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Min D, Park S, Kim S, Park HO. Patient Safety in Nursing Homes From an Ecological Perspective: An Integrated Review. J Patient Saf 2024; 20:77-84. [PMID: 38126786 DOI: 10.1097/pts.0000000000001189] [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: 12/23/2023]
Abstract
OBJECTIVES The aims of the study were to identify the systemic factors affecting the characteristics and safety of older adults living in nursing homes and the resulting resident outcomes and to explore the relationship between them through an integrated literature review. METHODS A literature search was conducted from April 22 to May 6, 2021, in the PubMed, Embase, Cochrane CENTRAL, CIHNAL, RISS, NDL, and KoreaMed databases. The following key words and MeSH terms were used for the search: "nursing home," "skilled nursing facility," "long-term care facility," and "patient safety" or "safety." RESULTS Forty-seven qualifying articles were finally selected. Three domains were derived as personal factors, 12 as facility factors, and one as a policy factor. The interrelationships between them could result in positive or negative resident outcomes. The relationship between them was also reconstructed from an ecological perspective. CONCLUSIONS The results demonstrated that the safety and quality of life of older adults living in nursing homes were affected by both individual and institutional factors.
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Affiliation(s)
- Deulle Min
- From the Department of Nursing, College of Medicine, Wonkwang University, Iksan
| | - Seungmi Park
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju
| | - Suhee Kim
- School of Nursing and Research Institute of Nursing Science, Hallym University
| | - Hye Ok Park
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
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2
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Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
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Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
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3
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Carnahan JL, Inger L, Rawl SM, Iloabuchi TC, Clark DO, Callahan CM, Torke AM. Complex Transitions from Skilled Nursing Facility to Home: Patient and Caregiver Perspectives. J Gen Intern Med 2021; 36:1189-1196. [PMID: 33140276 PMCID: PMC8131469 DOI: 10.1007/s11606-020-06332-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients who undergo the complex series of transitions from the hospital to a skilled nursing facility (SNF) back to home represent a unique patient population with multiple comorbidities and impaired functional abilities. The needs and outcomes of patients who are discharged from the hospital to SNF before returning home are understudied in care transitions scholarship. OBJECTIVE To study the patient and caregiver challenges and perspectives on transitions from the hospital to the SNF and back to home. DESIGN Between 48 h and 1 week after discharge from the SNF, semi-structured interviews were performed with a convenience sample of patients and caregivers in their homes. Within 1 to 2 weeks after the baseline interview, follow-up interviews were performed over the phone. PARTICIPANTS A total of 39 interviewees comprised older adults undergoing the series of transitions from hospital to skilled nursing facility to home and their informal caregivers. MAIN MEASURES A constructionist, grounded-theory approach was used to code the interviews, identify major themes and subthemes, and develop a theoretical model explaining the outcomes of the SNF to home transition. KEY RESULTS The mean age of the patients was 76.6 years and 64.8 years for the caregivers. Four major themes were identified: comforts of home, information needs, post-SNF care, and independence. Patients noted an extended time away from home and were motivated to return to and remain in the home. Information needs were variably met and affected post-SNF care, including medication management, appointments, and therapy gains and setbacks. Interviewees identified independent function at home as the most important outcome of the transition home. CONCLUSIONS Post-SNF in home support is needed rapidly after discharge from the SNF to prevent adverse outcomes. In-home support needs to be highly individualized based on a patient's and caregiver's unique situation and needs.
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Affiliation(s)
- Jennifer L Carnahan
- Indiana University Center for Aging Research, Indianapolis, IN, USA. .,Regenstrief Institute, Inc., Indianapolis, IN, USA. .,Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Lev Inger
- Parkview Research Center, Fort Wayne, IN, USA
| | - Susan M Rawl
- Indiana University School of Nursing, Indianapolis, IN, USA.,Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - Daniel O Clark
- Indiana University Center for Aging Research, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher M Callahan
- Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alexia M Torke
- Indiana University Center for Aging Research, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana University School of Nursing, Indianapolis, IN, USA.,Daniel F Evans Center for Spiritual and Religious Values in Healthcare, Indianapolis, IN, USA
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4
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Keniston A, McBeth L, Pell J, Bowden K, Ball S, Stoebner K, Scherzberg E, Moore SL, Nordhagen J, Anthony A, Burden M. Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach. JMIR Hum Factors 2021; 8:e24038. [PMID: 33890860 PMCID: PMC8105757 DOI: 10.2196/24038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/16/2021] [Accepted: 03/29/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Typical solutions for improving discharge planning often rely on one-way communication mechanisms, static data entry into the electronic health record (EHR), or in-person meetings. Lack of timely and effective communication can adversely affect patients and their care teams. OBJECTIVE Applying robust user-centered design strategies, we aimed to design an innovative EHR-based discharge readiness communication tool (the Discharge Today tool) to enable care teams to communicate any barriers to discharge, the status of patient discharge readiness, and patient discharge needs in real time across hospital settings. METHODS We employed multiple user-centered design strategies, including exploration of the current state for documenting discharge readiness and directing discharge planning, iterative low-fidelity prototypes, multidisciplinary stakeholder meetings, a brainwriting premortem exercise, and preproduction user testing. We iteratively collected feedback from users via meetings and surveys. RESULTS We conducted 28 meetings with 20 different stakeholder groups. From these stakeholder meetings, we developed 14 low-fidelity prototypes prior to deploying the Discharge Today tool for our pilot study. During the pilot study, stakeholders requested 46 modifications, of which 25 (54%) were successfully executed. We found that most providers who responded to the survey reported that the tool either saved time or did not change the amount of time required to complete their discharge workflow (21/24, 88%). Responses to open-ended questions offered both positive feedback and opportunities for improvement in the domains of efficiency, integration into workflow, avoidance of redundancies, expedited communication, and patient-centeredness. CONCLUSIONS Survey data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool.
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Affiliation(s)
- Angela Keniston
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Lauren McBeth
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Jonathan Pell
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Kasey Bowden
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | | | | | | | - Susan L Moore
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | | | - Marisha Burden
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
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5
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Shi X, Geng G, Hua J, Cui M, Xiao Y, Xie J. Development of an informational support questionnaire of transitional care for aged patients with chronic disease. BMJ Open 2020; 10:e036573. [PMID: 33203624 PMCID: PMC7674111 DOI: 10.1136/bmjopen-2019-036573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We developed an informational support questionnaire of transitional care (ISQTC) for aged patients with chronic disease and investigated its reliability and validity. SETTING This study was conducted in three large general hospitals in Nantong, Jiangsu Province, China. PARTICIPANTS A total of 130 aged patients with chronic diseases, admitted into outpatient and inpatient departments from three hospitals in China, participated in the study. The inclusion criteria were: (1) patients must provide consent to participate; (2) being 60 years and above; (3) being diagnosed with at least one chronic disease and hospitalised more than two times within the last 1 year; (4) being able to listen, speak, read and write. The exclusion criteria were: (1) refusing to participate; (2) language expression and communication barriers (and having no caregiver to assist in participation); (3) being in intensive care or long-term hospitalisation. PRIMARY AND SECONDARY OUTCOME MEASURES The developed questionnaire was validated and tested for reliability. The content validity of the questionnaire was determined through experts' interviews and Delphi expert consultation, and the structure validity of the questionnaire was determined by performing exploratory factor analysis. The coefficient of reliability of the questionnaire was measured using Cronbach's alpha. RESULTS Through Delphi expert consultation and exploratory factor analysis, the questionnaire was reduced from four dimensions and 12 items to three dimensions and 11 items. A total of 130 patients responded to the questionnaire. The alpha coefficient was 0.747. CONCLUSION The ISQTC is a reliable and valid instrument for evaluating aged patients with chronic disease in transitional care. TRIAL REGISTRATION DETAILS ChiCTR1900020923. The trial was registered on 22 January 2019.
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Affiliation(s)
- Xiaoliu Shi
- School of Medical, Nantong University, Nantong, Jiangsu, China
| | - Guiling Geng
- School of Medical, Nantong University, Nantong, Jiangsu, China
| | - Jianing Hua
- School of Medical, Nantong University, Nantong, Jiangsu, China
| | - Min Cui
- School of Medical, Nantong University, Nantong, Jiangsu, China
| | - Yuhua Xiao
- Affiliated Hospital of Nantong University, Nantong, China
| | - Juan Xie
- Department of Information Management, Affiliated Hospital of Nantong University, Nantong, China
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Kapoor A, Field T, Handler S, Fisher K, Saphirak C, Crawford S, Fouayzi H, Johnson F, Spenard A, Zhang N, Gurwitz JH. Characteristics of Long‐Term Care Residents That Predict Adverse Events after Hospitalization. J Am Geriatr Soc 2020; 68:2551-2557. [DOI: 10.1111/jgs.16770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Alok Kapoor
- University of Massachusetts Medical School Worcester Massachusetts
- Meyers Primary Care Institute Worcester Massachusetts
| | - Terry Field
- University of Massachusetts Medical School Worcester Massachusetts
- Meyers Primary Care Institute Worcester Massachusetts
| | | | - Kimberly Fisher
- University of Massachusetts Medical School Worcester Massachusetts
- Meyers Primary Care Institute Worcester Massachusetts
| | | | - Sybil Crawford
- University of Massachusetts Medical School Worcester Massachusetts
- Meyers Primary Care Institute Worcester Massachusetts
| | | | | | | | - Ning Zhang
- University of Massachusetts Medical School Worcester Massachusetts
- Meyers Primary Care Institute Worcester Massachusetts
- University of Massachusetts Amherst Massachusetts
| | - Jerry H. Gurwitz
- University of Massachusetts Medical School Worcester Massachusetts
- Meyers Primary Care Institute Worcester Massachusetts
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7
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Baumgartner AD, Clark CM, LaValley SA, Monte SV, Wahler RG, Singh R. Interventions to deprescribe potentially inappropriate medications in the elderly: Lost in translation? J Clin Pharm Ther 2020; 45:453-461. [PMID: 31873955 PMCID: PMC7200270 DOI: 10.1111/jcpt.13103] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/19/2019] [Accepted: 11/29/2019] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Use of potentially inappropriate medications (PIMs) remains common in older adults, despite the easy availability of screening tools such as the Beers and Screening Tool of Older Person's Prescriptions (STOPP) criteria. Multiple published studies have implemented these screening tools to encourage deprescribing of PIMs, with mixed results. Little is known about the reasons behind the success or failure of these interventions, or what could be done to improve their impact. Implementation science (IS) provides a set of theories, models and frameworks to address these questions. The goal of this study was to conduct a focused narrative review of the deprescribing literature through an IS lens-to determine the extent to which implementation factors were identified and the intermediate steps in the intervention were measured. A better understanding of the existing literature, including its gaps, may provide a roadmap for future research. METHODS PubMed search from 2000-2019 using appropriate MeSH headings. INCLUSION CRITERIA controlled trials or prospective cohort studies intended to reduce PIMs in the elderly that used hospitalizations and/or emergency department visits as outcome measures. Studies were reviewed to identify potential implementation factors (known as determinants), using the Consolidated Framework for Implementation Research (CFIR) as a guide. In addition, intermediate outcomes were extracted. RESULTS AND DISCUSSION Of the 548 reviewed abstracts, 14 studies met the inclusion criteria and underwent detailed analysis. Of the 14 studies, 10 acknowledged potential implementation determinants that could be mapped onto CFIR. The most commonly identified determinant was the degree of pharmacist integration into the medical team (seven of 14 studies), which mapped onto the CFIR construct of 'networks and communication'. Several important CFIR constructs were absent in the reviewed literature. Intermediate measures were captured by 12 of the 14 reviewed papers, but the choice of measures was inconsistent across studies. WHAT IS NEW AND CONCLUSION In recent high-quality studies of deprescribing interventions, we found limited acknowledgement of factors known to be important to successful implementation and inconsistent reporting of intermediate outcomes. These findings indicate missed opportunities to understand the factors underlying study outcomes. As a result, we run the risk of rejecting worthwhile interventions due to negative results, when the correct interpretation might be that they failed in implementation. In other words, they were 'lost in translation'. Studies that rigorously examine and report on the implementation process are needed to tease apart this important distinction.
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Affiliation(s)
- Andrew D Baumgartner
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Collin M Clark
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Susan A LaValley
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Scott V Monte
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Robert G Wahler
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Ranjit Singh
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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8
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Mobility Improvement and Rehospitalization Risk Following Discharge From Skilled Nursing Facility. TOPICS IN GERIATRIC REHABILITATION 2020. [DOI: 10.1097/tgr.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Martins MMFPDS, Trindade LDL, Vandresen L, Leite MJMGC, Pereira CMG, Landeiro MJL. Technologies used by nursing managers in Portuguese hospitals. Rev Gaucha Enferm 2020; 41:e20190294. [DOI: 10.1590/1983-1447.2020.20190294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/06/2020] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To analyze the association between the characteristics of nurse managers and the use of information technologies in Portuguese hospitals. Method: A cross-sectional quantitative study involving 138 nurse managers. The managers answered a questionnaire about the use of key information and communication technologies in management. The findings were submitted to descriptive and analytical statistical analysis. Results: Women predominated, with more than 25 years in the profession and more than ten in management. It showed that the managers identify the utility and easiness of a singular way for each technology, the use of which is influenced by the nurses' socio-occupational characteristics, their gender, specialization (having it or not), and the time of experience in services and management being significant. Conclusion: The study contributes to explain and predict the intention to use, as well as the mastery of technologies in hospital management, providing support of choice in the management of services and need for qualification for use.
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Affiliation(s)
| | - Letícia de Lima Trindade
- Universidade do Estado de Santa Catarina, Brasil; Universidade Comunitária da Região de Chapecó, Brasil
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10
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Kapoor A, Field T, Handler S, Fisher K, Saphirak C, Crawford S, Fouayzi H, Johnson F, Spenard A, Zhang N, Gurwitz JH. Adverse Events in Long-term Care Residents Transitioning From Hospital Back to Nursing Home. JAMA Intern Med 2019; 179:1254-1261. [PMID: 31329223 PMCID: PMC6646976 DOI: 10.1001/jamainternmed.2019.2005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Transition from hospital to nursing home is a high-risk period for adverse events in long-term care (LTC) residents. Adverse events include harms from medical care, including failure to provide appropriate care. OBJECTIVE To report the incidence, type, severity, and preventability of adverse events in LTC residents transitioning from hospital back to the same LTC facility. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of LTC residents discharged from hospital back to LTC from March 1, 2016, to December 31, 2017, and followed up for 45 days. In a random sample of 32 nursing homes located in 6 New England states, 555 LTC residents were selected, contributing 762 transitions from hospital back to the same LTC facility. MAIN OUTCOMES AND MEASURES The main outcome was an adverse event within the 45-day period after transition from hospital back to nursing home. Trained nurse abstractors reviewed nursing home records for the period, and then 2 physicians independently reviewed each potential adverse event to determine whether harm occurred and to characterize the type, severity, and preventability of each event. When reviewers disagreed, they met to reach consensus. RESULTS Of the 555 individual residents, 365 (65.6%) were female, and the mean (SD) age at the time of discharge was 82.2 (11.5) years. Five hundred twenty (93.7%) were non-Hispanic white, 21 (3.8%) were non-Hispanic black, 9 (1.6%) were Hispanic, and 5 (0.9%) were of other non-Hispanic race/ethnicity. In the cohort, there were 379 adverse events among 762 discharges. One hundred ninety-seven events (52.0%) related to resident care, with pressure ulcers, skin tears, and falls with injury representing the most common types of events in this category. Health care-acquired infections (108 [28.5%]) and adverse drug events (64 [16.9%]) were the next most common. One hundred ninety-eight (52.2%) adverse events were characterized as less serious. However, 145 (38.3%) events were deemed serious, 28 (7.4%) life-threatening, and 8 (2.1%) fatal. In terms of preventability, 267 (70.4%) adverse events were found to be preventable or ameliorable, with less serious events more often considered preventable or ameliorable (146 [73.7%]) compared with more severe events (121 [66.9%]). In addition, resident care-related adverse events such as fall with injury, skin tear, and pressure ulcer were more commonly deemed preventable (173 of 197 [87.8%]) compared with adverse drug events (39 of 64 [60.9%]) or health care-acquired infections (49 of 108 [45.4%]). CONCLUSIONS AND RELEVANCE Adverse events developed in nearly 4 of 10 of discharges from hospital back to LTC. Most were preventable or ameliorable. Standardized reporting of events and better coordination and information transfer across settings are potential ways to prevent adverse events in LTC residents.
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Affiliation(s)
- Alok Kapoor
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Terry Field
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Steven Handler
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kimberly Fisher
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | | | - Sybil Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | | | | | | | - Ning Zhang
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts.,School of Public Health and Health Sciences, University of Massachusetts, Amherst
| | - Jerry H Gurwitz
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
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11
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Morley JE. A Decade of JAMDA. J Am Med Dir Assoc 2017; 18:993-997. [PMID: 29169742 DOI: 10.1016/j.jamda.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO.
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12
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Hsieh YP, Huang YC, Lan SJ, Ho CS. Factors related to the decision-making for moving the older adults into long-term care facilities in Taiwan. Geriatr Gerontol Int 2016; 17:1319-1327. [PMID: 27578367 DOI: 10.1111/ggi.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/07/2016] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
Abstract
AIM To investigate the relationships between demographic characteristics of the elderly, type of long-term care (LTC) facilities, and the reasons for moving into LTC facilities. METHODS Research participants included people aged over 65 years, living in LTC facilities. A total of 1280 questionnaires were distributed to 111 LTC facilities in Taiwan; 480 questionnaires were retrieved, and 232 were included in the valid sample. The study used a non-linear canonical correlation analysis, which assesses the relationships among similar sets of categorical variables. RESULTS The results showed that the older adults in quadrant I were characterized by being involved in the decision-making regarding the choice of LTC facilities and received economic support from their children. The older adults in quadrant II mainly lived in LTC facilities to receive medical care, whereas those in quadrant III typically included individuals with low income, who did not choose to live in LTC facilities. Furthermore, those in quadrant IV had positive cognitions associated with LTC facilities. CONCLUSIONS We believe that the results of the present study will facilitate policy-making in the field of LTC, provide reference to the practitioners and the older adults, and identify the types of decisions older adults make when moving into LTC facilities, thus assisting older adults to improve their strategies regarding staying in LTC facilities. Geriatr Gerontol Int 2017; 17: 1319-1327.
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Affiliation(s)
- Yen-Ping Hsieh
- Department of Long Term Care, National Quemoy University, Kinmen, Taiwan
| | - Ying-Chia Huang
- Medical and Pharmaceutical Industry Technology and Development Center, New Taipei City, Taiwan
| | - Shou-Jen Lan
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Ching-Sung Ho
- Department of Long Term Care, National Quemoy University, Kinmen, Taiwan
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13
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Simmons SF, Schnelle JF, Sathe NA, Slagle JM, Stevenson DG, Carlo ME, McPheeters ML. Defining Safety in the Nursing Home Setting: Implications for Future Research. J Am Med Dir Assoc 2016; 17:473-81. [DOI: 10.1016/j.jamda.2016.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 12/21/2022]
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