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Bayer TA, Jiang L, Singh M, Kunicki ZJ, Browne JW, Nubong T, Kelso CM, McGeary JE, Wu WC, Rudolph JL. Skilled Nursing Facility Rehabilitation Intensity and Successful Discharge in Persons with Dementia. J Am Med Dir Assoc 2024; 25:105286. [PMID: 39341605 DOI: 10.1016/j.jamda.2024.105286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/22/2024] [Accepted: 08/25/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVES Skilled therapies (STs), including audiology, speech-language therapy, occupational therapy, and physical therapy, can address functional deficits in dementia. This study aims to quantify the association between ST and successful discharge after heart failure (HF) hospitalization in persons living with dementia. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We included veterans with dementia (VwD) hospitalized for HF in Veterans Affairs (VA) medical centers and then admitted to non-VA skilled nursing facilities (SNFs) from January 2011 to June 2019. METHODS Follow-up continued 120 days after SNF admission. We measured ST hours per week using MDS admission assessments. We defined successful discharge as SNF discharge occurring within 90 days of SNF admission with MDS discharge status not hospital or institutional setting, and 30 days' survival after discharge without Medicare or VA-paid rehospitalization or reinstitutionalization. We estimated relative risk using multiple variable regression to adjust for measured sources of confounding. RESULTS Our final sample included 8255 VwD. The mean (SD) age was 80 (10) years, and 8074 (98%) were male. Successful discharge occurred in 2776 (34%) of the sample. The median (IQR) weekly hours of ST was 10.4 (7.1-12.1). Sextile 1 received less than 5.2 hours per week of ST. The adjusted relative risk (95% CI) for sextiles 2-6 compared with sextile 1 were, respectively, 2.20 (1.85-2.62), 2.48 (2.09-2.94), 2.52 (2.12-2.99), 2.62 (2.21-3.11), and 2.69 (2.27-3.19). DISCUSSION During SNF care after HF hospitalization, 5.3 or more hours of STs per week was associated with a higher rate of successful discharge, in a roughly dose-dependent fashion, up to a 170% increase in the highest sextile of ST hours. CONCLUSIONS AND IMPLICATIONS Higher ST hours are associated with successful discharge from SNF after HF hospitalization.
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Affiliation(s)
- Thomas A Bayer
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA; Warren Alpert Medical School of Brown University, Division of Geriatrics and Palliative Medicine, Providence, RI, USA.
| | - Lan Jiang
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA
| | - Mriganka Singh
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA; Warren Alpert Medical School of Brown University, Division of Geriatrics and Palliative Medicine, Providence, RI, USA; Brown School of Public Health, Department of Health Services Policy, and Practice, Providence, RI, USA
| | - Zachary J Kunicki
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Julia W Browne
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | | | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Seattle, WA, USA
| | - John E McGeary
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - Wen-Chih Wu
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA; Brown School of Public Health, Department of Health Services Policy, and Practice, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - James L Rudolph
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA; Warren Alpert Medical School of Brown University, Division of Geriatrics and Palliative Medicine, Providence, RI, USA; Brown School of Public Health, Department of Health Services Policy, and Practice, Providence, RI, USA
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Kelly E, Spina E, Liantonio J. Comparative Analysis of Palliative Care Needs Identified in Inpatient Rehabilitation and Skilled Nursing Facilities by Multidisciplinary Team Members. Arch Phys Med Rehabil 2023; 104:2027-2034. [PMID: 37331422 DOI: 10.1016/j.apmr.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Assess access to, need for, and beliefs surrounding specialized palliative care (PC). DESIGN Observational, comparative analysis needs assessment survey. SETTING Four inpatient rehabilitation facilities (IRFs) or skilled nursing facilities with long-term care (SNFs/LTC) that provide subacute rehabilitation within 1 tertiary care system. PARTICIPANTS Allied health professionals, physicians, nursing, case managers, social workers, spiritual care (n=198). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Frequency of patient needs, attitudes about current systems, individual beliefs, and barriers to PC. Confidence in management, communicating, and navigating primary PC competencies among clinical pathway employees. RESULTS Of 198 respondents, 37% said PC was available at their facility. Those in IRF reported higher frequencies of grief/unmet spiritual needs of patients compared with SNF/LTC (P≤.001). Conversely, SNF/LTC reported higher frequencies of agitation, poor appetite, and end-of-life care (P≤.003). Respondents in SNF/LTC felt more confident managing end-of-life care, explaining what hospice and PC are and appropriateness for referral to each, discussing advance directives, determining appropriate decision-makers, and navigating ethical decisions than in IRFs (P≤.007). SNF/LTC participants reported higher effectiveness of their current system involving PC and ease of hospice transition compared with IRFs (P≤.008). A majority agreed that PC does not take away patient hope, could prevent recurrent hospitalizations, improve symptom management, communication, and patient and family satisfaction. The most common reported barriers to PC consultation were (1) attitudes and beliefs of staff or patients and families, (2) system issues with access, cost, or prognosis communication, and (3) lack of understanding of PC role. CONCLUSIONS A gap exists in PC access in IRF and SNF/LTC despite patient needs and staff beliefs. Future studies should focus on identifying which patients should be referred to PC in the post-acute setting and what outcomes can be used as a guide to meet the needs of this growing area of practice.
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Affiliation(s)
- Erin Kelly
- Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Elizabeth Spina
- Division of Palliative Care, Rochester Regional Health, Rochester, NY
| | - John Liantonio
- Department of Family Medicine, Division of Palliative Care, Thomas Jefferson University Hospital, Philadelphia, PA
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Meulenbroeks I, Seaman K, Raban MZ, Westbrook J. Allied health in residential aged care: Using routinely collected data to improve funding opportunities. Australas J Ageing 2023; 42:221-224. [PMID: 36069478 PMCID: PMC10946826 DOI: 10.1111/ajag.13136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
Consumers and providers have long been advocating for increased access to and delivery of allied health services in Australian residential aged care (RAC). There is significant evidence that allied health interventions are effective; however, there is limited evidence on the benefit of routine day-to-day allied health service delivery in RAC. This information is critical to effectively inform funders and policy advisors of the necessity of allied health in RAC. To improve arguments for future funding opportunities, providers, facilities and consumers need to partner together to use routinely collected, yet disparate, data, in electronic health and billing records, to improve data collection practices and evidence generation on allied health in aged care.
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Affiliation(s)
- Isabelle Meulenbroeks
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Karla Seaman
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Magdalena Z. Raban
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Johanna Westbrook
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
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Temkin‐Greener H, Yan D, Cai S. Post-acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status. Health Serv Res 2023; 58:164-173. [PMID: 36054521 PMCID: PMC9836959 DOI: 10.1111/1475-6773.14059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate how post-acute care (PAC) transitions affect minority older adults with Alzheimer's disease or related dementia (ADRD), and the extent to which dual Medicare-Medicaid eligibility may attenuate or exacerbate disparities in PAC outcomes. We examined: (1) PAC referrals by race/ethnicity and dual status; (2) individual, hospital, and market-level factors associated with PAC; (3) the association between PAC and outcomes. DATA SOURCES/STUDY SETTING We used the following secondary data: Master Beneficiary Summary File (MBSF), Medicare Provider Analysis and Review (MedPAR), Minimum Data Set (MDS), Area Health Resource File (AHRF), hospital Provider of Services (POS) file, and the area deprivation index (ADI). STUDY DESIGN This observational study consisted of 619,262 community-residing Medicare fee-for-service (FFS) beneficiaries with ADRD who had a hospital stay in 2017. DATA COLLECTION/EXTRACTION METHODS PAC discharge was to skilled nursing facilities (SNF), home health care (HHC) agencies or home without services. Outcomes were 30-day readmission and death. Multinomial logistic regressions with hospital random effects (RE), stratified by dual eligibility, were fit. PRINCIPAL FINDINGS Dual-related differences were significantly larger than race/ethnicity differences in PAC transitions. For example, the difference in the probability of SNF transitions between White and Black patients was 3.2% and 6.8%-points for non-duals and duals, respectively. The difference between non-dual/dual White patients was 21.6% points, and among Black patients 18.0%-points. The adjusted risk of 30-day readmission was 5.6 percentage point higher among non-duals discharged to SNF, compared to home, but such risk among duals was not statistically significantly different. The adjusted probabilities of 30-day mortality were larger for duals and non-duals who transitioned to SNF, compared to those discharged home. CONCLUSIONS PAC referrals and the resulting outcomes for Medicare beneficiaries with ADRD are associated with multi-level variables that need to be incorporated in discharge decision making.
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Affiliation(s)
- Helena Temkin‐Greener
- Department of Public Health SciencesUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Di Yan
- Department of Public Health SciencesUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Shubing Cai
- Department of Public Health SciencesUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
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Meulenbroeks I, Raban MZ, Seaman K, Westbrook J. Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review. BMC Geriatr 2022; 22:712. [PMID: 36031624 PMCID: PMC9420184 DOI: 10.1186/s12877-022-03386-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality. Methods Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist. Results Twenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n = 9), allied health assistants (n = 9), and social workers (n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies. Conclusion Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03386-9.
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Carpenter JG. Forced to Choose: When Medicare Policy Disrupts End-of-Life Care. J Aging Soc Policy 2022; 34:661-668. [PMID: 32223534 PMCID: PMC7679051 DOI: 10.1080/08959420.2020.1745737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
In the last six months of life, 30% of Medicare beneficiaries use the skilled nursing facility (SNF) benefit for post-acute care after a hospital stay. Frequently, the circumstances that indicate a need for SNF care are the same as those of a worsening illness trajectory such as functional decline and falls, unstable health conditions, and pain and other symptoms. The following case example and narrative discussion describes the national implications of this issue and the need for Medicare policy changes that allow for concurrent rehabilitative care and hospice services.
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Affiliation(s)
- Joan G Carpenter
- University of Pennsylvania School of Nursing and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Nursing Leadership and Palliative Care in Long-Term Care for Residents with Advanced Dementia. Nurs Clin North Am 2022; 57:259-271. [DOI: 10.1016/j.cnur.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Carpenter JG, Hanson LC, Hodgson N, Murray A, Hippe DS, Polissar NL, Ersek M. Implementing Primary Palliative Care in Post-acute nursing home care: Protocol for an embedded pilot pragmatic trial. Contemp Clin Trials Commun 2021; 23:100822. [PMID: 34381919 PMCID: PMC8340123 DOI: 10.1016/j.conctc.2021.100822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/10/2021] [Accepted: 07/24/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Older adults with serious illness frequently receive post-acute rehabilitative care in nursing homes (NH) under the Part A Medicare Skilled Nursing Facility (SNF) Benefit. Treatment is commonly focused on disease-modifying therapies with minimal consideration for goals of care, symptom relief, and other elements of palliative care. INTERVENTION The evidence-based Primary Palliative Care in Post-Acute Care (PPC-PAC) intervention for older adults is delivered by nurse practitioners (NP). PPC-PAC NPs assess and manage symptoms, conduct goals of care discussions and assist with decision making; they communicate findings with NH staff and providers. Implementation of PPC-PAC includes online and face-to-face training of NPs, ongoing facilitation, and a template embedded in the NH electronic health record to document PPC-PAC. OBJECTIVES The objectives of this pilot pragmatic clinical trial are to assess the feasibility, acceptability, and preliminary effectiveness of the PPC-PAC intervention and its implementation for 80 seriously ill older adults newly admitted to a NH for post-acute care. METHODS Design is a two-arm nonequivalent group multi-site pilot pragmatic clinical trial. The unit of assignment is at the NP and unit of analysis is NH patients. Recruitment occurs at NHs in Pennsylvania, New Jersey, Delaware, and Maryland. Effectiveness (patient quality of life) data are collected at two times points-baseline and 14-21 days. CONCLUSION This will be the first study to evaluate the implementation of an evidence-based primary palliative care intervention specifically designed for older adults with serious illness who are receiving post-acute NH care.
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Affiliation(s)
- Joan G. Carpenter
- University of Maryland School of Nursing, Baltimore, MD, USA
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Laura C. Hanson
- Division of Geriatric Medicine & Palliative Care Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nancy Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Andrew Murray
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Daniel S. Hippe
- The Mountain Whisper Light Statistics $ Data Science, Seattle, WA, USA
| | - Nayak L. Polissar
- The Mountain Whisper Light Statistics $ Data Science, Seattle, WA, USA
| | - Mary Ersek
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Tark A, Agarwal M, Dick AW, Song J, Stone PW. Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident's Place of Death. Am J Hosp Palliat Care 2020; 38:812-822. [PMID: 32878457 DOI: 10.1177/1049909120956650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Physician Orders for Life-Sustaining Treatment (POLST) program was developed to enhance quality of care delivered at End-of-Life (EoL). Although positive impacts of the POLST program have been identified, the association between a program maturity status and nursing home resident's likelihood of dying in their current care settings remain unanswered. This study aims to evaluate the impact of the POLST program maturity status on nursing home residents' place of death. Using multiple national-level datasets, we examined total 595,152 residents and their place of death. The result showed that the long-stay residents living in states where the program was mature status had 12% increased odds of dying in nursing homes compared that of non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes. The findings demonstrate that a well-structured and well-disseminated POLST program, combined with a continued effort to meet high standards of quality EoL care, can bring out positive health outcomes for elderly patients residing in care settings.
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Affiliation(s)
- Aluem Tark
- Columbia University School of Nursing, New York, NY, USA.,4083University of Iowa College of Nursing, Iowa City, IA, USA
| | - Mansi Agarwal
- Columbia University School of Nursing, New York, NY, USA
| | | | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
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Wang J, Yu F, Cai X, Caprio TV, Li Y. Functional outcome in home health: Do racial and ethnic minority patients with dementia fare worse? PLoS One 2020; 15:e0233650. [PMID: 32453771 PMCID: PMC7250428 DOI: 10.1371/journal.pone.0233650] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Evaluate the independent and interactive effects of dementia and racial/ethnic minority status on functional outcomes during a home health (HH) admission among Medicare beneficiaries. Methods Secondary analysis of data from the Outcome and Assessment Information Set [OASIS] and billing records in a non-profit HH agency in New York. Participants were adults ≥ 65 years old who received HH in CY 2017 with OASIS records at HH admission and HH discharge. Dementia was identified by diagnosis (ICD-10 codes) and cognitive impairment (OASIS: M1700, M1710, M1740). We used OASIS records to assess race/ethnicity (M0140) and functional status (M1800-M1870 on activities of daily living [ADL]). Functional outcome was measured as change in the composite ADL score from HH admission to HH discharge, where a negative score means improvement and a positive score means decline. Results The sample included 4,783 patients, among whom 93.9% improved in ADLs at HH discharge. In multivariable linear regression that adjusted for HH service use and covariates (R2 = 0.23), being African American (β = 0.21, 95% confidence interval [CI]: 0.06, 0.35, p = 0.005) and having dementia (β = 0.51, 95% CI: 0.41, 0.62, p<0.001) were independently related to less ADL improvement at HH discharge, with significant interaction related to further decrease in ADL improvement. Relative to white patients without dementia, African American patients with dementia (β = 1.08, 95% CI: 0.81, 1.35, p<0.001), Hispanics with dementia (β = 0.92, 95% CI: 0.38, 1.47, p = 0.001) and Asian Americans with dementia (β = 1.47, 95% CI: 0.81, 2.13, p<0.001) showed the least ADL improvement at HH discharge. Conclusion Racial/ethnic minority status and dementia were associated with less ADL improvement in HH with independent and interactive effects. Policies should ensure that these patients have equitable access to appropriate, adequate community-based services to meet their needs in ADLs and disease management for improved outcomes.
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Affiliation(s)
- Jinjiao Wang
- School of Nursing, University of Rochester, Rochester, NY, United States of America
- * E-mail:
| | - Fang Yu
- School of Nursing, University of Minnesota, Minneapolis, MN, United States of America
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States of America
| | - Thomas V. Caprio
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
- University of Rochester Medical Home Care, Rochester, NY, United States of America
- Finger Lakes Geriatric Education Center, Rochester, NY, United States of America
| | - Yue Li
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States of America
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Carpenter JG, Lam K, Ritter AZ, Ersek M. A Systematic Review of Nursing Home Palliative Care Interventions: Characteristics and Outcomes. J Am Med Dir Assoc 2020; 21:583-596.e2. [PMID: 31924556 DOI: 10.1016/j.jamda.2019.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/11/2019] [Accepted: 11/20/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal. OBJECTIVE To examine the characteristics and effectiveness of nursing home interventions that incorporated multiple palliative care domains (eg, physical aspects of care-symptom management, and ethical aspects-advance care planning). DESIGN Systematic review. METHODS We searched MEDLINE via PubMed, Embase, CINAHL, and Cochrane Library's CENTRAL from inception through January 2019. We included all randomized and nonrandomized trials that compared palliative care to usual care and an active comparator. We assessed the type of intervention, outcomes, and the risk of bias. RESULTS We screened 1167 records for eligibility and included 13 articles. Most interventions focused on staff education and training strategies and on implementing a palliative care team. Many interventions integrated advance care planning initiatives into the intervention. We found that palliative care interventions in nursing homes may enhance palliative care practices, including processes to assess and manage pain and symptoms. However, inconsistent outcomes and high or unclear risk of bias among most studies requires results to be interpreted with caution. CONCLUSIONS AND IMPLICATIONS Heterogeneity in methodology, findings, and study bias within the existing literature revealed limited evidence for nursing home palliative care interventions. Findings from a small group of diverse clinical trials suggest that interventions enhanced nursing home palliative care and improved symptom assessment and management processes.
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Affiliation(s)
- Joan G Carpenter
- University of Pennsylvania School of Nursing, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.
| | - Karissa Lam
- University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Ashley Z Ritter
- University of Pennsylvania National Clinician Scholars Program, Philadelphia, PA
| | - Mary Ersek
- University of Pennsylvania School of Nursing, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Construction and Validation of Risk-adjusted Rates of Emergency Department Visits for Long-stay Nursing Home Residents. Med Care 2019; 58:174-182. [DOI: 10.1097/mlr.0000000000001246] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abrahamson K, Mueller C, Duan Y, Cooke V. Heightening Person-Centered Care Processes in the Delivery of Nursing Restorative Care. J Gerontol Nurs 2019; 45:5-10. [PMID: 31026326 DOI: 10.3928/00989134-20190328-03] [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: 11/20/2022]
Abstract
The objective of the current study was to investigate the perspectives of nursing home (NH) providers regarding the requirements to achieve reimbursement for nursing restorative care (NRC) services and propose recommendations to state agencies to assist NH providers to conduct NRC programs that are person-centered and able to achieve full reimbursement. Methods included a survey of NH providers in one state and a stakeholder focus group to discuss survey findings and develop recommendations. Key findings are that NH providers perceive value to residents from the provision of NRC; providers do not associate these benefits with the stringent reimbursement requirements; and NHs often provide NRC that is individualized, based on resident goals and activity tolerance, as well as realistic given competing demands on staff, even when doing so means giving up reimbursement for NRC services. Recommendations include basing reimbursement for NRC on outcomes rather than the process; reconsideration of the frequency and intensity requirements for NRC components; and increased availability of NRC training/education and resources for providers and case-mix reviewers. [Journal of Gerontological Nursing, 45(5), 5-10.].
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Sloane PD, Katz PR, Zimmerman S. The Changing Landscape of Post-acute and Rehabilitative Care. J Am Med Dir Assoc 2019; 20:389-391. [DOI: 10.1016/j.jamda.2019.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/17/2022]
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