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Guisado-Clavero M, Ares-Blanco S, Serafini A, Del Rio LR, Larrondo IG, Fitzgerald L, Vinker S, van Pottebergh G, Valtonen K, Vaes B, Yilmaz CT, Torzsa P, Tilli P, Sentker T, Seifert B, Saurek-Aleksandrovska N, Sattler M, Petricek G, Petrazzuoli F, Petek D, Perjés Á, López NP, Neves AL, Murauskienė L, Lingner H, Nessler K, Heleno B, Krztoń-Królewiecka A, Kostić M, Korkmaz BÇ, Knežević S, Kirkovski A, Karathanos VT, Jandrić-Kočić M, Ivanna S, Ільков О, Hoffmann K, Hanževački M, Gómez-Johansson M, Gjorgjievski D, Domeyer PRJ, Peña MD, Divjak AĆ, Busneag IC, Brutskaya-Stempkovskaya E, Bayen S, Bakola M, Adler L, Assenova R, Astier-Peña MP, Gómez Bravo R. The role of primary health care in long-term care facilities during the COVID-19 pandemic in 30 European countries: a retrospective descriptive study (Eurodata study). Prim Health Care Res Dev 2023; 24:e60. [PMID: 37873623 PMCID: PMC10594530 DOI: 10.1017/s1463423623000312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/31/2022] [Accepted: 05/25/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND AND AIM Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic. METHODS Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care. RESULTS Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom's follow-up was performed mainly by PHC. CONCLUSION PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.
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Affiliation(s)
- Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary Health Care and
Community North Area of Madrid, Madrid,
Spain
| | - Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial
Atención Primaria, Servicio Madrileño de Salud, Madrid,
Spain; Instituto de Investigación Sanitaria Gregorio
Marañón, Madrid, Spain
| | - Alice Serafini
- Azienda Unità Sanitaria Locale di Modena; Laboratorio EduCare,
University of Modena and Reggio Emilia,
Italy
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de
Atención Primaria, Servicio Madrileño de Salud, Madrid,
Spain
| | - Ileana Gefaell Larrondo
- Federica Montseny Health Centre, Gerencia Asistencial de
Atención Primaria, Servicio Madrileño de Salud, Madrid,
Spain
| | - Louise Fitzgerald
- Member of Irish College of General Practice (MICGP), Member
of Royal College of Physician (MRCSI), Ireland
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine,
Tel Aviv University, Tel Aviv,
Israel; WONCA Europe President
| | - Gijs van Pottebergh
- Department of Public Health and Primary Health Care, KU
Leuven, Leuven, Belgium
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, City of
Vantaa and University of Helsinki, Helsinki,
Finland
| | - Bert Vaes
- Department of Public Health and Primary Health Care, KU
Leuven, Leuven, Belgium
| | - Canan Tuz Yilmaz
- Lecturer, Bursa Uludağ University, Family
Medicine Department, Turkey
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis
University, Hungary
| | - Paula Tilli
- Communicable Diseases and Infection Control Unit, City of
Vantaa and University of Helsinki, Helsinki,
Finland
| | | | - Bohumil Seifert
- Charles University, First Faculty of Medicine, Institute of
General Practice, Czech Republic
| | | | | | - Goranka Petricek
- Department of Family Medicine “Andrija Stampar” School of Public Health,
School of Medicine, University of Zagreb,
Croatia; Health Centre Zagreb West, Croatia
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care
Research, Lund University, Malmö,
Sweden
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine,
University of Ljubljana, Slovenia;
Chairperson of EGPRN
| | - Ábel Perjés
- Department of Family Medicine, University of
Semmelweis, Budapest, Hungary
| | - Naldy Parodi López
- Närhälsan Kungshöjd Health Centre, Gothenburg,
Sweden; Department of Pharmacology, Sahlgrenska Academy,
University of Gothenburg, Gothenburg,
Sweden
| | - Ana Luisa Neves
- Imperial College London, United Kingdom;
Faculty of Medicine, University of Porto,
Portugal
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of
Medicine, Vilnius University, Lithuania
| | - Heidrun Lingner
- Medizinische Hochschule Hannover, OE 5430, Carl Neuberg Str. 1,
30625Hannover, Germany
| | - Katarzyna Nessler
- Department of Family Medicine, UJCM at Uniwersytet
Jagielloński – Collegium Medicum, Poland
| | - Bruno Heleno
- Comprehensive Health Research Center, NOVA Medical School,
Universidade Nova de Lisboa; USF das Conchas,
Regional Health Administration Lisbon and Tagus Valley, Lisbon,
Portugal
| | | | - Milena Kostić
- Health Center “Dr Đorđe Kovačević”, Lazarevac,
Belgrade, Serbia
| | | | | | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius
University, Skopje, North Macedonia
| | - Vasilis Trifon Karathanos
- Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of
Health Sciences, University of Ioannina-Greece; Family Doctor,
GHS, Larnaca, Cyprus
| | | | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care,
UZHNU, Medical Faculty 2, Ukraine
| | - Оксана Ільков
- Department of Family Medicine and Outpatient Care, Medical Faculty 2,
Uzhhorod National University, Ukraine
| | - Kathryn Hoffmann
- Associate Professor and Medical Doctor for General Practice and Primary
Care, Medical University of Vienna, Austria
| | - Miroslav Hanževački
- Department of Family Medicine “Andrija Stampar” School of Public Health,
School of Medicine, University of Zagreb,
Croatia; Health Centre Zagreb West, Croatia
| | | | | | | | | | | | - Iliana-Carmen Busneag
- “Spiru Haret” University, Practising Family Doctor, Occupational
Health Expert, Bucharest, Romania
| | | | - Sabine Bayen
- Department of General Practice, University of Lille,
UFR3S, France
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of
Medicine, School of Health Science, University of Ioannina,
Ioannina, Greece
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine,
Tel Aviv University, Tel Aviv,
Israel
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine,
Medical University of Plovdiv, Bulgaria
| | - María Pilar Astier-Peña
- Healthcare Quality Technical Assistant, Territorial Quality Unit, Camp de
Tarragona Healthcare Directorate, Catalan Institute of Health,
Catalonia Government, Spain; Semfyc, Wonca World Executive Board,
University of Zaragoza, GIBA IIS Aragon,
Spain
| | - Raquel Gómez Bravo
- Centre Hospitalier Neuro-Psychiatrique, CHNP,
Rehaklinik, Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health; Institute for Health and
Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities,
Education, and Social Sciences, Luxembourg University,
Luxembourg
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Which Nursing Home Residents With Pneumonia Are Managed On-Site and Which Are Hospitalized? Results from 2 Years' Surveillance in 14 US Homes. J Am Med Dir Assoc 2020; 21:1862-1868.e3. [PMID: 32873473 DOI: 10.1016/j.jamda.2020.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Pneumonia is a frequent cause of hospitalization among nursing home (NH) residents, but little information is available as to how clinical presentation and other characteristics relate to hospitalization, and the differential use of antimicrobials based on hospitalization status. This study examined how hospitalized and nonhospitalized NH residents with pneumonia differ. DESIGN Data from a 2-year prospective study of residents who participated in a randomized controlled trial. SETTING AND PARTICIPANTS All residents from 14 NHs in North Carolina followed for pneumonia over a 2-year period. METHODS Clinical features, antimicrobial treatment, hospitalization, and demographic data on residents with a pneumonia diagnosis were abstracted from charts; NH information was obtained from NH administrators. RESULTS A total of 509 pneumonia episodes were reported for 395 unique residents; the incidence was not higher in the winter months, and 28% were hospitalized. The likelihood of hospitalization did not differ by clinical characteristics except that residents with a respiratory rate >25 breaths per minute were more likely to be hospitalized. Being on hospice [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.5-7.4] and not having dementia (OR 1.9, 95% CI 1.1-3.2) also related to increased likelihood of hospitalization. Fluoroquinolone (usually levofloxacin) monotherapy was the most common treatment (54%) in both settings, and ceftriaxone monotherapy varied by hospitalization status (7% of hospitalized vs 16% treated on-site). Approximately 36% of nonhospitalized residents received antimicrobials for more than 7 days. CONCLUSIONS/IMPLICATIONS Respiratory rate is associated with hospitalization but was not documented for more than a quarter of residents, suggesting the clinical benefit of more consistently conducting this assessment. Differential hospitalization rates for persons with dementia and on hospice suggest that care is being tailored to individuals' wishes, but this assumption merits study, as does use of fluoroquinolones (due to side effects) and treatment duration (due to potential contribution to antibiotic resistance).
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Russo A, Picciarella A, Russo R, Sabetta F. Clinical features, therapy and outcome of patients hospitalized or not for nursing-home acquired pneumonia. J Infect Chemother 2020; 26:807-812. [PMID: 32273175 DOI: 10.1016/j.jiac.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/24/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND nursing home-acquired pneumonia (NHAP), is among the main causes of hospitalization and mortality of frail elderly patients. Aim of this study was analysis of patients residing in long-term care facilities (LTCF) and developing pneumonia to reach a better knowledge of criteria for hospitalization and outcomes. MATERIALS/METHODS this is a prospective, observational study in which patients residing in 3 LTCFs (metropolitan area of Rome, Italy) and developing pneumonia, hospitalized or treated in LTCF, were recruited and followed up from January 2017 to June 2019. Primary endpoint was 30-day mortality, secondary endpoint was analysis of risk factors associated with hospitalization. RESULTS Overall, 146 episodes of NHAP were enrolled in the study: 57 patients were treated in LTCF, while 89 patients were hospitalized. Overall incidence rates of NHAP varied from 2.6 to 7.5 per 1000 residents. Methicillin-resistant Staphylococcus aureus was the most frequently isolated pathogen (25%), and in 28 (55%) patients was documented a MDR pathogen. For hospitalized patients was reported a higher 30-day mortality (43.8% Vs 7%, p < 0.001). Multivariate analysis showed that severe pneumonia, neoplasm, chronic hepatitis, antibiotic monotherapy, and malnutrition were independent risk factors for hospitalization from LTCF. MDR pathogen, severe pneumonia, COPD, and moderate to severe renal disease were independently associated with death at 30 days. CONCLUSION frail elderly patients in LTCF have a high risk of MDR etiology with a higher risk to receive an inadequate antibiotic therapy and a fatal outcome. These results point to the need for increased provision of acute care and strategies in LTCF.
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Affiliation(s)
| | | | - Roberta Russo
- Internal Medicine Unit, Policlinico Casilino, Rome, Italy
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Arai Y, Suzuki T, Jeong S, Inoue Y, Fukuchi M, Kosaka Y, Nagashima K, Ohta H. Effectiveness of home care for fever treatment in older people: A case-control study compared with hospitalized care. Geriatr Gerontol Int 2020; 20:482-487. [PMID: 32212207 DOI: 10.1111/ggi.13909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
Abstract
AIM To examine whether the outcomes of fever treatment through home care differ from those through hospitalized care for older people who regularly receive home care in Japan. METHODS A retrospective survey of medical record-based data for 679 older people who regularly received home care provided by a clinic in Japan. From these data, 61 fever cases (21 cases treated in the hospital and 40 treated at home and assigned to the hospitalized and home-care groups, respectively) were selected for analysis through a matching process. We compared the two groups in terms of mortality rate at 90 days after fever onset, and concerning changes in respective ranks for "Degree of Independent Living for the Elderly with Disability" and "Degree of Independent Living for the Elderly with Dementia" from immediately before fever onset to 90 days after fever onset. RESULTS The mortality rate tended to be higher in the hospitalized group than in the home-care group (33% vs. 13%, respectively, P = 0.05). The hospitalized group also had a higher proportion of patients whose disability had worsened (43% vs. 23%, respectively, P = 0.16) and a significantly higher proportion of patients whose dementia had worsened (29% vs. 6%, respectively, P = 0.03). CONCLUSIONS Our findings suggest that home care is more effective than hospitalized care for treating fever in older people who regularly receive home care in Japan, as it leads to lower mortality and better maintenance of activities of daily living capabilities. Geriatr Gerontol Int 2020; 20: 482-487.
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Affiliation(s)
| | - Takao Suzuki
- Institute for Gerontology, J. F. Oberlin University, Machida, Japan
| | - Seungwon Jeong
- Department of Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yusuke Inoue
- Faculty of Health and Welfare Science, Okayama Prefectural University, Sōja, Japan
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Baughman KR, Ludwick R, Jarjoura D, Kropp D, Shenoy V. Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments. THE GERONTOLOGIST 2019; 59:338-346. [PMID: 28958015 DOI: 10.1093/geront/gnx129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/28/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. We examined the professional judgments of SNF providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed and feelings of responsibility for ensuring ACP discussions. RESEARCH DESIGN AND METHODS Nurses and social workers (n = 350) within 29 urban SNFs completed surveys and rated vignettes describing eight typical SNF residents. Linear mixed modeling was used to examine factors that impacted ratings of need for ACP and responsibility for ensuring ACP. RESULTS Neither the race of the provider, resident, nor the interaction of the two were associated with either outcome variable. In contrast, providers rated (on a 9-point scale) residents at high risk for hospitalization as more in need of ACP (estimate = 0.86, confidence interval [CI] 0.65, 1.07) and felt more responsible for ensuring ACP (estimate = 0.60, CI 0.42, 0.78). DISCUSSION AND IMPLICATIONS Research on ACP is continuing to evolve and these results show the primacy of disease trajectory variables on providers' judgments about ACP. Differences between providers indicate a need for stronger policies and education. Further, research comparing rural, suburban, and urban SNFs is needed to explore possible forms of structural racism such as residential and SNF segregation.
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Affiliation(s)
- Kristin R Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown
| | - Ruth Ludwick
- Nursing Administration, University Hospitals Portage Medical Center Ravenna, Ohio
- College of Nursing, Kent State University, Ohio
| | | | - Denise Kropp
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown
| | - Vimal Shenoy
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown
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The decision-making process for unplanned admission to hospital unveiled in hospitalised older adults: a qualitative study. BMC Geriatr 2018; 18:318. [PMID: 30577791 PMCID: PMC6303984 DOI: 10.1186/s12877-018-1013-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The hazards of hospitalisation, and the growing demand for goal-oriented care and shared decision making, increasingly question whether hospitalisation always aligns with the preferences and needs of older adults. Although decision models are described comprehensively in the literature, little is understood about how the decision for hospitalisation is made in real life situations, especially under acute conditions. The aim of this qualitative study was to gain insight into how the decision to hospitalise was made from the perspective of the older patient who was unplanned admitted to hospital. METHODS Open interviews were conducted with 21 older hospitalised patients and/or their next of kin about the decision-making process leading to hospitalisation. Data were analysed according to the Constructivist Grounded Theory approach. RESULTS Although a period of complaints preceded the decision to unplanned hospitalisation, ranging from hours to years, the decision to hospitalise was always taken acutely. In all cases, there was an acute moment in which the home as a care environment was no longer considered adequate. This conclusion was based on a combination of factors including factors related to complaints, general practitioner and home environment. Three parties were involved in this assessment: the patient, his next of kin and the general practitioner. At the same time, a very positive value was attributed towards the hospital. Depending on the assessment of the home as care environment by the various parties, there were four routes to hospitalisation: referral, shared, demanding and bypassing. CONCLUSIONS For all participants, the decision to hospitalisation was taken acutely, even if the problems evoking admission were not acute, but present for a longer period. Participants saw admission as inevitable, due to the negative perceptions of the care environment at home at that moment, combined with the positive expectations of hospital care. Advance care planning, nor shared decision making were rarely seen in these interviews. An ethical dilemma occurred when the next of kin consented to hospitalisation against the wishes of the patient. More attention for participation of older adults in decision making and their goals is recommended.
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Cai S, Miller SC, Gozalo PL. Nursing Home-Hospice Collaboration and End-of-Life Hospitalizations Among Dying Nursing Home Residents. J Am Med Dir Assoc 2017; 19:439-443. [PMID: 29191764 DOI: 10.1016/j.jamda.2017.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Nursing homes (NHs) collaboration with hospices appears to improve end-of-life (EOL) care among dying NH residents. However, the potential benefits of NH-hospice collaboration may vary with the patterns of this collaboration. This study examines the relationship between the attributes of NH-hospice collaboration, especially the exclusivity of NH-hospice collaboration (ie, the number of hospice providers in a NH), and EOL hospitalizations among dying NH residents. DESIGN This national retrospective cohort study linked 2000-2009 NH assessments (ie, the Minimum Data Set 2.0) and Medicare data. A linear probability model with facility fixed-effects was estimated to examine the relationship between EOL hospitalization and the attributes of NH-hospice collaborations, adjusting for individual and facility characteristics. We also performed a set of sensitivity analyses, including stratified analyses by volume of hospice services in a NH and stratified analyses by rural vs urban NH locations. SETTINGS All Medicare and/or Medicaid certified US NHs with at least 8 years of data and at least 30 beds. PARTICIPANTS NH decedents resided in Medicare and/or Medicaid certified NHs in the US between 2000 and 2009. We restricted the analyses to those continuously enrolled in Medicare fee-for-service in the last 6 months of life and those who were in NHs for the last 30 days of life. In total, we identified 2,954,276 NH decedents over the study period. MEASUREMENTS The outcome variable was measured as dichotomous, indicating whether a dying NH resident was hospitalized in the last 30 days of life. The attributes of NH-hospice collaboration were measured by the volume of hospice services (defined as the ratio of number of hospice days to the total NH days per NH per calendar year) and the number of hospice providers in a NH (defined as the number of unique hospice providers in a NH per year). We categorized NHs into groups based on the number of hospice providers (1, 2 or 3, and ≥4) in the NH, and conducted sensitivity analysis using a different categorization (1, 2, and 3+ hospice providers). RESULTS The pattern of NH-hospice collaboration changed significantly over years; the average number of hospices in a NH increased from 1.4 in 2000 to 3.2 in 2009. The volume of NH-hospice collaboration also increased substantially. The multivariate regression analyses indicated that having more hospice providers in the NH was not associated with lower risks of EOL hospitalizations. After accounting for individual and facility characteristics, increasing hospice providers from 1 to at least 4 was associated with an overall 1 percentage point increase in the likelihood of EOL hospitalizations among dying residents (P < .01), and such relationship remained in NHs with moderate or high volume NHs in the stratified analyses. Stratified analysis by rural vs urban NHs suggested that the relationship between the number of hospice providers and EOL hospitalizations was mainly in urban NHs. CONCLUSIONS More hospice providers in the NH was not associated with lower EOL hospitalizations, especially among NHs with relatively high volume of hospice services.
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Affiliation(s)
- Shubing Cai
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY.
| | - Susan C Miller
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI
| | - Pedro L Gozalo
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI; Providence Veterans Affairs Medical Center, Providence, RI
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Kovach CR, Taneli Y, Neiman T, Dyer EM, Arzaga AJA, Kelber ST. Evaluation of an ultraviolet room disinfection protocol to decrease nursing home microbial burden, infection and hospitalization rates. BMC Infect Dis 2017; 17:186. [PMID: 28253849 PMCID: PMC5335784 DOI: 10.1186/s12879-017-2275-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/21/2017] [Indexed: 12/30/2022] Open
Abstract
Background The focus of nursing home infection control procedures has been on decreasing transmission between healthcare workers and residents. Less evidence is available regarding whether decontamination of high-touch environmental surfaces impacts infection rates or resident outcomes. The purpose of this study was to examine if ultraviolet disinfection is associated with changes in: 1) microbial counts and adenosine triphosphate counts on high-touch surfaces; and 2) facility wide nursing home acquired infection rates, and infection-related hospitalization. Methods The study was conducted in one 160-bed long-term care facility. Following discharge of each resident, their room was cleaned and then disinfected using a newly acquired ultraviolet light disinfection device. Shared living spaces received weekly ultraviolet light disinfection. Thirty-six months of pretest infection and hospitalization data were compared with 12 months of posttest data. Pre and posttest cultures were taken from high-touch surfaces, and luminometer readings of adenosine triphosphate were done. Nursing home acquired infection rates were analyzed relative to hospital acquired infection rates using analysis of variance procedures. Wilcoxon signed rank tests, The Cochran’s Q, and Chi Square were also used. Results There were statistically significant decreases in adenosine triphosphate readings on all high-touch surfaces after cleaning and disinfection. Culture results were positive for gram-positive cocci or rods on 33% (n = 30) of the 90 surfaces swabbed at baseline. After disinfectant cleaning, 6 of 90 samples (7.1%) tested positive for a gram-positive bacilli, and after ultraviolet disinfection 4 of the 90 samples (4.4%) were positive. There were significant decreases in nursing home acquired relative to hospital-acquired infection rates for the total infections (p = .004), urinary tract infection rates (p = .014), respiratory system infection rates (p = .017) and for rates of infection of the skin and soft tissues (p = .014). Hospitalizations for infection decreased significantly, with a notable decrease in hospitalization for pneumonia (p = .006). Conclusions This study provides evidence that the pulsed-xenon ultraviolet disinfection device is superior to manual cleaning alone for decreasing microbes on environmental surfaces, as well as decreasing infection rates, and the rates of hospitalization for infection. Results suggest that placing a stronger emphasis on environmental surface disinfection in long-term care facilities may decrease nursing home acquired infections.
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Affiliation(s)
- Christine R Kovach
- University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 5321, USA.
| | - Yavuz Taneli
- Department of Architecture, Uludag University, 16059 Görükle, Bursa, Turkey
| | - Tammy Neiman
- University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 5321, USA
| | - Elaine M Dyer
- Jewish Home and Care Center, 1414 N. Propect Avenue, Milwaukee, WI, 53202, USA
| | | | - Sheryl T Kelber
- University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 5321, USA
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Burkett E, Martin-Khan MG, Scott J, Samanta M, Gray LC. Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change. AUST HEALTH REV 2017; 41:246-253. [DOI: 10.1071/ah15165] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/23/2016] [Indexed: 11/23/2022]
Abstract
Objectives
The aim of the present study was to describe trends in and age and gender distributions of presentations of older people to Australian emergency departments (EDs) from July 2006 to June 2011, and to develop ED utilisation projections to 2050.
Methods
A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess trends in ED presentations. Three standard Australian Bureau of Statistics population growth models, with and without adjustment for current trends in ED presentation growth and effects of climate change, were examined with projections of ED presentations across three age groups (0–64, 65–84 and ≥85 years) to 2050.
Results
From 2006–07 to 2010–11, ED presentations increased by 12.63%, whereas the Australian population over this time increased by only 7.26%. Rates of presentation per head of population were greatest among those aged ≥85 years. Projections of ED presentations to 2050 revealed that overall ED presentations are forecast to increase markedly, with the rate of increase being most marked for older people.
Conclusion
Growth in Australian ED presentations from 2006–07 to 2010–11 was greater than that expected from population growth alone. The predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people.
What is known about the topic?
Rapid population aging is anticipated over coming decades. International studies and specific local-level Australian studies have demonstrated significant growth in ED presentations. There have been no prior national-level Australian studies of ED presentation trends by age group.
What does this paper add?
The present study examined national ED presentation trends from July 2006 to June 2011, with specific emphasis on trends in presentation by age group. ED presentation growth was found to exceed population growth in all age groups. The rate of ED presentations per head of population was highest among those aged ≥85 years. ED utilisation projections to 2050, using standard Australian Bureau of Statistics population modelling, with and without adjustment for current ED growth, were developed. The projections demonstrated linear growth in ED presentation for those aged 0–84 years, with growth in ED presentations of the ≥85 year age group demonstrating marked acceleration after 2030.
What are the implications for practitioners?
Growth in ED presentations exceeding population growth suggests that current models of acute health care delivery require review to ensure that optimal care is delivered in the most fiscally efficient manner. Trends in presentation of older people emphasise the imperative for ED workforce planning and education in care of this complex patient cohort, and the requirement to review funding models to incentivise investment in ED avoidance and substitutive care models targeting older people.
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Ronald LA, McGregor MJ, Harrington C, Pollock A, Lexchin J. Observational Evidence of For-Profit Delivery and Inferior Nursing Home Care: When Is There Enough Evidence for Policy Change? PLoS Med 2016; 13:e1001995. [PMID: 27093442 PMCID: PMC4836753 DOI: 10.1371/journal.pmed.1001995] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Margaret McGregor and colleagues consider Bradford Hill's framework for examining causation in observational research for the association between nursing home care quality and for-profit ownership.
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Affiliation(s)
- Lisa A. Ronald
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margaret J. McGregor
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Charlene Harrington
- School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Allyson Pollock
- Queen Mary, University of London, London, United Kingdom
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Joel Lexchin
- School of Health Policy and Management at York University, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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12
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Bohnet-Joschko S, Zippel C. Cost and care models for acutely ill nursing home residents in Germany: the example of pneumonia. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-015-0706-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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A Critical Review of Research on Hospitalization from Nursing Homes; What is Missing? AGEING INTERNATIONAL 2015. [DOI: 10.1007/s12126-015-9232-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVES To examine the association between payer status (Medicaid vs. private-pay) and the risk of hospitalizations among long-term stay nursing home (NH) residents who reside in the same facility. DATA AND STUDY POPULATION The 2007-2010 National Medicare Claims and the Minimum Data Set were linked. We identified newly admitted NH residents who became long-stayers and then followed them for 180 days. ANALYSES Three dichotomous outcomes-all-cause, discretionary, and nondiscretionary hospitalizations during the follow-up period-were defined. Linear probability model with facility fixed-effects and robust SEs were used to examine the within-facility difference in hospitalizations between Medicaid and private-pay residents. A set of sensitivity analyses were performed to examine the robustness of the findings. RESULTS The prevalence of all-cause hospitalization during a 180-day follow-up period was 23.3% among Medicaid residents compared with 21.6% among private-pay residents. After accounting for individual characteristics and facility effects, the probability of any all-cause hospitalization was 1.8-percentage point (P<0.01) higher for Medicaid residents than for private-pay residents within the same facility. We also found that Medicaid residents were more likely to be hospitalized for discretionary conditions (5% increase in the likelihood of discretionary hospitalizations), but not for nondiscretionary conditions. The findings from the sensitivity analyses were consistent with the main analyses. CONCLUSIONS We observed a higher hospitalization rate among Medicaid NH residents than private-pay residents. The difference is in part driven by the financial incentives NHs have to hospitalize Medicaid residents.
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Fan CW, Keating T, Brazil E, Power D, Duggan J. Impact of season, weekends and bank holidays on emergency department transfers of nursing home residents. Ir J Med Sci 2015; 185:655-661. [DOI: 10.1007/s11845-015-1332-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
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Stokoe A, Hullick C, Higgins I, Hewitt J, Armitage D, O'Dea I. Caring for acutely unwell older residents in residential aged-care facilities: Perspectives of staff and general practitioners. Australas J Ageing 2015; 35:127-32. [DOI: 10.1111/ajag.12221] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Amy Stokoe
- Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Carolyn Hullick
- Division of Emergency Medicine; John Hunter Hospital Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Isabel Higgins
- School of Nursing and Midwifery; Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
- Centre for Practice Opportunity and Development; Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Jacqueline Hewitt
- Emergency Department; John Hunter Hospital; Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Deborah Armitage
- Older Person Acute Care; Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Ian O'Dea
- Older Persons Journey; Community Health Strategy; Hunter New England Local Health District; Newcastle New South Wales Australia
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Ouslander JG, Schnelle JF, Han J. Is This Really an Emergency? Reducing Potentially Preventable Emergency Department Visits Among Nursing Home Residents. J Am Med Dir Assoc 2015; 16:354-7. [DOI: 10.1016/j.jamda.2015.01.096] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 11/28/2022]
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18
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Lim CJ, Kong DCM, Stuart RL. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. Clin Interv Aging 2014; 9:165-77. [PMID: 24477218 PMCID: PMC3894957 DOI: 10.2147/cia.s46058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS) programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions.
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Affiliation(s)
- Ching Jou Lim
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - David C M Kong
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Rhonda L Stuart
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia ; Department of Medicine, Monash University, Clayton, VIC, Australia
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Arendts G, Quine S, Howard K. Decision to transfer to an emergency department from residential aged care: A systematic review of qualitative research. Geriatr Gerontol Int 2013; 13:825-33. [DOI: 10.1111/ggi.12053] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Susan Quine
- School of Public Health; University of Sydney; Sydney; New South Wales; Australia
| | - Kirsten Howard
- School of Public Health; University of Sydney; Sydney; New South Wales; Australia
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Alrawi YA, Parker RA, Harvey RC, Sultanzadeh SJ, Patel J, Mallinson R, Potter JF, Trepte NJB, Myint PK. Predictors of early mortality among hospitalized nursing home residents. QJM 2013; 106:51-7. [PMID: 23064829 DOI: 10.1093/qjmed/hcs188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Emergency admissions from nursing homes (NHs) are associated with high mortality. Understanding the predictors of early mortality in these patients may guide clinicians in choosing appropriate site and level of care. METHODS We identified all consecutive admissions from NHs (all ages) to an Acute Medical Assessment Unit between January 2005 and December 2007. Analysis was performed at the level of the admission. The predictors of in-patient mortality at 7 days were examined using a generalized estimating equations analysis. RESULTS A total of 314 patients [32% male, mean age: 84.2 years (SD: 8.3 years)] were admitted during the study period constituting 410 emergency episodes. Twenty-three percent of admissions resulted in hospital mortality with 73% of deaths occurring within 1 week (50% within the first 3 days). For 7-day mortality outcome, patients with a modified early warning score (MEWS) of 4-5 on admission had 12 times the odds of death [95% confidence interval (CI) 1.40-103.56], whereas those with a score of ≥6 had 21 times the odds of death (95% CI 2.71-170.57) compared with those with a score of ≤1. An estimated glomerular filtration rate (eGFR) of 30-60 and <30 ml/min/m(2) was associated with nearly a 3-fold increase in the odds of death at 1 week (95% CI 1.10-7.97) and a 5-fold increase in the odds of death within 1 week (95% CI 1.75-14.96), respectively, compared with eGFR > 60 ml/min/m(2). C-reactive protein (CRP) >100 mg/l on admission was also associated with a 2.5 times higher odds of death (95% CI 1.23-4.95). Taking eight or more different medication items per day was associated with only a third of the odds of death (95% CI 0.09-0.98) compared with patients taking only three or fewer per day. CONCLUSION In acutely ill NH residents, MEWS is an important predictor of early hospital mortality and can be used in both the community and the hospital settings to identify patients whose death maybe predictable or unavoidable, thus allowing a more holistic approach to management with discussion with patient and relatives for planning of immediate care. In addition, CRP and eGFR levels on admission have also been shown to predict early hospital mortality in these patients and can be used in conjunction with MEWS in the same way to allow decision making on the appropriate level of care at the point of hospital admission.
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Affiliation(s)
- Y A Alrawi
- Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
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21
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Lau L, Chong CP, Lim WK. Hospital treatment in residential care facilities is a viable alternative to hospital admission for selected patients. Geriatr Gerontol Int 2012; 13:378-83. [PMID: 22804780 DOI: 10.1111/j.1447-0594.2012.00910.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine if hospital treatment in residential care facilities, led by a geriatric team, might be a viable alternative to inpatient admission for selected patients. METHODS Case series with a new intervention were compared with historical controls receiving the conventional treatment. Treatment in residential care facilities (TRC) by the Residential Care Intervention Program in The Elderly (RECIPE) service was compared against the conventional treatment group, aged care unit (ACU) inpatients. RESULTS A total of 95 patients in TRC and 167 patients in ACU were included. The mean Charlson Comorbidity Index score was 7 in both groups and demographics were similar, except more patients in the TRC group had dementia. Palliative care support was provided to 35.8% in the TRC group, compared with 7.8% in ACU, P < 0.001. Six-month mortality rates were similar at 30% for both groups. Rehospitalization rates at 6 months were similar at 41% for both groups. Length of care was significantly shorter for TRC (mean 2 days) compared with ACU (mean 11 days), P < 0.001. CONCLUSIONS Hospital treatment in residential care is viable for most patients, including those with dementia and those who need palliative care support. This model of care offers a valuable geriatric service to residents who would prefer to avoid hospital transfers, with no difference in mortality or rehospitalization rates for those treated in residential care, but a significant reduction in length of care.
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Affiliation(s)
- Liza Lau
- Department of Aged Care, The Northern Clinical Research Centre, The University of Melbourne, Melbourne, Victoria, Australia
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22
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Management of Health-Care Associated Pneumonia (HCAP). ITALIAN JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.itjm.2011.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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23
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Dombrowski W, Yoos JL, Neufeld R, Tarshish CY. Factors predicting rehospitalization of elderly patients in a postacute skilled nursing facility rehabilitation program. Arch Phys Med Rehabil 2012; 93:1808-13. [PMID: 22555006 DOI: 10.1016/j.apmr.2012.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 03/31/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine potential risk factors for rehospitalization of skilled nursing facility (SNF) rehabilitation patients. DESIGN Retrospective review of rehabilitation charts. SETTING SNF rehabilitation beds (n=114) at a 514-bed urban, academic nursing home that receives patients from tertiary care hospitals. PARTICIPANTS Consecutive rehabilitation patients (n=50) who were rehospitalized during days 4 to 30 of rehabilitation, compared with a matched group of rehabilitation patients (n=50) who were discharged without rehospitalization. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Data on potential risk factors were collected: demographics, medical history, conditions associated with preceding hospitalization, and initial rehabilitation examination and laboratory values. The clinical conditions precipitating rehospitalizations were noted. RESULTS Sixty-two percent of rehospitalizations were related to complications or recurrence of the same medical condition that was treated during the preceding hospitalization. The rehospitalized group had significantly more comorbidities including anemia (P=.001) and malignant solid tumors (P<.001), index hospitalizations involving a gastrointestinal condition (P=.001), needed more assistance with eating (P=.001) and walking (P=.03), and had lower hemoglobin (P=.002) and albumin levels (P<.001). A logistic regression model found that the strongest predictors for rehospitalization are a history of a malignant solid tumor (odds ratio [OR]=10.10), a recent hospitalization involving gastrointestinal conditions (OR=4.62), and a low serum albumin level (with each unit decrease in albumin, the odds of rehospitalization are 4 times greater [OR=.24, P=.005]). CONCLUSIONS Comorbid conditions, reasons for index hospitalization, and laboratory values are associated with an increased risk for rehospitalization. Further studies are needed to identify high-risk elderly patients and target interventions to minimize rehospitalizations.
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Affiliation(s)
- Wen Dombrowski
- Department of Medical Affairs, Jewish Home Lifecare, New York, NY, USA
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24
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Predictors of Hospitalization in Italian Nursing Home Residents: The U.L.I.S.S.E. Project. J Am Med Dir Assoc 2012; 13:84.e5-10. [DOI: 10.1016/j.jamda.2011.04.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 04/01/2011] [Accepted: 04/01/2011] [Indexed: 11/20/2022]
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Eklund K, Klefsgård R, Ivarsson B, Geijer M. Positive experience of a mobile radiography service in nursing homes. Gerontology 2011; 58:107-11. [PMID: 21860216 DOI: 10.1159/000329452] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 05/19/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For elderly people living in nursing homes, a transport to hospital for a radiological examination can lead to increased anxiety, disorientation and other problems related to the new environment. OBJECTIVE To investigate the usefulness of a mobile radiography service for radiological assessment of patients in nursing homes from the patient and staff perspectives. METHODS Lightweight equipment with a digital flat-panel detector was used for mobile radiography on nursing home patients in their own rooms. Data on patient and staff experiences from the service were collected using a questionnaire with closed and open-ended questions. Image quality was evaluated by the radiographer and a radiologist. RESULTS The majority of 241 radiography examinations were of the musculoskeletal system (94%). Twelve of 123 patients had pathology that required hospital treatment, while 22 patients with radiographic pathology could be treated locally. The main beneficial factors were security and comfort, acceptance from the patients, no need for transportation, no need for staff to be absent from the nursing homes. CONCLUSION Mobile radiography in nursing homes is technically feasible, with good image quality. The most beneficial results were that patients avoided unnecessary transport back and forth to the hospital, and that the majority of patients could be treated locally.
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Affiliation(s)
- Karin Eklund
- Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
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26
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Kada O, Brunner E, Likar R, Pinter G, Leutgeb I, Francisci N, Pfeiffer B, Janig H. [From the nursing home to hospital and back again… A mixed methods study on hospital transfers from nursing homes]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2011; 105:714-22. [PMID: 22176980 DOI: 10.1016/j.zefq.2011.03.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 03/21/2011] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
Abstract
Hospital transfers from nursing homes are frequent, costly, often preventable, and can have negative effects on the residents' health. The present study investigated the current situation in Carinthia (Austria) regarding the characteristics of relocated nursing home residents, the proportion of avoidable transfers, the consequences of relocation from the physicians' and nurses' perspectives and ways for improving nursing home care. Retrospectively, the documentations of a regional hospital (N=4149), a rescue service (N=10754), and a social insurance agency (N=7051) were analysed; qualitative interviews with physicians (N=25) and nursing administrators (N=16) were conducted. A considerable proportion of these transports seemed to be avoidable: for example, about 40% of the ambulatory treatments in the emergency department of the investigated hospital were inappropriate. Options for improving the current situation will be discussed.
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Affiliation(s)
- Olivia Kada
- Fachhochschule Kärnten, Studienbereich Gesundheit und Pflege.
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Codde J, Arendts G, Frankel J, Ivey M, Reibel T, Bowen S, Babich P. Transfers from residential aged care facilities to the emergency department are reduced through improved primary care services: an intervention study. Australas J Ageing 2011; 29:150-4. [PMID: 21143359 DOI: 10.1111/j.1741-6612.2010.00418.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To assess the impact of an enhanced primary care service for residential aged care facilities (RACF) on the transfer of patients from RACF to a hospital emergency department (ED). METHODS A before-after study of an enhanced primary care service provided by experienced ED-based nurses under the governance of general practitioners. The intervention was analysed comparatively using standardised normal deviates and seasonal autoregressive integrated moving average models, complemented by qualitative assessment. RESULTS There was a statistically significant reduction (17%, P < 0.001) in the number of transfers during the intervention period. This finding held when adjusting for the seasonality of ED referrals over a 4-year period. The intervention was highly valued by clinicians in RACF and ED. CONCLUSION Enhanced primary care services reduce the number of transfers to ED from RACF.
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Affiliation(s)
- Jim Codde
- South Metropolitan Area Health Service, Perth, Western Australia, Australia
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Codde J, Frankel J, Arendts G, Babich P. Quantification of the proportion of transfers from residential aged care facilities to the emergency department that could be avoided through improved primary care services. Australas J Ageing 2010; 29:167-71. [PMID: 21143362 DOI: 10.1111/j.1741-6612.2010.00496.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jim Codde
- South Metropolitan Area Health Service, Western Australia, Australia
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Arendts G, Reibel T, Codde J, Frankel J. Can transfers from residential aged care facilities to the emergency department be avoided through improved primary care services? Data from qualitative interviews. Australas J Ageing 2010; 29:61-5. [PMID: 20553535 DOI: 10.1111/j.1741-6612.2009.00415.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To explore the factors that influence the transfer of patients from residential aged care facilities (RACF) to hospital emergency departments (ED), and describe features of improved primary care in RACF that could result in reduced transfer. METHODS a. Three focus groups conducted with family and carers of RACF residents, along with RACF, ED and general practice staff. b. Semistructured one-on-one interviews with nine residents of RACF. RESULTS Five main themes emerged--staffing and skill mix in RACF, treatment options in RACF, end of life decision-making, communication and bureaucratic requirements. Analysis of the semistructured interviews demonstrated parallel concerns with many of the focus groups indicators. There was a strong but not universal preference among residents to minimise RACF to ED transfer. CONCLUSIONS The transfer of residents from RACF to ED is influenced by multiple interrelated factors, and strategies to reduce transfer should address these.
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Affiliation(s)
- Glenn Arendts
- Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research and University of Western Australia, Perth, Western Australia, Australia.
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Rich SE, Williams CS, Zimmerman S. Concordance of family and staff member reports about end of life in assisted living and nursing homes. THE GERONTOLOGIST 2009; 50:112-20. [PMID: 19549716 DOI: 10.1093/geront/gnp089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To identify differences in perspectives that may complicate the process of joint decision making at the end of life, this study determined the agreement of family and staff perspectives about end-of-life experiences in nursing homes and residential care/assisted living communities and whether family and staff roles, involvement in care, and interaction are associated with such agreement. DESIGN AND METHODS This cross-sectional study examined agreement in 336 family-staff pairs of postdeath telephone interviews conducted as part of the Collaborative Studies of Long-Term Care. Eligible deaths occurred in or within 3 days of leaving one of a stratified random sample of 113 long-term care facilities in four states and after the resident had lived in the facility (3)15 days of the last month of life. McNemar p values and kappas were determined for each concordance variable, and mixed logistic models were run. RESULTS Chance-adjusted family-staff agreement was poor for expectation of death within weeks (66.9% agreement, kappa = .33), course of illness (62.9%, 0.18), symptom burden (59.6%, 0.18), and familiarity with resident's physician (59.2%, 0.05). Staff were more likely than family to expect death (70.2% vs 51.5%, p < .001) and less likely to report low symptom burden (39.6% vs 46.6%, p = .07). Staff involvement in care related to concordance and perspectives of adult children were more similar to those of staff than were other types of family members. IMPLICATIONS Family and staff perspectives about end-of-life experiences may differ substantially; efforts can be made to improve family-staff communication and interaction for joint decision making.
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Affiliation(s)
- Shayna E Rich
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA.
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The Controversy Inherent in Managing Frail Nursing Home Residents During Complex Hurricane Emergencies. J Am Med Dir Assoc 2008; 9:599-604. [DOI: 10.1016/j.jamda.2008.05.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 05/22/2008] [Accepted: 05/30/2008] [Indexed: 11/18/2022]
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Bassim CW, Gibson G, Ward T, Paphides BM, Denucci DJ. Modification of the Risk of Mortality from Pneumonia with Oral Hygiene Care. J Am Geriatr Soc 2008; 56:1601-7. [PMID: 18691286 DOI: 10.1111/j.1532-5415.2008.01825.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carol W Bassim
- Dental Service, Washington, DC, Veterans Affairs Medical Center, Washington, District of Columbia, USA.
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Boockvar KS, Gruber-Baldini AL, Stuart B, Zimmerman S, Magaziner J. Medicare expenditures for nursing home residents triaged to nursing home or hospital for acute infection. J Am Geriatr Soc 2008; 56:1206-12. [PMID: 18482299 DOI: 10.1111/j.1532-5415.2008.01748.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare Medicare payments of nursing home residents triaged to nursing home with those of nursing home residents triaged to the hospital for acute infection care. DESIGN Observational study with propensity score matching. SETTING Fifty-nine nursing homes in Maryland. PARTICIPANTS Two thousand two hundred eighty-five individuals admitted to the 59 nursing homes and followed between 1992 and 1997. MEASUREMENTS Demographic and clinical data were obtained from interviews and medical record review and linked to Medicare payment records. Incident infection was ascertained according to medical record review for new infectious diagnoses or prescription of antibiotics. Hospital triage was defined as hospital transfer within 3 days of infection onset. Hospital triage patients were paired with similar nursing home triage patients using propensity score matching. Medicare expenditures for triage groups were compared in 1997 dollars. RESULTS Of 3,618 infection cases, 28% were genitourinary infections, 20% skin, 14% upper respiratory, 12% lower respiratory, 4% gastrointestinal, and 2% bloodstream. Two hundred fifty-six pairs of hospital and nursing home triage cases fulfilled matching criteria. Mean Medicare payments+/-standard deviation were $5,202+/-7,310 and $996+/-2,475 per case in the hospital and nursing home triage groups, respectively, for a mean difference of $4,206 (95% confidence interval=$3,260-5,151). Mean payments per case in the hospital triage group were $3,628 higher in inpatient expenditures, $482 higher in physician visit expenditures, $161 higher in emergency department expenditures, and $147 higher in skilled nursing day expenditures. CONCLUSION Per-case Medicare expenditures are higher with hospital triage than for nursing home triage for nursing home residents with acute infection. This result may be used to estimate cost savings to Medicare of interventions designed to reduce hospital use by nursing home residents.
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Affiliation(s)
- Kenneth S Boockvar
- Geriatric Research, Education, and Clinical Center, JJ Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA.
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Bouncing-back: rehospitalization in patients with complicated transitions in the first thirty days after hospital discharge for acute stroke. Home Health Care Serv Q 2008; 26:37-55. [PMID: 18032199 DOI: 10.1300/j027v26n04_04] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND "Bounce-backs" (movements from a less intensive to a more intensive care setting) soon after hospital discharge are common, but reasons for bouncing-back remain unknown. OBJECTIVE To examine how the primary diagnosis for first rehospitalization relates to thirty-day bounce-back number and initial discharge destination in acute stroke. POPULATION Administrative data from 5,250 Medicare beneficiaries > or = 65 years discharged with acute ischemic stroke in 1998-2000 to a rehabilitation center, skilled nursing facility or home with home health care and with at least one thirty day rehospitalization. ANALYSIS Probability of thirty-day bounce-back was calculated using multivariate models. RESULTS Infections and aspiration pneumonitis were the most common reasons for rehospitalization, regardless of initial discharge site. CONCLUSIONS Efforts addressing aspirations and infections, the preventable complications of immobility, will be critical in decreasing acute stroke bounce-backs.
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Abstract
Nursing home-associated pneumonia (NHAP) is associated with considerable morbidity and mortality. The etiology of NHAP continues to be debated and has influenced treatment guideline recommendations. Diagnosis may not be straightforward but at least one respiratory symptom usually is present and the presence of hypoxemia is a key finding. Treatment recommendations vary depending on the organisms believed the predominant cause of NHAP. Pneumococcal and influenza vaccination remain the most important methods for prevention of NHAP at present.
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Affiliation(s)
- Joseph M Mylotte
- Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY 14215, USA.
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