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Morrow CD, Perraillon MC, Wald HL, Nelson JL, Reeder BP, Battaglia C, Boxer RS. Challenges in Heart Failure Disease Management in Skilled Nursing Facilities: A Qualitative Study. J Gerontol Nurs 2022; 48:14-17. [PMID: 35511061 DOI: 10.3928/00989134-20220404-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical guidelines recommend clinicians in skilled nursing facilities (SNFs) monitor body weight and signs and symptoms related to heart failure (HF) and encourage a sodium restricted diet to improve HF outcomes; however, SNFs face considerable challenges in HF disease management (HF-DM). In the current study, we characterized the challenges of HF-DM with data from semi-structured, in-depth interviews with patients, caregivers, staff, and physicians from nine SNFs. Patients receiving skilled nursing care were interviewed together as a dyad with their caregiver. A data-driven, qualitative descriptive approach was used to understand the process and challenges of HF-DM. Coded text was categorized into descriptive themes. Interviews with five dyads (n = 10 individuals), SNF nurses and certified nursing assistants (n = 13), and physicians (n = 2) revealed that, among the sample, HF care was not prioritized above other competing health concerns. Staff operated in the challenging SNF environment largely without protocols or educational materials to prompt HF-DM. [Journal of Gerontological Nursing, 48(5), 13-17.].
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Lafo J, Singh M, Jiang L, Correia S, Madrigal C, Clements R, Wu WC, Erqou S, Rudolph JL. Outcomes in heart failure patients discharged to skilled nursing facilities with delirium. ESC Heart Fail 2022; 9:1891-1900. [PMID: 35293145 PMCID: PMC9065834 DOI: 10.1002/ehf2.13895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022] Open
Abstract
AIM Heart failure (HF) outcomes are disproportionately worse in patients discharged to skilled nursing facilities (SNF) as opposed to home. We hypothesized that dementia and delirium were key factors influencing these differences. Our aim was to explore the associations of dementia and delirium with risk of hospital readmission and mortality in HF patients discharged to SNF. METHODS AND RESULTS The study population included Veterans hospitalized for a primary diagnosis of HF and discharged to SNFs between 2010 and 2015. Pre-existing dementia was identified based on International Classification of Diseases-9 codes. Delirium was determined using the Minimum Data Set 3.0 Confusion Assessment Method algorithm. Proportional hazard regression analyses were used to model outcomes and were adjusted for covariates of interest. Patients (n = 21 655) were older (77.0 ± 10.5 years) and predominantly male (96.9%). Four groups were created according to presence (+) or absence (-) of dementia and delirium. Relative to the dementia-/delirium- group, the dementia-/delirium+ group was associated with increased 30 day mortality [adjusted hazard ratio (HR) = 2.2, 95% confidence interval (CI) = 1.7, 3.0] and 365 day mortality (adjusted HR = 1.5, 95% CI = 1.3, 1.7). Readmission was highest in the dementia-/delirium+ group after 30 days (HR = 1.2, 95% CI = 1.0, 1.5). In the group with dementia (delirium-/dementia+), 30 day mortality (12.8%; HR = 0.7, 95% CI = 0.7, 0.8) and readmissions (5.3%; HR = 1.0, 95% CI = 0.8, 1.1) were not different relative to the reference group. CONCLUSIONS Delirium, independent of pre-existing dementia, confers increased risk of hospital readmission and mortality in HF patients discharged to SNFs. Managing HF after hospitalization is a complex cognitive task and an increased focus on mental status in the acute care setting prior to discharge is needed to improve HF management and transitional care, mitigate adverse outcomes, and reduce healthcare costs.
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Affiliation(s)
- Jacob Lafo
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Psychiatry & Human Behavior, Brown University, Providence, RI, USA
| | - Mriganka Singh
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lan Jiang
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Stephen Correia
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Psychiatry & Human Behavior, Brown University, Providence, RI, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Caroline Madrigal
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Rachel Clements
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Wen-Chih Wu
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sebhat Erqou
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James L Rudolph
- Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, 830 Chalkstone Avenue, Providence, RI, 02908, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center for Gerontology, Brown University School of Public Health, Providence, RI, USA
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3
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Friedman DM, Goldberg JM, Molinsky RL, Hanson MA, Castaño A, Raza SS, Janas N, Celano P, Kapoor K, Telaraja J, Torres ML, Jain N, Wessler JD. A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: Retrospective Analysis. JMIR Cardio 2021; 5:e29101. [PMID: 34061037 PMCID: PMC8411436 DOI: 10.2196/29101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/04/2021] [Accepted: 05/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background Patients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, postconsultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc., a cardiovascular digital health company, to 11 SNFs (3510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era. Objective The aim of the study was to assess whether a virtual cardiovascular care program could reduce the 30-day hospital readmission rate for patients with HF discharged to SNF relative to the expected rate for this population. Methods We performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted 1 or more telemedicine visit via smartphone, tablet, or laptop for cardiac patients identified by a SNF care team. Postconsult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF. Results We observed lower hospital readmission among patients who received 1 or more virtual consultations compared with the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3510 patients admitted to SNF. A total of 185/3510 patients (5.27%) received virtual cardiovascular care via the Heartbeat Health program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65%) requiring 1 televisit and 14 (35%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as US $860 per patient. Conclusions The investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations.
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Affiliation(s)
- Daniel M Friedman
- Heartbeat Health, Inc., New York, NY, United States.,Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, United States
| | | | - Rebecca L Molinsky
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Mark A Hanson
- Heartbeat Health, Inc., New York, NY, United States.,Innovative Practice & Telemedicine Section, Department of Emergency Medicine, The George Washington University, Washington, DC, United States
| | - Adam Castaño
- Heartbeat Health, Inc., New York, NY, United States
| | | | - Nodar Janas
- Heartbeat Health, Inc., New York, NY, United States.,Cassena Care, LLC, Woodbury, NY, United States
| | - Peter Celano
- Heartbeat Health, Inc., New York, NY, United States
| | - Karen Kapoor
- Heartbeat Health, Inc., New York, NY, United States
| | | | | | - Nayan Jain
- Heartbeat Health, Inc., New York, NY, United States
| | - Jeffrey D Wessler
- Heartbeat Health, Inc., New York, NY, United States.,Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
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4
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Morrow CD, Reeder BP, Perraillon MC, Ozkaynak M, Wald HL, Eber LE, Trojanowski JI, Battaglia C, Boxer RS. Information Needs of Skilled Nursing Facility Staff to Support Heart Failure Disease Management. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:878-885. [PMID: 33936463 PMCID: PMC8075486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Characterize key tasks and information needs for heart failure disease management (HF-DM) in the distinct care setting of skilled nursing facility (SNF) staff in partnership with community-based clinical stakeholders. Develop design recommendations contextualized to the SNF setting for informatics interventions for improved HF-DM in the SNF setting. METHODS Semi-structured interviews with fifteen participants (registered nurses, licensed practical nurses, certified nursing aides and physicians) from 8 Denver-metro SNFs. Data coded using a data-driven, inductive approach. RESULTS Key tasks of HF-DM: symptom assessment, communicating change in condition, using equipment, documentation of daily weights, and monitoring patients. Themes: 1) HF-DM is challenged by a culture of verbal communication; 2) staff face knowledge barriers in HF-DM that are partially attributed to unmet information needs. HF-DM information needs: identification of HF patients, HF signs and symptoms, purpose of daily weights, indicators of worsening HF, purpose of sodium restricted diet, and materials to improve patients' understanding of HF. DISCUSSION AND CONCLUSIONS HF-DM information needs are not fully supported by current SNF information systems.
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Affiliation(s)
| | - Blaine P Reeder
- Sinclair School of Nursing, University of Missouri, Columbia, MO
- MU Institute for Data Science and Informatics, University of Missouri, Columbia, MO
| | | | | | | | | | | | | | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente, Aurora, CO
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5
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Patient Characteristics Are Not Associated With Documentation of Weight and Heart Failure Related Sign and Symptom Assessment in Skilled Nursing Facilities. J Am Med Dir Assoc 2020; 22:1265-1270.e1. [PMID: 33071159 DOI: 10.1016/j.jamda.2020.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Monitoring body weight and signs and symptoms related to heart failure (HF) can alert clinicians to a patient's worsening condition but the degree to which these practices are performed in skilled nursing facilities (SNFs) is unknown. This study analyzed the frequency of these monitoring practices in SNFs and explored associated factors at both the patient and SNF level. DESIGN An observational study of data from the usual care arm of the SNF Connect Trial, a randomized cluster trial of a HF disease management intervention. The data extracted from charts were combined with publicly available facility data. A linear regression model was estimated to evaluate the frequency of HF disease management conditional on patient and facility covariates. SETTING Data from 28 SNFs in Colorado. PARTICIPANTS Patients discharged from hospital to SNFs with a primary or secondary diagnosis of HF. MEASUREMENTS Patient-level covariates included demographics, New York Heart Association class, type of HF, and Charlson comorbidity index. Facility-level covariates were from Nursing Home Compare. RESULTS The sample (n = 320) was majority female (66%), white (93%), with mean age 80 ± 10 years and a Charlson comorbidity index of 3.2 ± 1.5. Seventy percent had HF with preserved ejection fraction, mean ejection fraction of 50 ± 16% and 40% with a New York Heart Association class III-IV. On average, patients were weighed 40% of their days in the SNF and had documentation of at least 1 HF-related sign or symptom 70% of their days in the SNF. Patient-level factors were not associated with frequency of documenting weight and assessments of HF-related signs/symptoms. Health Inspection Star Rating was positively associated with weight monitoring (P < .05) but not associated with symptom assessment. CONCLUSIONS AND IMPLICATIONS Patient-level factors are not meaningfully associated with the documentation of weight tracking or sign/symptom assessment. Monitoring weight was instead associated with the Health Inspection Star Rating.
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Drake C, Wald HL, Eber LB, Trojanowski JI, Nearing KA, Boxer RS. Research Priorities in Post-acute and Long-term Care: Results of a Stakeholder Needs Assessment. J Am Med Dir Assoc 2019; 20:911-915. [PMID: 30982714 DOI: 10.1016/j.jamda.2019.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Conduct a needs assessment among post-acute and long-term care (PA-LTC) stakeholder groups to identify (1) research topics of highest priority and (2) perspectives on research, including concerns/barriers to conducting research in the PA-LTC setting. DESIGN Mixed methods multistakeholder engagement process. Needs assessment conducted with tailored strategies per stakeholder group: interview, survey, and focus group. SETTING AND PARTICIPANTS Four stakeholder groups-medical directors/providers (n = 89), administrative leadership (n = 5), frontline staff (n = 17), and family members of residents and residents themselves (n = 11)-were recruited from the Colorado PA-LTC community through an academic-community partnership between the University of Colorado and Colorado Medical Directors Association. MAIN OUTCOME(S) Stakeholder perspectives on research and high priority PA-LTC research topics. RESULTS Research priorities common across stakeholder groups included polypharmacy (overuse of medication generally and overuse of antibiotics specifically), care transitions, mental health (including dementia, Alzheimer's disease, behaviors), chronic pain, urinary tract infection, and quality of life issues. Providers specifically prioritized heart failure, Parkinson's, and other chronic illnesses. Administrators and directors of nurses emphasized hospitalizations. Staff prioritized medication/therapy compliance. Families/residents prioritized neurologic disease. Concerns included staff burden, consenting process, privacy, and family involvement. CONCLUSIONS/IMPLICATIONS PA-LTC patients have a lot to offer as participants and decision makers in research, frontline staff are enthusiastic about participation, family members want to be involved, and providers value research findings in their practice but need a more supportive environment to produce and participate in research.
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Affiliation(s)
| | | | | | | | | | - Rebecca S Boxer
- University of Colorado School of Medicine, Aurora, CO; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
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7
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Harrington CC. Evidence-Based Practice Guideline: Assessing Heart Failure in Long-Term Care Facilities. J Gerontol Nurs 2019; 45:18-24. [PMID: 30985905 DOI: 10.3928/00989134-20190409-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Evidence suggests the most crucial elements to successful heart failure (HF) management in long-term care (LTC) include improving staffs' HF knowledge to recognize and intervene in early symptom exacerbations, embedding an effective and integrated interprofessional communication system into daily care processes, risk stratification, and anticipatory advanced care planning. Despite a large body of evidence describing best practices, quality HF management remains elusive in LTC facilities. Studies have shown that care quality and outcomes improve when the entire team, including direct caregivers, have an active role in residents' care planning and implementation. The current article summarizes a revised evidence-based practice guideline on assessing HF, addressing a systematic approach to care delivery, and implementing evidence-based best practices for HF quality improvement initiatives in LTC, post-acute care, and short-term rehabilitation settings. [Journal of Gerontological Nursing, 45(7), 18-24.].
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8
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Gustavson AM, Boxer RS, Nordon-Craft A, Marcus RL, Daddato A, Stevens-Lapsley JE. Advancing Innovation in Skilled Nursing Facilities through Academic Collaborations. PHYSICAL THERAPY JOURNAL OF POLICY, ADMINISTRATION, AND LEADERSHIP 2018; 18:5-16. [PMID: 35747320 PMCID: PMC9217103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There is growing recognition that acute hospitalization contributes to marked functional decline in older adult populations. Nearly 20% of all hospitalized older adults in the United States are discharged to skilled nursing facilities (SNFs) to address these functional deficits. However, current approaches to care in SNFs may not adequately restore function, which may contribute to low community discharge rates and high hospital readmission rates. Barriers to rehabilitation innovation in SNFs include management, staff, patient, and researcher-level factors. This clinical commentary builds upon clinical innovation strategies in other health care settings by describing barriers in the context of the SNF environment. Fostering collaboration between academic clinical researchers and SNFs may be the answer to advancing rehabilitation practices and care delivery, thereby improving outcomes in this vulnerable population.
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Affiliation(s)
- Allison M. Gustavson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Rebecca S. Boxer
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO
- Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, CO
| | - Amy Nordon-Craft
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Robin L. Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Andrea Daddato
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Jennifer E. Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, CO
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Heckman GA, Shamji AK, Ladha R, Stapleton J, Boscart V, Boxer RS, Martin LB, Crutchlow L, McKelvie RS. Heart Failure Management in Nursing Homes: A Scoping Literature Review. Can J Cardiol 2018; 34:871-880. [DOI: 10.1016/j.cjca.2018.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/31/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022] Open
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Orr NM, Jones CD, Daddato AE, Boxer RS. Post-acute Care for Patients with Heart Failure. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0583-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
PURPOSE/OBJECTIVES Older adults, in particular those discharged to skilled nursing facilities (SNFs), are at high risk for readmission. As part of a multifaceted approach to reduce readmissions, a community hospital initiated a 3-prong approach (Collaboration, Communication, and Competency) and partnered with regional SNFs. PRIMARY PRACTICE SETTINGS El Camino Hospital, an independent, locally owned, not-for-profit district, acute care hospital in Northern California, and 11 participating SNFs in the same region. FINDINGS/CONCLUSIONS Collaboration: The combined leadership team developed a case report form and instituted regular reviews of 7-day readmissions. Communication: Standardized form for transferring patients to SNFs, form for transfer from SNF to emergency department, and consent form to enable SNFs to administer antipsychotic medications were developed. Regular phone and video conferencing between clinicians at the hospital and receiving SNF were instituted. Competency: Educational series to recognize and intervene to prevent readmission, and mutual exchange of best practices among hospital and SNF staff, were instituted. Continued work among ECH and the participating SNFs has improved the flow of information in both directions; favorable results from the broader study to reduce readmissions hospital-wide provide support for these efforts. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Initiating collaboration with the SNFs is imperative in the changing health care landscape. Because of the complexity of the problem, acute care facilities and SNFs need to create a partnership to ensure smooth patient transition. Communication between care settings is essential in achieving optimum patient outcomes.
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12
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Burke RE, Hess E, Barón AE, Levy C, Donzé JD. Predicting Potential Adverse Events During a Skilled Nursing Facility Stay: A Skilled Nursing Facility Prognosis Score. J Am Geriatr Soc 2018; 66:930-936. [PMID: 29500814 DOI: 10.1111/jgs.15324] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To derive a risk prediction score for potential adverse outcomes in older adults transitioning to a skilled nursing facility (SNF) from the hospital. DESIGN Retrospective analysis. SETTING Medicare Current Beneficiary Survey (2003-11). PARTICIPANTS Previously community-dwelling Medicare beneficiaries who were hospitalized and discharged to SNF for postacute care (N=2,043). MEASUREMENTS Risk factors included demographic characteristics, comorbidities, health status, hospital length of stay, prior SNF stays, SNF size and ownership, treatments received, physical function, and active signs or symptoms at time of SNF admission. The primary outcome was a composite of undesirable outcomes from the patient perspective, including hospital readmission during the SNF stay, long SNF stay (≥100 days), and death during the SNF stay. RESULTS Of the 2,043 previously community-dwelling beneficiaries hospitalized and discharged to a SNF for post-acute care, 589 (28.8%) experienced one of the three outcomes, with readmission (19.4%) most common, followed by mortality (10.5%) and long SNF stay (3.5%). A risk score including 5 factors (Barthel Index, Charlson-Deyo comorbidity score, hospital length of stay, heart failure diagnosis, presence of an indwelling catheter) demonstrated very good discrimination (C-statistic=0.75), accuracy (Brier score=0.17), and calibration for observed and expected events. CONCLUSION Older adults frequently experience potentially adverse outcomes in transitions to a SNF from the hospital; this novel score could be used to better match resources with patient risk.
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Affiliation(s)
- Robert E Burke
- Research and Hospital Medicine Sections, Department of Medicine, Denver Veterans Affairs Medical Center, Denver, Colorado.,Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado.,Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Edward Hess
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Denver Veterans Affairs Medical Center, Denver, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Anna E Barón
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Cari Levy
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Denver Veterans Affairs Medical Center, Denver, Colorado.,Division of Health Care Policy and Research, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | - Jacques D Donzé
- Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.,Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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13
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Bahrmann P, Hardt R. [Chronic heart failure in older patients : Updated national healthcare guidelines on chronic heart failure from a geriatric perspective]. Z Gerontol Geriatr 2018; 51:165-168. [PMID: 29374297 DOI: 10.1007/s00391-018-1371-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/05/2017] [Accepted: 01/08/2018] [Indexed: 12/28/2022]
Abstract
The incidence and prevalence of chronic heart failure (CHF) increase with age. In the second edition of the National Disease Management Guidelines (NVL) on CHF, published in August 2017, geriatric aspects are specifically addressed. The paper provides an overview of the recommendations by the guidelines on drug therapy, device therapy and operative therapy as well on the coordination of care focusing on older and multimorbid patients.
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Affiliation(s)
- Philipp Bahrmann
- Institut für Biomedizin des Alterns (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland. .,Med. Klinik II, Asklepios Paulinen Klinik Wiesbaden, Geisenheimer Str. 10, 65197, Wiesbaden, Deutschland.
| | - Roland Hardt
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
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Boscart VM, Heckman GA, Huson K, Brohman L, Harkness KI, Hirdes J, McKelvie RS, Stolee P. Implementation of an interprofessional communication and collaboration intervention to improve care capacity for heart failure management in long-term care. J Interprof Care 2017; 31:583-592. [PMID: 28876202 DOI: 10.1080/13561820.2017.1340875] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Heart failure affects up to 20% of nursing home residents and is associated with high morbidity, mortality, and transfers to acute care. A major barrier to heart failure management in nursing home settings is limited interprofessional communication. Guideline-based heart failure management programs in nursing homes can reduce hospitalisation rates, though sustainability is limited when interprofessional communication is not addressed. A pilot intervention, 'Enhancing Knowledge and Interprofessional Care for Heart Failure', was implemented on two units in two conveniently selected nursing homes to optimise interprofessional care processes amongst the care team. A core heart team was established, and participants received tailored education focused on heart failure management principles and communication processes, as well as weekly mentoring. Our previous work provided evidence for this intervention's acceptability and implementation fidelity. This paper focuses on the preliminary impact of the intervention on staff heart failure knowledge, communication, and interprofessional collaboration. To determine the initial impact of the intervention on selected staff outcomes, we employed a qualitative design, using a social constructivist interpretive framework. Findings indicated a perceived increase in team engagement, interprofessional collaboration, communication, knowledge about heart failure, and improved clinical outcomes. Individual interviews with staff revealed innovative ways to enhance communication, supporting one another with knowledge and engagement in collaborative practices with residents and families. Engaging teams, through the establishment of core heart teams, was successful to develop interprofessional communication processes for heart failure management. Further steps to be undertaken include assessing the sustainability and effectiveness of this approach with a larger sample.
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Affiliation(s)
- Veronique M Boscart
- a Conestoga College Institute of Technology and Advanced Learning , Kitchener , Ontario , Canada
| | - George A Heckman
- b Research Institute for Aging and School of Public Health and Health Systems , University of Waterloo , Waterloo , Ontario , Canada
| | - Kelsey Huson
- c Colleges in Seniors Care, Conestoga College Institute of Technology and Advanced Learning , School of Health & Life Sciences and Community Services , Kitchener , Ontario , Canada
| | - Lisa Brohman
- d Sunnyside Home Seniors' Services , Kitchener , Ontario , Canada
| | - Karen I Harkness
- e McMaster University , Clinical Lead, Heart Failure and Cardiovascular Chronic Disease Management, Cardiac Care Network, Hamilton Health Sciences , Hamilton , Ontario , Canada
| | - John Hirdes
- f School of Public Health and Health Systems , University of Waterloo , Waterloo , Ontario , Canada
| | | | - Paul Stolee
- h School of Public Health and Health Systems , University of Waterloo , Waterloo , Ontario , Canada
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15
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Heckman GA, Boscart VM, Huson K, Costa A, Harkness K, Hirdes JP, Stolee P, McKelvie RS. Enhancing Knowledge and InterProfessional care for Heart Failure (EKWIP-HF) in long-term care: a pilot study. Pilot Feasibility Stud 2017; 4:9. [PMID: 28694988 PMCID: PMC5501130 DOI: 10.1186/s40814-017-0153-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 06/08/2017] [Indexed: 12/05/2022] Open
Abstract
Background Heart failure (HF) affects 20% of long-term care (LTC) residents and is associated with significant morbidity, acute care visits, and mortality. Barriers to HF management are staff knowledge gaps and ineffective interprofessional (IP) communication. This pilot study assessed the acceptability, feasibility, and impact of an intervention to (1) improve HF knowledge; (2) improve IP communication; and (3) integrate improved knowledge and communication processes into work routines. Methods The intervention provides multimodal IP education about HF in LTC, including specialist-supported bedside teaching. It was piloted on single units in two facilities. A mixed-methods repeated-measures approach was used to collect qualitative and quantitative process and outcome data at baseline and 6 months post-intervention. Results Results were similar at both sites. Participants developed optimized IP communication to promote HF care. Results indicate a perceived increase in staff confidence and self-efficacy, strengthened assessment and clinical proficiency skills, and more effective IP collaboration. Staff deemed the intervention useful and feasible. Conclusions This pilot study suggests that a novel intervention in which HF-specific knowledge is applied by LTC staff to improve IP collaboration in their own work place is acceptable and feasible and has a favourable preliminary impact on staff knowledge and IP communication.
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Affiliation(s)
- George A Heckman
- Research Institute for Aging, 250 Laurelwood Drive, Waterloo, Ontario N2J 0E2 Canada.,School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
| | - Veronique M Boscart
- Research Institute for Aging, 250 Laurelwood Drive, Waterloo, Ontario N2J 0E2 Canada.,School of Health & Life Sciences and Community Services, Conestoga College Institute of Technology and Advanced Learning, 299 Doon Valley Dr, Kitchener, Ontario N2G 4M4 Canada
| | - Kelsey Huson
- School of Health & Life Sciences and Community Services, Conestoga College Institute of Technology and Advanced Learning, 299 Doon Valley Dr, Kitchener, Ontario N2G 4M4 Canada
| | - Andrew Costa
- Research Institute for Aging, 250 Laurelwood Drive, Waterloo, Ontario N2J 0E2 Canada.,Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8 Canada
| | - Karen Harkness
- Heart Failure and Cardiovascular Chronic Disease Management, Cardiac Care Network, 4100 Yonge St, North York, Ontario M2P 2B5 Canada.,Hamilton Health Sciences Corporation, 1200 Main St. West, Hamilton, Ontario L8N 3Z5 Canada.,McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8 Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
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Manemann SM, Chamberlain AM, Boyd CM, Weston SA, Killian J, Leibson CL, Cheville A, St Sauver J, Dunlay SM, Jiang R, Roger VL. Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A Community Linkage Study. Mayo Clin Proc 2017; 92:S0025-6196(17)30087-3. [PMID: 28365097 PMCID: PMC5597448 DOI: 10.1016/j.mayocp.2017.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To examine the effect of skilled nursing facility (SNF) use on hospitalizations in patients with heart failure (HF) and to examine predictors of hospitalization in patients with HF admitted to a SNF. PATIENTS AND METHODS Olmsted County, Minnesota, residents with first-ever HF from January 1, 2000, through December 31, 2010, were identified, and clinical data were linked to SNF utilization data from the Centers for Medicare and Medicaid Services. Andersen-Gill models were used to determine the association between SNF use and hospitalizations and to determine predictors of hospitalization. RESULTS Of 1498 patients with incident HF (mean ± SD age, 75±14 years; 45% male), 605 (40.4%) were admitted to a SNF after HF diagnosis (median follow-up, 3.6 years; range, 0-13.0 years). Of those with a SNF admission, 225 (37%) had 2 or more admissions. After adjustment for age, sex, ejection fraction, and comorbidities, SNF use was associated with a 50% increased risk of hospitalization compared with no SNF use (adjusted hazard ratio, 1.52; 95% CI, 1.31-1.76). In SNF users, arrhythmia, asthma, chronic kidney disease, and the number of activities of daily living requiring assistance were independently associated with an increased risk of hospitalization. CONCLUSION Approximately 40% of patients with HF were admitted to a SNF at some point after diagnosis. Compared with SNF nonusers, SNF users were more likely to be hospitalized. Characteristics associated with hospitalization in SNF users were mostly noncardiovascular, including reduced ability to perform activities of daily living. These findings underscore the effect of physical functioning on hospitalizations in patients with HF in SNFs and the importance of strategies to improve physical functioning.
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Affiliation(s)
| | | | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jill Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Andrea Cheville
- Division of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | | | - Shannon M Dunlay
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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17
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Managing Heart Failure in Long-Term Care: Recommendations from an Interprofessional Stakeholder Consultation. Can J Aging 2016; 35:447-464. [DOI: 10.1017/s071498081600043x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉInsuffisance cardiaque (IC) affecte autant que 20 pour cent des résidents en soins de longue durée (SLD), et est associée à la morbidité substantielle, la mortalité et l’utilisation des services de santé. L’objectif de notre étude était de formuler des recommandations sur la mise en œuvre de processus pour prendre soin de l’insuffisance cardiaque dans SLD. Un processus de consultation itérative triphasé avec les parties prenantes a été guidé par la participation d’un panel d’experts et a servi à élaborer des recommandations. Dix-sept recommandations ont été faites. Éléments clés des celles-ci se concentrent sur l’amélioration de la communication interprofessionnelle et accroître les connaissances relatives à l’insuffisance cardiaque entre tous les intervenants dans SLD. Des recommandations systématiques incluent améliorer la communication entre les foyers de SLD et soins aigus et autres prestataires de santé externes, et développer des interventions dans l’ensemble des installations afin de réduire les apports de sodium alimentaire et d’augmenter l’activité physique.
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18
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Orr NM, Boxer RS, Dolansky MA, Allen LA, Forman DE. Skilled Nursing Facility Care for Patients With Heart Failure: Can We Make It "Heart Failure Ready?". J Card Fail 2016; 22:1004-1014. [PMID: 27769909 PMCID: PMC7245613 DOI: 10.1016/j.cardfail.2016.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/06/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
Skilled nursing facilities (SNFs) have emerged as an integral component of care for older adults with heart failure (HF). Despite their prominent role, poor clinical outcomes for the medically complex patients with HF managed in SNFs are common. Barriers to providing quality care include poor transitional care during hospital-to-SNF and SNF-to-community discharges, lack of HF training among SNF staff, and a lack of a standardized care process among SNF facilities. Although no evidence-based practice standards have been established, various measures and tools designed to improve HF management in SNFs are being investigated. In this review, we discuss the challenges of HF care in SNFs as well as potential targets and recommendations that can help improve care with respect to transitions, HF management within SNFs, and modifiable factors within facilities. Policy considerations that might help catalyze improvements in SNF-based HF management are also discussed.
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Affiliation(s)
- Nicole M Orr
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts; Post-Acute Cardiology Care, Wellesley, Massachusetts.
| | - Rebecca S Boxer
- Eastern Colorado (Denver) Veterans Association GRECC, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | | | - Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel E Forman
- Geriatric Cardiology Section, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Dolansky MA, Capone L, Leister E, Boxer RS. Targeting heart failure rehospitalizations in a skilled nursing facility: A case report. Heart Lung 2016; 45:392-6. [PMID: 27340005 DOI: 10.1016/j.hrtlng.2016.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/08/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We report on a skilled nursing facility (SNF) that added designated heart failure (HF) beds and created a patient registry to track the number and reasons for rehospitalization. BACKGROUND Targeting the reduction of rehospitalizations from SNFs is an important goal and patients with HF are particularly vulnerable for rehospitalizations as HF disease management programs in SNFs are rare. METHODS A case study of a local quality improvement initiative. RESULTS The data from the registry revealed, that compared to patients without HF, patients with HF were more often rehospitalized for cardiopulmonary symptoms and less often for infection. In addition, patients with HF were most often rehospitalized during the first 7 days of their SNF stay and if they had a primary hospital discharge diagnosis of HF. CONCLUSION We highlight the benefits of a patient registry to guide future quality improvement initiatives to reduce patient rehospitalization rates.
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Affiliation(s)
| | | | - Erin Leister
- University of Colorado School of Public Health, Department of Biostatistics and Informatics, USA
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20
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Morley JE. Opening Pandora's Box: The Reasons Why Reducing Nursing Home Transfers to Hospital are so Difficult. J Am Med Dir Assoc 2016; 17:185-7. [DOI: 10.1016/j.jamda.2015.12.098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 12/31/2015] [Indexed: 11/25/2022]
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21
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Jurgens CY, Goodlin S, Dolansky M, Ahmed A, Fonarow GC, Boxer R, Arena R, Blank L, Buck HG, Cranmer K, Fleg JL, Lampert RJ, Lennie TA, Lindenfeld J, Piña IL, Semla TP, Trebbien P, Rich MW. Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America. J Card Fail 2016; 21:263-99. [PMID: 25863664 DOI: 10.1016/j.cardfail.2015.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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22
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Orr NM, Forman DE, De Matteis G, Gambassi G. Heart Failure Among Older Adults in Skilled Nursing Facilities: More of a Dilemma Than Many Now Realize. CURRENT GERIATRICS REPORTS 2015; 4:318-326. [PMID: 27398289 DOI: 10.1007/s13670-015-0150-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Post-acute care, encompassing long-term care hospitals, home health, inpatient rehabilitation, and skilled nursing facilities, is increasingly employed as an integral part of management for more complicated patients, particularly as hospitals seek to maintain costs and decrease length of stay. Skilled nursing facilities (SNFs) in particular are progressively utilized for patients with complex medical processes, including today's growing population of older hospitalized heart failure (HF) patients who pose a prominent challenge due to their high risks of mortality, 30-day readmissions, and substantial aggregate cost burden to the healthcare system. Publications to date have largely grouped post-hospitalized HF patients together when reporting demographic or outcome data, without differentiating those at SNFs from those at traditional nursing homes or other post-acute care settings. SNF patients suffer distinctive vulnerabilities and needs, and understanding these distinctions has implications for determining goals of care. In this review we evaluate HF patients referred to SNFs, and discuss the characteristics, outcomes, and management challenges associated with this particular population.
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Affiliation(s)
- Nicole M Orr
- Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA; Post-Acute Cardiology Care, LLC, Wellesley, MA 02481, USA
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Giuseppe De Matteis
- Department of Medical Sciences, Division of Internal Medicine and Angiology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Giovanni Gambassi
- Department of Medical Sciences, Division of Internal Medicine and Angiology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy
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23
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Thinking Outside the Box: Treating Acute Heart Failure Outside the Hospital to Improve Care and Reduce Admissions. J Card Fail 2015; 21:667-73. [DOI: 10.1016/j.cardfail.2015.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/12/2015] [Accepted: 05/15/2015] [Indexed: 01/16/2023]
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24
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Jurgens CY, Goodlin S, Dolansky M, Ahmed A, Fonarow GC, Boxer R, Arena R, Blank L, Buck HG, Cranmer K, Fleg JL, Lampert RJ, Lennie TA, Lindenfeld J, Piña IL, Semla TP, Trebbien P, Rich MW. Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circ Heart Fail 2015; 8:655-87. [PMID: 25855686 DOI: 10.1161/hhf.0000000000000005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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25
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Nazir A, Dennis ME, Unroe KT. Implementation of a heart failure quality initiative in a skilled nursing facility: lessons learned. J Gerontol Nurs 2014; 41:26-33. [PMID: 25531299 DOI: 10.3928/00989134-20141216-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 10/28/2014] [Indexed: 01/11/2023]
Abstract
Skilled nursing facilities (SNFs) are organizations that represent complex adaptive systems, offering barriers to the implementation of quality improvement (QI) initiatives. The current article describes the authors' efforts to use the approach of reflective adaptive process to implement a new model of care (i.e., the Skilled Heart Unit Program) for effective heart failure (HF) care in one SNF. A team of stakeholders from the local hospital system and a local SNF was convened to design and implement this new model. Evaluation of the implementation processes confirmed the value of the implementation approach, which centered on team-based approaches, staff engagement, and flexibility of processes to respect the SNF's needs and culture. Interviews with facility staff and the administrator revealed their perceptions that the strategy resulted in better HF care, enhanced teamwork between staff and clinicians, and improved staff job satisfaction. This work provides a unique blueprint of strategic QI implementation for patients with HF in the SNF setting.
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Abstract
RÉSUMÉL'insuffisance cardiaque (IC) est fréquente chez les résidents en soins de longue durée (SLD), et peut représenter 40 pour cent des transferts aux soins aigus. Des lignes directrices de l’IC de la Société canadienne de cardiologie approuvent les traitements standards, mais les résidents de SLD sont moins susceptibles de recevoir un traitement.* Cette étude qualitative a utilisé des groupes de discussion pour explorer les perceptions, de 18 médécins et infirmières praticiennes dans trois foyers de l’Ontario, des pratiques de soins de l’IC et les défis de SLD. Par exemple, les participants ont rapporté les défis concernant aptitudes diagnostiques et les connaissances procédurales de l’IC. Ils ont également identifié la nécessité de la collaboration interprofessionnelle et la clarification des rôles pour améliorer les soins et les résultats de l’IC. Pour résoudre ces problèmes, les interventions multi-modales et l'enseignement de chevet sont requis. Le leadership a été considéré comme essentielle pour améliorer les soins de l’IC. Plusieurs préoccupations ont surgi concernant les lacunes dans les connaissances et les déficits cliniques chez les fournisseurs de soins primaires qui traitent l'insuffisance cardiaque chez les résidents de SLD. Pour améliorer les soins de l'IC à long terme, des solutions éducatives et interprofessionnelles multi-modales et cliniquement ciblées sont nécessaires.
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Heckman GA, Boscart VM, McKelvie RS. Management considerations in the care of elderly heart failure patients in long-term care facilities. Future Cardiol 2014; 10:563-77. [DOI: 10.2217/fca.14.35] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT: Heart failure, a condition that affects up to 20% of older persons residing in long-term care facilities, is an important cause of morbidity, health service utilization and death. Effective and interprofessional heart failure care processes could potentially improve care, outcomes and quality of life and delay decline or hospital admission. This article reviews the clinical aspects of heart failure, and the challenges to the diagnosis and management of this condition in long-term care residents who are frail and are affected by multiple comorbidities.
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Affiliation(s)
- George A Heckman
- Research Institute on Aging, University of Waterloo, BMH 3734, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Veronique M Boscart
- Conestoga College, School for Health & Life Sciences & Community Services, 299 Doon Valley Drive, Kitchener, ON, N2G 4M4, Canada
| | - Robert S McKelvie
- McMaster University & Hamilton Health Sciences, David Braley Cardiac, Vascular & Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
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Morley JE. Adverse events in post-acute care: the Office of the Inspector General's report. J Am Med Dir Assoc 2014; 15:305-6. [PMID: 24726233 DOI: 10.1016/j.jamda.2014.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 11/26/2022]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
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Boxer RS, Dolansky MA, Bodnar CA, Singer ME, Albert JM, Gravenstein S. A randomized trial of heart failure disease management in skilled nursing facilities: design and rationale. J Am Med Dir Assoc 2013; 14:710.e5 -11. [PMID: 23871475 DOI: 10.1016/j.jamda.2013.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 05/29/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Heart failure (HF) disease management can improve health outcomes for older community dwelling patients with heart failure. HF disease management has not been studied in skilled nursing facilities, a major site of transitional care for older adults. METHODS AND ANTICIPATED RESULTS The objective of this trial is to investigate if a HF- disease management program (HF-DMP) in skilled nursing facilities (SNF)s will decrease all-cause rehospitalizations for the first 60 days post-SNF admission. The trial is a randomized cluster trial to be conducted in 12 for-profit SNF in the greater Cleveland area. The study population is inclusive of patients with HF regardless of ejection fraction but excludes those patients on dialysis and with a life expectancy of 6 months or less. The HF-DMP includes 7 elements considered standard of care for patients with HF documentation of left ventricular function, tracking of weight and symptoms, medication titration, discharge instructions, 7-day follow-up appointment post-SNF discharge, and patient education. The HF-DMP is conducted by a research nurse tasked with adhering to each element of the program and regularly audited to maintain fidelity of the program. Additional outcomes include health status, self-care management, and discharge destination. CONCLUSIONS The SNF-Connect Trial is the first trial of its kind to assess if a HF-DMP will improve outcomes for patients in SNFs. This trial will provide evidence on the effectiveness of HF-DMP to improve outcomes for older frail HF patients undergoing postacute rehabilitation.
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Affiliation(s)
- Rebecca S Boxer
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH.
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Dolansky MA, Hitch JA, Piña IL, Boxer RS. Improving heart failure disease management in skilled nursing facilities: lessons learned. Clin Nurs Res 2013; 22:432-47. [PMID: 23606187 DOI: 10.1177/1054773813485088] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of the study was to design and evaluate an improvement project that implemented HF management in four skilled nursing facilities (SNFs). Kotter's Change Management principles were used to guide the implementation. In addition, half of the facilities had an implementation coach who met with facility staff weekly for 4 months and monthly for 5 months. Weekly and monthly audits were performed that documented compliance with eight key aspects of the protocol. Contextual factors were captured using field notes. Adherence to the HF management protocols was variable ranging from 17% to 82%. Facilitators of implementation included staff who championed the project, an implementation coach, and physician involvement. Barriers were high staff turnover and a hierarchal culture. Opportunities exist to integrate HF management protocols to improve SNF care.
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Affiliation(s)
- Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Jung M, Yeh AY, Pressler SJ. Heart Failure and Skilled Nursing Facilities: Review of the Literature. J Card Fail 2012; 18:854-71. [DOI: 10.1016/j.cardfail.2012.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/26/2012] [Accepted: 09/28/2012] [Indexed: 01/11/2023]
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High Technology Coming to a Nursing Home Near You. J Am Med Dir Assoc 2012; 13:409-12. [DOI: 10.1016/j.jamda.2012.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 12/22/2022]
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Aronow WS, Rich MW, Goodlin SJ, Birkner T, Zhang Y, Feller MA, Aban IB, Jones LG, Bearden DM, Allman RM, Ahmed A. In-hospital cardiology consultation and evidence-based care for nursing home residents with heart failure. J Am Med Dir Assoc 2011; 13:448-52. [PMID: 21982687 DOI: 10.1016/j.jamda.2011.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/02/2011] [Accepted: 09/02/2011] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine the association between cardiology consultation and evidence-based care for nursing home (NH) residents with heart failure (HF). PARTICIPANTS Hospitalized NH residents (n = 646) discharged from 106 Alabama hospitals with a primary discharge diagnosis of HF during 1998-2001. DESIGN Observational. MEASUREMENTS OF EVIDENCE-BASED CARE: Preadmission estimation of left ventricular ejection fraction (LVEF) for patients with known HF (n = 494), in-hospital LVEF estimation for HF patients without known LVEF (n = 452), and discharge prescriptions of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs or ARBs) to systolic HF (LVEF <45%) patients discharged alive who were eligible to receive those drugs (n = 83). Eligibility for ACEIs or ARBs was defined as lack of prior allergy or adverse effect, serum creatinine lower than 2.5 mg/dL, serum potassium lower than 5.5 mEq/L, and systolic blood pressure higher than 100 mm Hg. RESULTS Preadmission LVEF was estimated in 38% and 12% of patients receiving and not receiving cardiology consultation, respectively (adjusted odds ratio [AOR], 3.49; 95% CI, 2.16-5.66; P < .001). In-hospital LVEF was estimated in 71% and 28% of patients receiving and not receiving cardiology consultation, respectively (AOR, 6.01; 95% CI, 3.69-9.79; P < .001). ACEIs or ARBs were prescribed to 62% and 82% of patients receiving and not receiving cardiology consultation, respectively (AOR, 0.24; 95% CI, 0.07-0.81; P = .022). CONCLUSION In-hospital cardiology consultation was associated with significantly higher odds of LVEF estimation among NH residents with HF; however, it did not translate into higher odds of discharge prescriptions for ACEIs or ARBs to NH residents with systolic HF who were eligible for the receipt of these drugs.
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