共查询到20条相似文献，搜索用时 62 毫秒
1.
Rodney Laine Welsh James E. Graham Amol M. Karmarkar Natalie E. Leland Jacques G. Baillargeon Dana L. Wild Kenneth J. Ottenbacher 《Journal of the American Medical Directors Association》2017,18(4):367.e1-367.e10
Objectives
Examine the effects of postacute discharge setting on unplanned hospital readmissions following total knee arthroplasty (TKA) in older adults.Design
Secondary analyses of 100% Medicare (inpatient) claims files.Setting
Acute hospitals across the United States.Participants
Medicare fee-for-service beneficiaries ≥66 years of age who were discharged from an acute hospital following TKA in 2009-2011 (n = 608,031).Measurements
The outcome measure was unplanned readmissions at 30, 60, and 90 days. The independent variable of interest was postacute discharge setting: inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), or community. Covariates included demographic, clinical, and facility-level factors. The top 10 reasons for readmission were tabulated for each discharge setting across the 3 consecutive 30-day time periods.Results
A total of 32,226 patients (5.3%) were re-admitted within 30 days. Compared with community discharge, patients discharged to IRF and SNF had 44% and 40% higher odds of 30-day readmission, respectively. IRF and SNF discharge settings were also associated with 48% and 45% higher odds of 90-day readmission, respectively, compared with community discharge. The largest increase in readmission rates occurred within the first 30 days of hospital discharge for each discharge setting. From 1 to 30 days, postoperative and post-traumatic infections were among the top causes for readmission in all 3 discharge settings. From 31 to 60 days, postoperative or traumatic infections remained in the top 5-7 reasons for readmission in all settings, but they were not in the top 10 at 61 to 90 days.Conclusions
Patients discharged to either SNF or IRF, in comparison with those discharged to the community, had greater likelihood of readmission within 30 and 90 days. The reasons for readmission were relatively consistent across discharge settings and time periods. These findings provide new information relevant to the delivery of postacute care to older adults following TKA. 相似文献2.
Himali Weerahandi Li Li Haikun Bao Jeph Herrin Kumar Dharmarajan Joseph S. Ross Kunhee Lucy Kim Simon Jones Leora I. Horwitz 《Journal of the American Medical Directors Association》2019,20(4):432-437
Objective
Discharge to skilled nursing facilities (SNFs) is common in patients with heart failure (HF). It is unknown whether the transition from SNF to home is risky for these patients. Our objective was to study outcomes for the 30 days after discharge from SNF to home among Medicare patients hospitalized with HF who had subsequent SNF stays of 30 days or less.Design
Retrospective cohort study.Setting and participants
All Medicare fee-for-service beneficiaries 65 and older admitted during 2012-2015 with a HF diagnosis discharged to SNF then subsequently discharged home.Measures
Patients were followed for 30 days following SNF discharge. We categorized patients by SNF length of stay: 1 to 6 days, 7 to 13 days, and 14 to 30 days. For each group, we modeled time to a composite outcome of unplanned readmission or death after SNF discharge. Our model examined 0-2 days and 3-30 days post-SNF discharge.Results
Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home. Overall, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge. The hazard rate of the composite outcome for each group was significantly increased on days 0 to 2 after SNF discharge compared to days 3 to 30, as reflected in their hazard rate ratios: for patients with SNF length of stay 1 to 6 days, 4.60 (4.23-5.00); SNF length of stay 7 to 13 days, 2.61 (2.45-2.78); SNF length of stay 14 to 30 days, 1.70 (1.62-1.78).Conclusions/implications
The hazard rate of readmission after SNF discharge following HF hospitalization is highest during the first 2 days home. This risk attenuated with longer SNF length of stay. Interventions to improve postdischarge outcomes have primarily focused on hospital discharge. This evidence suggests that interventions to reduce readmissions may be more effective if they also incorporate the SNF-to-home transition. 相似文献3.
Hillary Lum Oluyomi Obafemi Joanna Dukes Molly Nowels Kristina Samon Rebecca S. Boxer 《Journal of the American Medical Directors Association》2017,18(10):885-890
Background
Individuals with heart failure (HF) who are hospitalized and admitted to skilled nursing facilities (SNFs) are at high risk for rehospitalization and death. The care preferences of this high-risk population have not been studied.Objectives
To describe care preferences of patients with HF admitted to SNFs for rehabilitation based on Medical Orders for Scope of Treatment (MOST) documentation, and evaluate goal-concordant care based on MOST documentation, emergency department (ED) visits, and hospitalization.Design, setting, and participants
Retrospective study of patients with HF in 35 SNFs enrolled in a randomized controlled trial of HF-disease management versus usual care between July 2014 and May 2016.Measurements
Validity of MOST forms, care preference documentation, and ED visits/hospitalizations within 60 days of SNF admission.Results
Of 370 patients (mean age 78.6 years, 58% women, 25% systolic HF), 278 (75%) had a MOST form in the SNF chart, of which 96 forms (35%) were invalid. The most common reason for an invalid MOST form was missing date accompanying patient or provider signature. Of 182 valid MOST forms, 47% of patients chose no cardiopulmonary resuscitation (“No CPR”), 58% selected “Full Treatment,” 17% chose “Selective Treatment,” and 23% chose “Comfort-Focused Treatment.” Patients who were older [odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.25, 1.81] and female (OR = 2.33, 95% CI = 1.18, 4.59) had higher odds of choosing “No CPR.” Sixty-six of 182 patients (36%) with valid MOST forms had an ED/hospital visit within 60 days of SNF admission; only 3 patients received medical care that was potentially discordant: all 3 chose “Comfort-Focused Treatment” and were hospitalized for more than symptom management.Conclusion
Seventy-five percent of patients with HF admitted to SNFs had care preferences documented using the MOST form, and 95% received goal-concordant care based on care preferences documented during the SNF admission. Clinicaltrials.gov # NCT01822912. 相似文献4.
5.
Verena R. Cimarolli Joann P. Reinhardt Jillian Minahan Orah Burack Channing Thomas Regina Melly 《Journal of the American Medical Directors Association》2017,18(11):991.e1-991.e4
Objectives
Use of exercise technologies has benefits for community-dwelling older adults in terms of improved gait and balance. But research on the feasibility of use of exercise technologies in various geriatric health care settings is lacking. Hence, the current study examined the feasibility of implementing an exercise technology intended to augment rehabilitation in patients receiving post-acute care (PAC) in a skilled nursing facility (SNF). We focused on 3 indicators of feasibility: extent of usage (including predictors of more intense use), patients' acceptability of the technology, and limited efficacy.Design
Cross-sectional study with data from patients' electronic medical records (EMR), exercise technology portal, and patient interviews.Setting
SNF.Participants
A sample of post-acute patients (n = 237).Measurements
Sociodemographic and health-related variables, time spent using the technology, and 8 items of the Physical Activity Enjoyment Scale (PACES).Results
Average time spent using the technology varied greatly (range, 1–460 minutes). A regression analysis showed that patients who had a longer length of stay (β = .01, P < .05) and were younger (β = ?0.01, P < .05) spent significantly more time using the technology. Acceptability of technology was high among patients. Finally, patients who used the technology had lower 30-day rehospitalization rates.Conclusion
Exercise technology is feasible to use in supporting rehabilitation in patients receiving PAC in a SNF and seems to have beneficial effects. 相似文献6.
Marije S. Holstege Monique A.A. Caljouw Ineke G. Zekveld Romke van Balen Aafke J. de Groot Jolanda C.M. van Haastregt Jos M.G.A. Schols Cees M.P.M. Hertogh Jacobijn Gussekloo Wilco P. Achterberg 《Journal of the American Medical Directors Association》2017,18(5):383-387
Objective
To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay.Design
Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program.Setting/Participants
Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72–85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff).Intervention
National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients’ (care) needs, care coordination, team cooperation, and quality of care.Measurements
Data on patients’ characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index ≥15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke.Results
In the total population, at 1 year postimplementation there was 12% more ADL independence [odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00–2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01–2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09–3.63).Conclusions
This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries. 相似文献7.
Claudia K.Y. Lai Xiaojuan Wan 《Journal of the American Medical Directors Association》2017,18(6):509-514
Objectives
Studies reporting prompted voiding (PV) interventions were of short duration and were delivered by research personnel rather than nursing home staff. This study examined the effectiveness of the use of PV by nursing home staff in managing urinary incontinence among residents over a 6-month period.Design
A randomized controlled trial.Setting
Five nursing homes in Hong Kong.Participants
Data were collected from 52 nursing home residents who had been admitted to the facility for at least 6 months prior to the initiation of the study and whose incontinence had been stable over the 6-month period.Intervention
The PV intervention was delivered by the staff for 6 months. All nursing home staff were trained to ensure that they would be able to correctly deliver the intervention before initiating the intervention. The control group received the usual care.Measurements
Outcomes were defined in terms of wet episodes per day, incontinence rate per day, self-initiated toileting per day, and total continent toileting per day. Data were collected at baseline, 3 months postintervention (T1), and 6 months postintervention (T2).Results
There were significant differences between the two groups in wet episodes per day, incontinence rate per day, and total continent toileting per day at 6 months post-intervention, with positive results found in the intervention group. A decrease of 9.1% was observed in the incontinence rate of the intervention group.Conclusions
PV was shown to have positive effects, although the effects in this study were not as powerful as those found in overseas studies. The intervention delivered by staff was sustainable for a 6-month period. Nursing home operators should promote better continence care through PV, as it is a sustainable noninvasive behavioral intervention that can be mastered by staff with training. 相似文献8.
Shinya Tanaka Kentaro Kamiya Nobuaki Hamazaki Ryota Matsuzawa Kohei Nozaki Emi Maekawa Chiharu Noda Minako Yamaoka-Tojo Atsuhiko Matsunaga Takashi Masuda Junya Ako 《Journal of the American Medical Directors Association》2017,18(2):176-181
Objectives
A simple and inexpensive tool for screening of sarcopenia would be helpful for clinicians. The present study was performed to determine whether the SARC-F questionnaire is useful in screening of patients with cardiovascular disease (CVD) for impaired physical function.Design
Cross-sectional study.Setting
Single university hospital.Participants
A total of 235 Japanese patients ≥65 years old admitted to our hospital for CVD.Measurements
SARC-F, handgrip strength, leg strength, respiratory muscle strength, standing balance, usual gait speed, Short Physical Performance Battery (SPPB) score, and 6-minute walking distance were measured before discharge from hospital. The patients were divided into 2 groups according to SARC-F score: SARC-F < 4 (nonsarcopenia group) and SARC-F ≥ 4 (sarcopenia group).Results
The sarcopenia prevalence rate was 25.5% and increased with age (P trend < .001). The sarcopenia group (SARC-F score ≥ 4) had significantly lower handgrip strength, leg strength, and respiratory muscle strength, poorer standing balance, slower usual gait speed, lower SPPB score, and shorter 6-minute walking distance compared to the nonsarcopenia group (SARC-F score < 4). Patients in the sarcopenia group had consistently poorer physical function even after adjusting for covariates.Conclusion
The SARC-F questionnaire is a useful screening tool for impaired physical function in elderly CVD patients. These findings support the use of the SARC-F for screening in hospital settings. 相似文献9.
Lucas Morin Davide L. Vetrano Giulia Grande Laura Fratiglioni Johan Fastbom Kristina Johnell 《Journal of the American Medical Directors Association》2017,18(6):551.e1-551.e7
Objectives
To investigate the prevalence and factors associated with the use of medications of questionable benefit throughout the final year of life of older adults who died with dementia.Design
Register-based, longitudinal cohort study.Setting
Entire Sweden.Participants
All older adults (≥75 years) who died with dementia between 2007 and 2013 (n = 120,067).Measurements
Exposure to medications of questionable benefit was calculated for each of the last 12 months before death, based on longitudinal data from the Swedish Prescribed Drug Register.Results
The proportion of older adults with dementia who received at least 1 medication of questionable benefit decreased from 38.6% 12 months before death to 34.7% during the final month before death (P < .001 for trend). Among older adults with dementia who used at least 1 medication of questionable benefit 12 months before death, 74.8% remained exposed until their last month of life. Living in an institution was independently associated with a 15% reduction of the likelihood to receive ≥1 medication of questionable benefit during the last month before death (odds ratio 0.85, 95% confidence interval 0.88–0.83). Antidementia drugs accounted for one-fifth of the total number of medications of questionable benefit. Lipid-lowering agents were used by 8.3% of individuals during their final month of life (10.2% of community-dwellers and 6.6% of institutionalized people, P < .001).Conclusion
Clinicians caring for older adults with advanced dementia should be provided with reliable tools to help them reduce the burden of medications of questionable benefit near the end of life. 相似文献10.
Kathleen Abrahamson Jaclyn Myers Arif Nazir 《Journal of the American Medical Directors Association》2017,18(6):539-543
Objectives
The objective of this study was to evaluate the feasibility and impact of implementing a person-centered medical care model for post-acute care residents within a skilled nursing facility (SNF).Design
A mixed-method (qualitative and quantitative) pilot evaluation.Setting
An 89-bed SNF located within a large midwestern city.Participants
Forty SNF post-acute patients admitted to the facility during a 6-month period were enrolled in the pilot evaluation. The patients were 75% women, 57% African American, and had an average age of 73. To meet inclusion criteria, patients must have been admitted to the facility for rehabilitation with a plan for community discharge, and be cognitively able to consent as indicated by a cognitive screening tool or assent to participation with family member consent.Intervention
The person-centered medical care model included (1) biweekly interdisciplinary care plan meetings, scheduled at a time of patients' preference and held in the patient's room; (2) patient selection of health-related goals that guide team discussions; (3) use of lay-language that facilitated patient understanding; (4) team accountability to the patient for patient care preferences; and (5) monthly care-team meetings to exchange feedback regarding the team's performance and the model.Measurement
Evaluation data included admission and discharge Patient Activation Measure surveys; admission and discharge Care of Chronic Conditions surveys; admission and biweekly modified Castle Satisfaction Surveys; admission and discharge Patient and Caregiver Engagement surveys; and semistructured interviews with a sample of staff, family members, and patients.Results
A significant (P < .01) improvement was noted between admission and discharge on both the Care for Chronic Conditions and the Patient Activation Measure surveys. Patient satisfaction surveys trended toward higher ratings over time on most questions, with significant improvement in 2 questions addressing satisfaction with their medical provider. Interviews revealed a perception that the model encouraged an environment of respect and honesty in patient communications, and an overall positive experience. The challenges of scheduling and time were noted by respondents.Conclusions
Implementation of person-centered medical care within an SNF was feasible, yet required changing care processes to better address individual goals and facilitate communication among patients, providers, and SNF staff. Overall pilot results indicated that patients and staff members viewed the person-centered care experience positively. Further research is needed to examine long-term effects of the model on resident outcomes. 相似文献11.
John E. Morley Hidenori Arai Li Cao Birong Dong Reshma A. Merchant Bruno Vellas Renuka Visvanathan Jean Woo 《Journal of the American Medical Directors Association》2017,18(6):489-494
Background
Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric syndromes (frailty, sarcopenia, anorexia of aging, and cognitive decline) will delay or avert the development of disability.Objectives
To identify simple screening programs available for primary health professionals to identify geriatric syndromes.Data sources
PubMed for the last 5 years and study authors.Results
A number of screening programs for early detection of geriatric syndromes have been developed for use by primary care health providers, for example, EasyCare, Gérontopôle Frailty Screening Tool, the Rapid Geriatric Assessment, the Kihon Checklist, and others.Limitations
This is an evolving area with limited information on the outcomes of intervention and possible harms.Conclusion
Validated screening programs exist but more work is required to determine their utility in improving outcomes of older persons. 相似文献12.
Jana Hummel Cecilia Weisbrod Leila Boesch Katharina Himpler Klaus Hauer Martin Hautzinger Andrea Gaebel Tania Zieschang Andrea Fickelscherer Slawomira Diener Ilona Dutzi Bertram Krumm Peter Oster Daniel Kopf 《Journal of the American Medical Directors Association》2017,18(4):341-349
Background
Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression.Objectives
To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness.Design
Randomized controlled trial with waiting list control group.Setting
Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients’ homes.Participants
A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness.Intervention
Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group.Measurements
HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician.Results
The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures.Conclusions
CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients.13.
Nadège Costa Emiel O. Hoogendijk Michael Mounié Robert Bourrel Yves Rolland Bruno Vellas Laurent Molinier Matteo Cesari 《Journal of the American Medical Directors Association》2017,18(5):453.e7-453.e12
Objectives
Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period.Design
This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study.Setting
Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included.Participants
Resident in NH, older than 60 years and had a group iso-resource score ranging from 2 to 5.Measurements
Pneumonia events were characterized according to the Observatoire du Risque Infectieux en Geriatrie criteria. Direct medical and nonmedical costs were assessed from the French health insurance perspective. Healthcare resources was retrospectively gathered from the French Social Health Insurance database and valued using the tariffs reimbursed by the French health insurance. Sociodemographic variables, clinical factors, vaccinations, cognition, depression, functional status, frailty index, as well as group iso-resource score were also recorded.Results
Among the 800 patients initially included in the Incidence of Pneumonia and Related Consequences in Nursing Home Resident study, 345 which were listed in the database of the French Social Health Insurance were included in this economic study. Among them, 64 (18%) experienced at least 1 episode of pneumonia during the 1-year follow-up period. Mean annual total additional cost for a patient who experienced at least 1 episode of pneumonia during the 1 year follow-up period is 2813€. On average, total annual costs increased by 60% to 93% when a patient experienced at least 1 episode of pneumonia.Conclusions
NH-acquired pneumonia has a great impact on total cost of care for NH residents. Our results suggest the potential economic savings that could be achieved if pneumonia could be prevented in NHs. 相似文献14.
Alain Queyroux Bernard Saricassapian Daniel Herzog Karin Müller Isabelle Herafa Dorothée Ducoux Benoît Marin Thierry Dantoine Pierre-Marie Preux Achille Tchalla 《Journal of the American Medical Directors Association》2017,18(6):528-532
Importance
Dental neglect and high levels of unmet dental needs are becoming increasingly prevalent among elderly residents of long-term care facilities, although frail, elderly, and dependent populations are the most in need of professional dental care. Little is known about the validity of teledentistry for diagnosing dental pathology in nursing home residents.Objectives
To evaluate the accuracy of teledentistry for diagnosing dental pathology, assessing the rehabilitation status of dental prostheses, and evaluating the chewing ability of older adults living in nursing homes (using direct examination as a gold standard).Design
Multicenter diagnostic accuracy study performed in France and Germany.Setting
Eight nursing homes in France and Germany.Participants
Nursing home residents with oral or dental complaints, self-reported or reported by caregivers, willing to receive oral or dental preventive care. In total, 235 patients were examined. The mean age was 84.4 ± 8.3 years, and 59.1% of the subjects were female.Intervention
The patients were examined twice. Each patient was his or her own control. First, the dental surgeon established a diagnosis by reviewing a video recorded in the nursing home and accessed remotely. Second, within a maximum of 7 days, patients were examined conventionally (face-to-face) by the same surgeon who established the initial diagnosis.Measurements
All residents received a comprehensive clinical examination in their home by a trained geriatrician and underwent a dental hygiene evaluation that used the Silness-Loe and Greene-Vermillion dental hygiene assessment indices. The diagnoses established via the video recording and in the face-to-face setting were compared. The main outcome measure was number of dental pathologies.Results
In total, 128 (55.4%) patients had a dental pathology. The sensitivity of teledentistry for diagnosing dental pathology was 93.8% (95% confidence interval [CI] 90.7–96.9), and the specificity was 94.2% (95% CI 91.2–97.2). Among the 128 cases of dental pathology identified by teledentistry, 6 (4.8%) were false positives. The teledentistry assessments were quicker than the face-to-to-face examinations (12 and 20 minutes, respectively).Conclusions
Teledentistry showed excellent accuracy for diagnosing dental pathology in older adults living in nursing homes; its use may allow more regular checkups to be carried out by dental professionals. 相似文献15.
Kimberly J. Rask Jennifer Hodge Linda Kluge 《Journal of the American Medical Directors Association》2017,18(11):991.e11-991.e15
Objectives
Identify contextual and implementation factors impacting the effectiveness of an organizational-level intervention to reduce preventable hospital readmissions from affiliated skilled nursing facilities (SNFs).Design
Observational study of the implementation of Interventions to Reduce Acute Care Transfers tools in 3 different cohorts.Setting
SNFs.Participants
SNFs belonging to 1 of 2 corporate entities and a group of independent SNFs that volunteered to participate in a Quality Improvement Organization (QIO) training program.Intervention
Two groups of SNFs received INTERACT II training and technical assistance from corporate staff, and 1 group of SNFs received training from QIO staff.Measurements
Thirty-day acute care hospital readmissions from Medicare fee-for-service claims, contextual factors using the Model for Understanding Success in Quality framework.Results
All 3 cohorts were able to deliver the INTERACT training program to their constituent facilities through regional events as well as onsite technical assistance, but the impact on readmission rates varied. Facilities supported by the QIO and corporation A were able to achieve statistically significant reductions in 30-day readmission rates. A review of contextual factors found that although all cohorts were challenged by staff turnover and workload, corporation B facilities struggled with a less mature quality improvement (QI) culture and infrastructure.Conclusions
Both corporations demonstrated a strong corporate commitment to implementing INTERACT II, but differences in training strategies, QI culture, capacity, and competing pressures may have impacted the effectiveness of the training. Proactively addressing these factors may help long-term care organizations interested in reducing acute care readmission rates increase the likelihood of QI success. 相似文献16.
Judith L. Poey Linda Hermer Laci Cornelison Migette L. Kaup Patrick Drake Robyn I. Stone Gayle Doll 《Journal of the American Medical Directors Association》2017,18(11):974-979
Objective
Person-centered care (PCC) is meant to enhance nursing home residents' quality of life (QOL). Including residents' perspectives is critical to determining whether PCC is meeting residents’ needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents.Design
A longitudinal, retrospective cohort study using an in-person survey.Setting
Three hundred twenty nursing homes in Kansas enrolled or not enrolled in a pay-for-performance program, Promoting Excellent Alternatives in Kansas (PEAK 2.0), to promote PCC in nursing homes.Participants
A total of 6214 nursing home residents in 2013-2014 and 5538 residents in 2014-2015, with a Brief Interview for Mental Status score ≥8, participated in face-to-face interviews. Results were aggregated to the nursing home level.Measurements
My InnerView developed a Resident Satisfaction Survey for Kansas composed of 32 questions divided into QOL, QOC, QOS, and global satisfaction subdomains.Results
After controlling for facility characteristics, satisfaction with overall QOL and QOC was higher in homes that had fully implemented PCC. Although some individual measures in the QOS domain (eg, food) showed greater satisfaction at earlier levels of implementation, high satisfaction was observed primarily in homes that had fully implemented PCC.Conclusion
These findings provide evidence for the effectiveness of PCC implementation on nursing home resident satisfaction. The PEAK 2.0 program may provide replicable methods for nursing homes and states to implement PCC systematically. 相似文献17.
Abebaw Mengistu Yohannes Hana Mülerová Kim Lavoie Jorgen Vestbo Steve I. Rennard Emile Wouters Nicola A. Hanania 《Journal of the American Medical Directors Association》2017,18(11):955-959.e6
Background
Depression increases disability and health care utilization in older patients with chronic obstructive pulmonary disease (COPD).Objectives
To determine contribution of depressive symptoms to the incidence of moderate-severe and severe acute exacerbations of COPD (AECOPD) over 3 years.Design
We analyzed data collected from a prospective cohort of patients with COPD (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; ECLIPSE).Setting
Multicentered outpatient.Participants
A total of 2059 patients with COPD with complete data (63.7% men, mean age 63.4 + 7.1 years).Measurements
Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Moderate-severe AECOPDs were collected; a subset of very severe AECOPD was defined as requiring hospital admission.Results
A total of 540 (26%) patients with COPD reported high depressive symptoms (CES-D ≥16). High depressive symptoms at baseline related to an increased risk of moderate-severe and severe AECOPD during the follow-up (odds ratio [OR] 1.18; 95% confidence interval [CI] 1.07–1.30; for moderate-severe and OR 1.36; 95% CI 1.09–1.69 for severe events risk of hospitalizations) independent of key covariates of an AECOPD history before recruitment in the study, history of gastroesophageal reflux, baseline severity of airflow limitation, and white blood cell count that were also associated with an increased risk of moderate to severe exacerbations (all P < .001).Conclusion
Presence of high depressive symptoms at baseline were associated with subsequent moderate-severe exacerbations and hospital admissions in patients with COPD over 3 years, independent of a history of exacerbations and other demographic and clinical factors. Targeted personalized medicine that focuses both on AECOPD risk and depression may be a step forward to improving prognosis of patients with COPD. 相似文献18.
Laura Saarelainen Anna-Maija Tolppanen Marjaana Koponen Antti Tanskanen Reijo Sund Jari Tiihonen Sirpa Hartikainen Heidi Taipale 《Journal of the American Medical Directors Association》2017,18(1):87.e15-87.e21
Objectives
To investigate the association between benzodiazepine and related drug (BZDR) use and hip fracture as well as postfracture mortality and duration of hospital stay in community-dwellers with and without Alzheimer disease (AD).Design
Retrospective cohort study.Setting
The register-based Medication Use and Alzheimer's disease (MEDALZ) study, including all community-dwelling persons diagnosed with AD in Finland during 2005–2011 (n = 70,718) and their matched comparison persons without AD.Participants
Persons without BZDR use during the year preceding the AD diagnosis or the corresponding matching date as well as persons without history of hip fracture were included in this study.Measurements
We investigated the risk of hip fracture associated with BZDR use compared with nonuse separately in persons with and without AD. Further, we investigated the association between BZDR use during hip fracture and 1-year mortality as well as longer than a 4-month hospital stay after hip fracture. Associations were reported as hazard ratios and odds ratios with 95% confidence intervals (CI).Results
BZDR use was associated with an increased risk of hip fracture in persons with and without AD (adjusted hazard ratio 1.4 [95% CI 1.2–1.7] and 1.6 [95% CI 1.3–1.9], respectively). BZDR use during hip fracture was associated with longer than 4-month postfracture hospital stay in persons with AD [adjusted odds ratio 1.9 (95% CI 1.3–2.8)] but not in comparison persons. One-year mortality was not associated with BZDR use during hip fracture.Conclusions
Higher threshold in prescribing BZDRs for neuropsychiatric symptoms might decrease the hip fracture rate and affect the length of hospital stay in persons with AD. 相似文献19.
Canan Ziylan Annemien Haveman-Nies Stefanie Kremer Lisette C.P.G.M. de Groot 《Journal of the American Medical Directors Association》2017,18(2):145-151
Objectives
Sufficient protein intake can decrease undernutrition risk among community-dwelling older adults. This study aimed to increase community-dwelling older adults' daily protein intake with acceptable and applicable protein-enriched bread and readymade meals at home.Design
Double-blind randomized controlled trial of 2 weeks.Setting
Senior residential center in the Netherlands.Participants
Forty-two community-dwelling elderly residents (≥65 years) participated, with a mean age of 74.0 ± 6.9 years and mean body mass index of 28.5 ± 3.45 kg/m2.Intervention
The intervention group (n = 22) received 5 protein-enriched readymade meals and plentiful protein-enriched bread during 2 weeks, whereas the control group (n = 20) received the regular equivalents during these 2 weeks.Measurements
Food intake was assessed by using dietary food record-assisted 24-hour recalls and by weighing meal leftovers. Acceptability of the enriched products was assessed with product evaluation questionnaires and in-depth interviews.Results
Mean intake of food products (g) and energy (kJ) did not differ significantly between the control and the intervention groups. Total daily protein intake in the intervention group was 14.6 g higher than in the control group (87.7 vs 73.1 g/d, P = .004). Expressed in g/kg body weight per day, protein intake was significantly higher in the intervention group than in the control group (1.25 vs 0.99 g/kg/d, P = .003). The enriched products were equally liked, scoring 7.7 of 10.0. The in-depth interviews with participants indicated high acceptability of the enriched products.Conclusion
This study showed that community-dwelling older adults' protein intake can be increased to recommended levels with highly acceptable and applicable protein-enriched products that fit into the normal eating pattern. Future studies should investigate whether this effect is maintained in the long-term among a frailer population. 相似文献20.
Bram de Boer Jan P.H. Hamers Sandra M.G. Zwakhalen Frans E.S. Tan Hanneke C. Beerens Hilde Verbeek 《Journal of the American Medical Directors Association》2017,18(1):40-46