:1-29. doi: 10.1080/08959420.2022.2029266. Epub ahead of print.
PMID: 35129098.
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2021

Levy C, Zimmerman S, Mor V, Gifford D, Greenberg SA, Klinger JH, Lieblich C, Linnebur S, McAllister A, Nazir A, Pace D, Stone R, Resnick B, Sloane PD, Ouslander J, Gaugler JE. Pragmatic Trials in Long-Term Care: Challenges, Opportunities, Recommendations. J Am Med Dir Assoc. 2021 Dec 14:S1525-8610(21)01011-2. doi: 10.1016/j.jamda.2021.11.024. Epub ahead of print.
PMID: 34919838

Jones TS, Jones EL, Barnett CC Jr, Moore JT, Wikiel KJ, Horney CP, Unruh M, Levy CR, Robinson TN. A Multidisciplinary High-Risk Surgery Committee May Improve Perioperative Decision Making for Patients and Physicians. J Palliat Med. 2021 Dec;24(12):1863-1866. doi: 10.1089/jpm.2021.0141.
PMID: 34851187

Moyo P, Corneau E, Cornell PY, Mochel AL, Magid KH, Levy C, Mor V. Antipsychotic initiation and new diagnoses excluded from quality-measure reporting among Veterans in community nursing homes contracted by the Veterans Health Administration in the United States. Int J Methods Psychiatr Res. 2021 Nov 5:e1898. doi: 10.1002/mpr.1898. Epub ahead of print.
PMID: 34739736

Palat ST, Eber LB, Lum H, Levy C. Monoclonal Antibody Use in Post-Acute and Long-Term Care: A Call to Action. J Am Med Dir Assoc. 2021 Nov 1:S1525-8610(21)00912-9. doi: 10.1016/j.jamda.2021.10.010. Epub ahead of print. PMCID: PMC8559999.
PMID: 34736892

Jones CD, Thomas J, Ytell K, Roczen ML, Levy CR, Jordan SR, Lum HD, Gritz M. Is Health Information Exchange Participation Associated With Hospital Readmissions From Home Health Care? J Am Med Dir Assoc. 2021 Sep 1:S1525-8610(21)00738-6. doi: 10.1016/j.jamda.2021.08.012. Epub ahead of print.
PMID: 34480865

Levy C, Esmaeili A, Smith D, Hogikyan R, Periyakoil V, Carpenter JG, Sales A, Ersek M. Family members' experience improves with care preference documentation in home based primary care. J Am Geriatr Soc. 2021 Aug 14. doi: 10.1111/jgs.17410. Epub ahead of print.
PMID: 34390489.

Levy C, Au D, Ozkaynak M. Innovation and Quality Improvement: Safe or Sabotage in Nursing Homes? J Am Med Dir Assoc. 2021 Aug;22(8):1670-1671. doi: 10.1016/j.jamda.2021.06.026.
PMID: 34334162.

Magid KH, Solorzano N, Manheim C, Haverhals LM, Levy C. Social Support and Stressors among VA Medical Foster Home Caregivers. J Aging Soc Policy. 2021 May 28:1-21. doi: 10.1080/08959420.2021.1927619. Epub ahead of print.
PMID: 34047675.

Magid KH, Manheim C, Haverhals LM, Thomas KS, Saliba D, Levy C. (2021). Who Receives Care in VA Medical Foster Homes? Fed Pract. 2021;38(3):102-109. doi:10.12788/fp.0102.

Gillespie SM, Li J, Karuza J, Levy C, Dang S, Olsan T, Kinosian B, Intrator O. Factors Associated With Hospitalization by Veterans in Home-Based Primary Care. J Am Med Dir Assoc. 2021 May;22(5):1043-1051.e1. doi: 10.1016/j.jamda.2020.12.033. Epub 2021 Jan 29.
PMID: 33524340

Wojtusiak J, Asadzadehzanjani N, Levy C, Alemi F, Williams AE. Computational Barthel Index: an automated tool for assessing and predicting activities of daily living among nursing home patients. BMC Med Inform Decis Mak. 2021 Jan 9;21(1):17. doi: 10.1186/s12911-020-01368-8. PMCID: PMC7796534.
PMID: 33422059

Manheim C, Haverhals L, Gilman C, Karuza J, Olsan T, Edwards S, Levy C, Gillespie S. VA Home Based Primary Care Teams: Partnering with and Acting as Caregivers for Veterans. Home Health Care Serv Q. 2021 Jan-Mar;40(1):1-15. doi: 10.1080/01621424.2020.1869634. Epub 2021 Jan 7. PMID: .
PMID: 33411588

2020

Kononowech J, Landis-Lewis Z, Carpenter J, Ersek M, Hogikyan R, Levy C, Phibbs C, Scott W, Sales AE. Visual process maps to support implementation efforts: a case example. Implement Sci Commun. 2020 Nov 25;1(1):105. doi: 10.1186/s43058-020-00094-6. PMCID: PMC7687814.
PMID: 33292818

Griffith MF, Levy CR, Parikh TJ, Stevens-Lapsley JE, Eber LB, Palat ST, Gozalo PL, Teno JM. Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia. J Am Med Dir Assoc. 2020 Dec;21(12):1879-1884. doi: 10.1016/j.jamda.2020.09.010. Epub 2020 Oct 21. PMCID: PMC7577734.
PMID: 33263287

Haverhals LM, Gilman C, Manheim C, Bauers C, Kononowech J, Levy C. Implementation of VA's Life-Sustaining Treatment Decisions Initiative: Facilitators and Barriers to Early Implementation Across Seven VA Medical Centers. J Pain Symptom Manage. 2020 Nov 3:S0885-3924(20)30863-0. doi: 10.1016/j.jpainsymman.2020.10.034. Epub ahead of print.
PMID: 33157178

Griffith MF, Levy CR, Lum HD, Teno JM, Dale CR. Trends in Advance Care Planning for Patients with COPD in an Integrated Health Care System. Ann Am Thorac Soc. 2020 Nov 4. doi: 10.1513/AnnalsATS.202001-077RL. Epub ahead of print.
PMID: 33147425

Ayele R, Manges KA, Leonard C, Lee M, Galenbeck E, Molla M, Levy C, Burke RE. How Context Influences Hospital Readmissions from Skilled Nursing Facilities: A Rapid Ethnographic Study. J Am Med Dir Assoc. 2020 Sep 14:S1525-8610(20)30665-4. doi: 10.1016/j.jamda.2020.08.001. Online ahead of print.PMID:
PMID: 32943342

Lum HD, Dukes J, Daddato AE, Juarez-Colunga E, Shanbhag P, Kutner JS, Levy CR, Sudore RL. Effectiveness of Advance Care Planning Group Visits Among Older Adults in Primary Care. J Am Geriatr Soc. 2020 Oct;68(10):2382-2389. doi: 10.1111/jgs.16694. Epub 2020 Jul 29.PMID:
PMID: 32726475

2019

Presley CJ, Han L, O'Leary JR, Zhu W, Corneau E, Chao H, Shamas T, Rose M, Lorenz K, Levy CR, Mor V, Gross CP. Concurrent Hospice Care and Cancer-Directed Treatment for Advanced Lung Cancer and Receipt of Aggressive Care at the End of Life in the Veteran's Health Administration. J Palliat Med. 2020 Aug;23(8):1038-1044. doi: 10.1089/jpm.2019.0485. Epub 2020 Mar 2.PMID:
PMID: 32119800

Jones CD, Nearing KA, Burke RE, Lum HD, Boxer RS, Stevens-Lapsley JE, Ozkaynak M, Levy CR. ""What Would It Take to Transform Post-Acute Care?"" 2019 Conference Proceedings on Re-envisioning Post-Acute Care. J Am Med Dir Assoc. 2020 Aug;21(8):1012-1014. doi: 10.1016/j.jamda.2020.02.004. Epub 2020 Mar 17.PMID:
PMID: 32192872

Jones CD, Falvey J, Hess E, Levy CR, Nuccio E, Barón AE, Masoudi FA, Stevens-Lapsley J. Predicting Hospital Readmissions from Home Healthcare in Medicare Beneficiaries. J Am Geriatr Soc. 2019 Dec;67(12):2505-2510. doi: 10.1111/jgs.16153. Epub 2019 Aug 29. PMID: ; PMCID: PMC7323864.
PMID: 31463941

Jones CD, Levy CR. Improved Communication in Home Health Care Could Reduce Hospital Readmission Rates. JAMA Intern Med. 2019 Aug 1;179(8):1151-1152. doi: 10.1001/jamainternmed.2019.2727.
PMID: 31380950

Gustavson AM, Drake C, Lakin A, Daddato AE, Falvey JR, Capell W, Lum HD, Jones CD, Unroe KT, Towsley GL, Stevens-Lapsley JE, Levy CR, Boxer RS; PACRATS Investigators. Conducting Clinical Research in Post-acute and Long-term Nursing Home Care Settings: Regulatory Challenges. J Am Med Dir Assoc. 2019 Jul;20(7):798-803. doi: 10.1016/j.jamda.2019.04.022.
PMID: 31248598

Jones CD, Jones J, Bowles KH, Schroeder S, Masoudi FA, Coleman EA, Falvey J, Levy CR, Boxer RS. Patient, Caregiver, and Clinician Perspectives on Expectations for Home Healthcare after Discharge: A Qualitative Case Study. J Hosp Med. 2019 Feb;14(2):90-95. doi: 10.12788/jhm.3140.
PMID: 30785416

Falvey JR, Burke RE, Levy CR, Gustavson AM, Price L, Forster JE, Stevens-Lapsley JE. Impaired Physical Performance Predicts Hospitalization Risk for Participants in the Program of All-Inclusive Care for the Elderly. Phys Ther. 2019 Jan 1;99(1):28-36. doi: 10.1093/ptj/pzy127
PMID: 30602041

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