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Dash D, Kirkwood D, Yu-Hin Siu H, Boyd H, Correia RH. Describing Nursing Homes Physicians With Competence or Focused Practice in Caring for Older Adults. J Am Med Dir Assoc 2024:105112. [PMID: 38945173 DOI: 10.1016/j.jamda.2024.105112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | | | - Henry Yu-Hin Siu
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hugh Boyd
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca H Correia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Dash D, Moser A, Feldman S, Saliba D, Bakaev I, Smalbrugge M, Robert B, Karuza J, Heckman G, Katz PR, Costa AP. Focusing on Provider Quality Measurement: Continued Consensus and Feasibility Testing of Practice-Based Quality Measures for Primary Care Providers in Long-Term Care. J Am Med Dir Assoc 2024; 25:189-194. [PMID: 38101456 DOI: 10.1016/j.jamda.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023]
Abstract
Medical providers in long-term care (LTC) use a unique skillset in delivering comprehensive resident care. Publicly reported quality measures (QMs) do not directly emphasize medical provider competency and their role in care. The impact of providers is understudied and to a large extent, unknown. Our objective was to define, test, and validate QMs to pragmatically measure the practice-based quality of medical providers in a pilot study. We included 7 North American LTC homes with data from practicing medical providers for LTC residents. We engaged in a 4-phased approach. In phase 1, experts rated 95 candidate QMs using 5 pragmatic-focused criteria in a RAND-modified Delphi process. Phase 2 involved specifying 37 QMs for collection (4 QMs were dropped during pilot testing). We created an abstraction manual and data collection tool for all QMs. Phase 3 involved a retrospective chart review in 7 LTC homes on 33 QMs with trained data abstractors. Data were sufficient to analyze performance for 26 QMs. Lastly, in phase 4 results and psychometric properties were reviewed with an expert panel. They ranked the tested measures for validity and feasibility for use by a nonphysician auditor to evaluate medical provider performance based on medical record review. In total, we examined data from 343 resident charts from 7 LTC homes and 49 providers. Our process yielded 10 QMs as being specified for measurement, feasible to collect, and had good test performance. This is the only study to systematically identify a subset of QMs for feasible collection from the medical record by various data collectors. This pragmatic approach to measuring practice-based quality and quantifying select medical provider competencies allows for the evaluation of individual and facility-level performance and facilitates quality improvement initiatives. Future work should perform broader testing and validate and refine operationalized QMs.
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Affiliation(s)
- Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrea Moser
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Senior Services and Long-Term Care Division, City of Toronto, Toronto, ON, Canada
| | - Sid Feldman
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Baycrest Health Sciences, Toronto, ON, Canada
| | - Debra Saliba
- University of California Los Angeles, Borun Center at David Geffen School of Medicine, Los Angeles, CA, USA; Geriatric Research, Education, and Clinical Centers, Veterans Administration, Los Angeles, CA, USA; RAND Corporation, Santa Monica, CA, USA
| | - Innokentiy Bakaev
- Department of Medicine, Hebrew SeniorLife, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Benoît Robert
- Perley Health, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, ON, Canada
| | - Jurgis Karuza
- Division of Geriatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - George Heckman
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Paul R Katz
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
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Dash D, Siu H, Kirkwood D, Correia RH, Katz P, Moser A, von Schlegell A, Collins R, Costa AP. Did the Long-Term Care Physician Workforce Change During the Pandemic? Describing MRP Trends in Ontario, Canada. J Am Med Dir Assoc 2023; 24:1042-1047.e1. [PMID: 37160254 DOI: 10.1016/j.jamda.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To examine the practice patterns and trends of long-term care (LTC) physicians between 2019 and 2021 in Ontario, Canada. DESIGN Population-level descriptive time trend study. SETTING AND PARTICIPANTS Most responsible physicians (MRPs) of LTC residents of publicly funded LTC homes in Ontario, Canada, from September 2019 to December 2021. METHODS We examined the number of MRPs in publicly regulated Ontario LTC homes before and during the COVID-19 pandemic using population-level administrative databases. Characteristics of MRPs and practice patterns were generated at baseline and across distinct time periods of the pandemic in descriptive tables. We created a Sankey diagram to visualize MRP practice changes over time. RESULTS More than one-quarter of pre-pandemic MRPs were no longer MRPs by the end of 2021, although most continued to practice in non-LTC settings. There was a decrease from 1444 to 1266 MRPs over time. Other characteristics of MRPs remained stable over the pandemic time periods. At baseline, LTC physicians were MRP for an average of 57.3 residents. By the end of 2021, this caseload decreased to 53.3 residents per MRP. MRPs increasingly billed monthly management compensation fees over the fee-for-service model across the pandemic time periods. The number of MRPs working in an LTC home shifted to fewer MRPs per home. CONCLUSIONS AND IMPLICATIONS MRP demographic characteristics did not change over the course of the pandemic. The observed shifts in practice patterns showed a reduction in the overall LTC MRP workforce, who delivered care to fewer residents on average in LTC homes with fewer colleagues to rely on. Future work can study how changes to LTC MRPs' practice patterns impact physician coverage, access and continuity of care, and health services and quality outcomes among residents.
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Affiliation(s)
- Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Henry Siu
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Rebecca H Correia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paul Katz
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Andrea Moser
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; City of Toronto Senior Services and Long-Term Care Division, Toronto, Ontario, Canada
| | - Ahmed von Schlegell
- Trillium Health Partners, Mississauga, Ontario, Canada; Schlegel Villages, Kitchener, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Rhonda Collins
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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Collins RL, Williams EM, Moser AL, Varughese JM, Robert B. The Role of the Medical Director in Ontario Long-Term Care Homes: Impact of COVID-19. J Am Med Dir Assoc 2022; 23:1603-1607. [PMID: 35944589 PMCID: PMC9289006 DOI: 10.1016/j.jamda.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/20/2022]
Abstract
Objectives The pandemic has uncovered a broad lack of understanding of the role of the Medical Director in Canadian Long-Term Care (LTC) Homes. Our objectives were to identify the current demographics and practices of LTC Medical Directors, discover how the pandemic affected their practice habits, and inform the content of the Ontario Long-Term Care Clinicians Medical Director Course, to ensure that Medical Directors have the requisite knowledge of the responsibilities of their role. Design Email survey. Setting and Participants Medical directors in Ontario long-term care homes. Methods Responses to open-ended, close-ended, multiple-choice, and free-text questions. Results A total of 156 medical directors (approximately 24%) completed the survey. Ninety-four percent were family physicians. Approximately 40% of participants had been a medical director for fewer than 5 years, whereas more than 11% have been in the role for greater than 30 years. More than 60% spend fewer than 2 hours per week in their administrative role, with fewer than 23% completing formal evaluations of the attending clinicians. Greater than 75% are either satisfied or extremely satisfied in their medical director role, citing excellent engagement and collaboration with team members. Feelings of dissatisfaction were associated with pandemic stress, increased hours and responsibility, inadequate remuneration, lack of ability to make decisions and lack of acknowledgement that physicians add value to the interdisciplinary team. Conclusion and Implications It is clear that medical directors are in a unique position to impact the care of residents within LTC. It is imperative to engage medical directors as integral members of the LTC health care team. This can be achieved by acknowledging their medical expertise for improving outcomes, providing them with the authority for decision making, compensating them appropriately, and clearly defining the role. By making these changes, we can ensure that there is a higher likelihood to sustain effective medical leadership in LTC.
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