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Shin JH, Jung SO, Min EJ. Factors Influencing Hospitalization of Nursing Home Residents in Korea Using Regularized Negative Binomial Regression. Policy Polit Nurs Pract 2024; 25:141-151. [PMID: 38874520 DOI: 10.1177/15271544241259427] [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] [Indexed: 06/15/2024]
Abstract
The appropriateness of hospitalization for nursing home (NH) residents is still up for debate, with determining factors including timeliness, available treatment, healthcare staff, medication options in hospitals, and safety issues. Although the factors leading to hospitalization have been studied expansively, research on staffing is limited. Thus, this study aimed to investigate organizational predictors, nurse staffing, and government incentives and find important factors to hospitalization due to infection or disease among NH residents in Korea. A cross-sectional design was used, and data were collected via survey from a total of 51 NHs from August 27, 2021 to March 25, 2022. A total of 32 explanatory variables were included. The response variable was the count of hospitalized residents due to infection or disease. We analyzed data using least absolute shrinkage and negative binomial regression. We found that registered nurses' increased hours per resident day were related to decreased hospitalizations due to infection or disease. Appropriate retention and recruitment of nurse staffing with professional leadership should be performed to increase the quality of care for NH residents.
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Affiliation(s)
- Juh H Shin
- School of Nursing, George Washington University, USA
| | - Sun O Jung
- College of Nursing, Ewha Womans University, Korea
| | - Eun J Min
- College of Medicine, The Catholic University of Korea, Korea
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Luna G, Kim M, Miller R, Parekh P, Kim ES, Park SY, Abdulbaseer U, Gonzalez C, Stiehl E. Interprofessional relationships and their impact on resident hospitalizations in nursing homes: A qualitative study. Appl Nurs Res 2023; 74:151747. [PMID: 38007247 DOI: 10.1016/j.apnr.2023.151747] [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: 09/14/2022] [Revised: 08/09/2023] [Accepted: 10/24/2023] [Indexed: 11/27/2023]
Abstract
AIM The aim of this study is to explore experiences and perspectives of nurses and providers (e.g., physicians, medical directors, fellows, and nurse practitioners) on reducing preventable hospitalizations of nursing home (NH) residents in relation to interprofessional relationship and hospitalization decision-making process. BACKGROUND Preventable NH resident hospitalization continues to be a pressing public health issue. Studies show that improved interprofessional relationship may help reduce hospitalization, yet research on communication processes and interactions among different NH staff remains limited. METHODS This is a qualitative descriptive study. Two focus groups were held with fourteen nurses and thirteen in-depth, qualitative interviews were conducted with providers from two Chicagoland NHs. Focus group sessions and interviews were transcribed, coded, and analyzed for common themes based on qualitative description method. RESULTS All study participants agreed that providers have the ultimate responsibility for hospitalization decisions. However, nurses believed they could influence those decisions, depending on provider characteristics, trust, and resident conditions. Nurses and providers differed in the way they experienced and conveyed emotions, and differed in key elements affecting hospitalization decisions such as structural or environmental factors (e.g., lacking staff and equipment at the facility, poor communication between the NH and hospitals) and interpersonal factors (e.g., characteristics of effective nurses or providers and the effective interactions between them). CONCLUSIONS Interpersonal factors, including perceived competence, respect, and trust, may influence NH hospitalization decisions and be targeted for reducing preventable hospitalizations of residents.
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Affiliation(s)
- Geraldine Luna
- Chicago Department of Public Health, 333 S State St #200, Chicago, IL 60604, United States of America.
| | - Mhinjine Kim
- University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, United States of America.
| | - Richard Miller
- University of Illinois Chicago, 2170 West Bowler Street, Chicago, IL 60612, United States of America.
| | - Pooja Parekh
- University of Illinois Chicago, 1355 S. Halsted St., Chicago, IL 60607, United States of America.
| | - Esther S Kim
- University of Illinois Chicago, 625 W Madison St., Chicago, IL 60661, United States of America.
| | - Sophia Yaejin Park
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Ummesalmah Abdulbaseer
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Cristina Gonzalez
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Emily Stiehl
- University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, United States of America.
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Candon M, Bergman A, Rose A, Song H, David G, Spetz J. The Relationship Between Scope of Practice Laws for Task Delegation and Nurse Turnover in Home Health. J Am Med Dir Assoc 2023; 24:1773-1778.e2. [PMID: 37634547 PMCID: PMC10735229 DOI: 10.1016/j.jamda.2023.07.023] [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: 04/14/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Nurse turnover can compromise the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. In this study, we used human resource records from a multistate home health organization to examine the relationship between nurse turnover and whether nurses can delegate tasks to unlicensed aides. DESIGN A retrospective, cross-sectional analysis. SETTING AND PARTICIPANTS The study sample included 1820 licensed practical nurses and 3309 registered nurses, who spanned 30 states. The study period was 2016 through 2018. METHODS We used weighted least squares to study the relationship between nurse turnover for registered and licensed practical nurses and task delegation across state-years. We measured task delegation continuously (0-16 tasks) and as a binary variable (14 or more tasks, which indicated the state was in the top half of the distribution). RESULTS Across state-years, the turnover rate was 30.8% for licensed practical nurses and 36.8% for registered nurses. Although there was no significant relationship between task delegation and turnover among registered nurses, we found that states in which nurses could delegate the most tasks had lower turnover rates among licensed practical nurses. CONCLUSION AND IMPLICATIONS The ability to delegate tasks to unlicensed aides was correlated with lower turnover rates among licensed practical nurses, but not among registered nurses. This suggests that the ability to delegate tasks is more likely to affect the workload of licensed practical nurses. This also points to a potential and unexplored element of expanding the scope of practice for nurses: reduced turnover. Given the added work-related hazards associated with home health care, including working in isolation, a lack of social recognition, and inadequate reimbursement, states should consider whether changes in their policy environment could benefit nurses working in home health.
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Affiliation(s)
- Molly Candon
- Departments of Psychiatry and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
| | - Alon Bergman
- Departments of Medical Ethics and Health Policy and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber Rose
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Hummy Song
- Department of Operations, Information, and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Guy David
- Departments of Medical Ethics and Health Policy and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Brazier JF, Geng F, Meehan A, White EM, McGarry BE, Shield RR, Grabowski DC, Rahman M, Santostefano C, Gadbois EA. Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2325993. [PMID: 37498600 PMCID: PMC10375301 DOI: 10.1001/jamanetworkopen.2023.25993] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Importance Staffing shortages have been widely reported in US nursing homes during the COVID-19 pandemic, but traditional quantitative research analyses have found mixed evidence of staffing shortfalls. Objective To examine whether nursing home administrator perspectives can provide context for conflicting aggregate staffing reports in US nursing homes during the COVID-19 pandemic. Design, Setting, and Participants In a qualitative study, convergent mixed-methods analysis integrating qualitative and quantitative data sets was used. Semistructured qualitative interviews were conducted between July 14, 2020, and December 16, 2021. Publicly available national Payroll Based Journal data were retrieved from January 1, 2020, to September 30, 2022, on 40 US nursing homes in 8 health care markets that varied by region and nursing home use patterns. Staffing and resident measures were derived from Payroll Based Journal data and compared with national trends for 15 436 US nursing homes. Nursing home administrators were recruited for interviews. Of the 40 administrators who consented to participate, 4 were lost to follow-up. Exposure Four repeated, semistructured qualitative interviews with participants were conducted. Interview questions focused on the changes noted during the COVID-19 pandemic in nursing homes. Main Outcomes and Measures Thematic description of nursing home administrator compensatory strategies to provide context for quantitative analyses on nursing home staffing levels during the COVID-19 pandemic. Results A total of 156 interviews were completed with 40 nursing home administrators. Administrators reported experiencing staff shortages during the COVID-19 pandemic and using compensatory strategies, such as overtime, cross-training, staff-to-resident ratio adjustments, use of agency staff, and curtailing admissions, to maintain operations and comply with minimum staffing regulations. Payroll Based Journal data measures graphed from January 1, 2020, to September 30, 2022, supported administrator reports showing that study facilities had reductions in staff hours, increased use of agency staff, and decreased resident census. Findings were similar to national trends. Conclusions and Relevance In this qualitative, convergent mixed-methods study, nursing home administrators reported the major staffing strain they experienced at their facilities and the strategies they used to offset staffing shortages. Their experiences provide context to quantitative analyses on aggregate nursing home census data. The short-term compensatory measures administrators used to comply with regulations and maintain operations may be detrimental to the long-term stability of this workforce.
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Affiliation(s)
- Joan F Brazier
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Fangli Geng
- Student, PhD Program in Health Policy, Harvard University, Cambridge Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Amy Meehan
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Elizabeth M White
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Brian E McGarry
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Renee R Shield
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Momotazur Rahman
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Christopher Santostefano
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Emily A Gadbois
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
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Choi S, Lee J. Factors Influencing RNs' Intention to Stay in Nursing Homes: Multilevel Modeling Approach. J Gerontol Nurs 2023; 49:40-48. [PMID: 37379045 DOI: 10.3928/00989134-20230616-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
The current study investigated factors that influence the intention to stay (ITS) of RNs working in South Korean nursing homes (NHs). Thirty-six questionnaire responses from organizational NHs and 101 from individual RNs were analyzed using multilevel regression analysis. At the individual level, RNs' ITS increased with years of work at their current NH, and that of RNs who received emergency calls to work at night was lower than that of RNs with fixed night shifts. At the organizational level, ITS was higher when the ratios of RNs to residents and RNs to nursing staff were higher. To improve ITS, NHs should consider adopting mandatory deployment of RNs, increasing their RN to resident ratios, and implementing a fixed night shift RN system, wherein night shift working hours count as twice the daytime hours, and night shift is voluntary. [Journal of Gerontological Nursing, 49(7), 40-48.].
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Chen AC, Epstein AM, Joynt Maddox KE, Grabowski DC, Orav EJ, Barnett ML. Care delivery approaches and perceived barriers to improving quality of care: A national survey of skilled nursing facilities. J Am Geriatr Soc 2023; 71:2141-2150. [PMID: 36918371 PMCID: PMC10363227 DOI: 10.1111/jgs.18331] [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: 11/10/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Nursing home quality of care is a persistent challenge, with recent reports calling for increased reforms to improve quality and safety. Less is known about the clinical approaches currently used and the barriers perceived by skilled nursing facilities (SNFs) to provide care for their short-stay residents. METHODS We conducted a nationally representative survey of SNFs from October 2020 to May 2021 to understand their care delivery approaches and perceived barriers. Our primary outcomes were the reported number of 23 separate care delivery approaches and the reported number of 12 separate barriers to reduce spending or improve care for SNF short-stay residents. We also performed stratified analyses by facility participation in bundled payments and other SNF characteristics. RESULTS We received 377 responses from 693 SNFs contacted (response rate = 54%). SNFs reported an average of 16.8 care delivery approaches and an average of 5.0 barriers. While there were some differences observed in SNF characteristics, such as by bundled payments participation or ownership type, there were common care delivery approaches and barriers shared by most facilities. Care management practices, including reviewing the patient census and medication reconciliation on discharge, were the most common delivery approaches reported. SNFs were less likely to ensure the completion of a follow-up appointment with a primary care provider or track repeat emergency room visits. Issues concerning staffing, such as staff turnover and/or burnout, and lack of resources to provide patients social support, mental health, and substance use services, were the most cited barriers to care delivery. CONCLUSIONS Nationally, SNFs implemented a wide array of care delivery approaches, but challenges with staffing and limited resources to address patients' social and mental health needs were dominant. Individual SNFs may have limited ability to address these key barriers, so the involvement of many stakeholders across the entire healthcare system may be necessary.
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Affiliation(s)
- Amanda C Chen
- Harvard Graduate School of Arts and Sciences, Boston, Massachusetts, USA
| | - Arnold M Epstein
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Karen E Joynt Maddox
- Center for Economics and Policy, Institute of Public Health at Washington University, St. Louis, Missouri, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael L Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Sun C, Xing Y, Wen Y, Wan X, Ding Y, Cui Y, Xu W, Wang X, Xia H, Zhang Q, Yuan M. Association between career adaptability and turnover intention among nursing assistants: the mediating role of psychological capital. BMC Nurs 2023; 22:29. [PMID: 36732804 PMCID: PMC9894670 DOI: 10.1186/s12912-023-01187-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND High turnover intention of nursing assistants was detrimental to the sustainability of long-term care. Career adaptability is an important determinant in reducing turnover intention, but little research has explored the mechanism from the perspective of psychological capital. The aim of this study was to analyze the association between career adaptability and turnover intention and to examine the mediating role of psychological capital between career adaptability and turnover intention among nursing assistants in mainland China. METHODS A cross-sectional online study was conducted among 276 nursing assistants from eight nursing homes in Nanjing, China. The participants' career adaptability, psychological capital, and turnover intention were obtained. SPSS 26.0 and Amos 24.0 software were employed for statistical analysis. RESULTS Career adaptability was positively related to psychological capital and negatively linked to turnover intention (P < 0.01). Psychological capital played a fully mediating role (β = -0.085, P < 0.05) in the relationship between career adaptability and turnover intention, and the largest indirect effect was generated through the curiosity dimension. CONCLUSIONS The management of long-term care facilities should focus on assessing the level of career adaptability of nursing assistants. The overall improvement of career adaptability and psychological capital is conducive in reducing turnover intention. Targeted interventions are recommended to improve career adaptability and reduce turnover intentions by increasing career curiosity. Online career adaptability programs can be developed for nursing assistant students to improve their psychological capital and facilitate career transitions.
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Affiliation(s)
- Changxian Sun
- grid.89957.3a0000 0000 9255 8984Nanjing Medical University, Nanjing, China ,grid.495415.8Jiangsu Vocational Institute of Commerce, Nanjing, China
| | - Yurong Xing
- grid.89957.3a0000 0000 9255 8984Nanjing Medical University, Nanjing, China
| | - Yuting Wen
- grid.89957.3a0000 0000 9255 8984Nanjing Medical University, Nanjing, China
| | - Xia Wan
- grid.89957.3a0000 0000 9255 8984The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Yaping Ding
- grid.89957.3a0000 0000 9255 8984Nanjing Medical University, Nanjing, China
| | - Yan Cui
- grid.89957.3a0000 0000 9255 8984Nanjing Medical University, Nanjing, China
| | - Wenhui Xu
- grid.89957.3a0000 0000 9255 8984Nanjing Medical University, Nanjing, China
| | - Xiaoxiao Wang
- grid.89957.3a0000 0000 9255 8984Nanjing Medical University, Nanjing, China
| | - Hongling Xia
- grid.89957.3a0000 0000 9255 8984Nanjing Medical University, Nanjing, China
| | - Qian Zhang
- grid.89957.3a0000 0000 9255 8984Nanjing Medical University, Nanjing, China
| | - Min Yuan
- grid.495415.8Jiangsu Vocational Institute of Commerce, Nanjing, China ,grid.443514.30000 0004 1791 5258Jinshen College of Nanjing Audit University, Nanjing, China
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An M, Heo S, Hwang YY, Kim J, Lee Y. Factors Affecting Turnover Intention among New Graduate Nurses: Focusing on Job Stress and Sleep Disturbance. Healthcare (Basel) 2022; 10:healthcare10061122. [PMID: 35742172 PMCID: PMC9223151 DOI: 10.3390/healthcare10061122] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the high prevalence of nurses’ turnover and the turnover intention of new nurses, there are insufficient studies examining turnover intention at the time when job orientation is completed and independent nursing commences. Thus, this study examined turnover intention levels and identified the factors affecting turnover intention of new Generation Z nurses, focusing on job stress and sleep disturbance, at the eighth week after completing job orientation. This was a cross-sectional descriptive correlational study. Using a convenient sampling method, 133 new nurses were recruited. Data were collected using a structured questionnaire consisting of demographic and occupational characteristics, job stress, sleep disturbance, and turnover intention. Descriptive statistics were computed to describe the sample and interest variables. Logistic regression analysis was performed to examine the association of job stress and sleep disturbance with turnover intention. Most nurses were women (91.7%) and approximately two-thirds worked in the surgical ward (n = 61, 45.9%). Turnover intention was 12.8%, average job stress was 40.11 ± 90.7, and average sleep disturbance was 42.39 ± 15.27. New graduate nurses’ turnover intention was associated with job stress (OR = 1.07, 95% CI = 1.02–1.12) and sleep disturbance (OR = 1.19, 95% CI = 1.05–1.35), and this model explained 47.7% of the variance. Study findings determine that job stress and sleep disturbance were significant predictors of turnover intention in new nurses at the eighth week after joining the hospital. Therefore, nursing administrators should focus on new nurses’ job stress and sleep disturbance, and provide them with timely assessment and management to reduce turnover intention.
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Affiliation(s)
- Minjeong An
- College of Nursing, Chonnam National University, Gwangju 61469, Korea;
| | - Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA 30341, USA;
| | | | - JinShil Kim
- College of Nursing, Gachon University, Incheon 21936, Korea;
| | - Yeonhu Lee
- Department of Trauma Ward, Chonnam National University Hospital, Gwangju 61469, Korea
- Correspondence: ; Tel.: +82-10-9405-7399
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Bergman A, Song H, David G, Spetz J, Candon M. The Role of Schedule Volatility in Home Health Nursing Turnover. Med Care Res Rev 2022; 79:382-393. [PMID: 34311619 PMCID: PMC9122113 DOI: 10.1177/10775587211034310] [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] [Indexed: 11/17/2022]
Abstract
Despite considerable research on nursing turnover, few studies have considered turnover among nurses working in home health care. Using novel administrative data from one of the largest home health care organizations in the United States, this study examined turnover among home health nurses, focusing on the role of schedule volatility. We estimated separation rates among full-time and part-time registered nurses and licensed practical nurses and used daily visit logs to estimate schedule volatility, which was defined as the coefficient of variation of the number of daily visits in the prior four weeks. Between 2016 and 2019, the average annual separation rate of home health nurses was over 30%, with most separations occurring voluntarily. Schedule volatility and turnover were positively associated for full-time nurses, but not for part-time nurses. These results suggest that reducing schedule volatility for full-time nurses could mitigate nursing turnover in home health care.
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Affiliation(s)
- Alon Bergman
- University of Pennsylvania, Philadelphia, PA, USA
| | - Hummy Song
- University of Pennsylvania, Philadelphia, PA, USA
| | - Guy David
- University of Pennsylvania, Philadelphia, PA, USA
| | - Joanne Spetz
- University of California, San Francisco, CA, USA
| | - Molly Candon
- University of Pennsylvania, Philadelphia, PA, USA
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Zheng Q, Williams CS, Shulman ET, White AJ. Association between staff turnover and nursing home quality - evidence from payroll-based journal data. J Am Geriatr Soc 2022; 70:2508-2516. [PMID: 35524769 DOI: 10.1111/jgs.17843] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/11/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Staff turnover is considered an important indicator of nursing home quality. We used auditable staffing data from the Centers for Medicare & Medicaid Services (CMS) Payroll-Based Journal (PBJ) system to calculate turnover measures for nurse staff and administrators and examined the relationship between turnover and nursing home quality. METHODS Our analyses included data from 13,631 nursing homes that submitted complete staffing data through PBJ for 2018Q3 - 2019Q4. We identified turnover based on gaps in days worked by eligible employees, allowing us to calculate turnover measures that do not depend on termination dates reported by nursing homes, which are not captured in PBJ. We linked staff turnover measures to nursing home quality measures and star ratings published on CMS' Care Compare website in January 2020 and examined the relationship between turnover and quality of care. We used ordinary least squared models for continuous outcomes and ordered logit models for categorical outcomes, controlling for facility, and county characteristics. RESULTS Mean annual turnover rates were about 44% for RNs and 46% for total nurse staff. On average, there was one administrator leaving each nursing home during this period although about half of nursing homes had no administrator turnover. Turnover rates varied greatly across nursing homes. For-profit and larger nursing homes had higher turnover rates. Higher turnover was consistently associated with lower quality of care. CONCLUSIONS Our study highlights the importance of staff turnover due to its relationship to nursing home quality. In January 2022, CMS started posting turnover measures on Care Compare to allow consumers to use this information in their assessment of nursing home quality and to motivate nursing homes to implement innovative strategies to retain staff. While these actions are challenging, they are nonetheless warranted for improving the quality of care for nursing home residents.
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Affiliation(s)
- Qing Zheng
- Division of Health and Environment, Abt Associates, Durham, North Carolina, USA
| | | | - Evan T Shulman
- Division of Nursing Homes, Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
| | - Alan J White
- Division of Health and Environment, Abt Associates, Durham, North Carolina, USA
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Paulus A, Baernholdt M, Kear T, Jones T, Thacker L. Factors Associated With Hospital Readmissions Among U.S. Dialysis Facilities. J Healthc Qual 2022; 44:59-68. [PMID: 34191751 DOI: 10.1097/jhq.0000000000000300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The Centers for Medicare and Medicaid uses the standardized readmission ratio (SRR) to evaluate 30-day readmissions among dialysis providers in the U.S. Readmissions among dialysis recipients remains 37%. This study investigates associations among dialysis facilities and patient characteristics with facility's performance on the SRR. METHODS Descriptive, longitudinal, approach using multivariate regression analysis on data retrieved from the Dialysis Facility Report to evaluate the associations between facility-level (staffing, profit status, chain membership, clinic size, care, length of care, vascular access type, glomerular filtration rate (GFR), creatinine, hemoglobin, use of erythropoietin-stimulating agent, albumin, and primary dialysis modality) with the SRR. RESULTS Factors associated with a high SRR included nurse ratios, facility average GFR, and Northeast geographic location. Factors associated with a low SRR included patient care technician ratio, length of predialysis nephrology care, initiation of dialysis with an arteriovenous fistula, average hemoglobin, and Western geographic location. CONCLUSIONS This study defines the influence predialysis nephrology care has on dialysis facilities SRRs. Access to care, adequate preparation for dialysis, and transitional support affect facilities' performance; however, without an appropriate staffing model, dialysis facilities may continue to struggle to reduce readmissions.
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Sharma H, Xu L. Association between wages and nursing staff turnover in Iowa nursing homes. Innov Aging 2022; 6:igac004. [PMID: 35770065 PMCID: PMC9233199 DOI: 10.1093/geroni/igac004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
Nursing staff turnover is a substantial concern for nursing homes that care for millions of older individuals, especially during the COVID-19 pandemic. Low pay is considered as one of the key reasons for high turnover. However, we do not know whether increasing wages can lead to lower turnover. In this study, we fill this gap in our understanding by analyzing the relationship between wages and nursing staff turnover.
Research Design and Methods
We obtained data on hourly wages (Medicare Cost Reports), turnover (Iowa Department of Human Services), and nursing home and resident characteristics (Nursing Home Compare and LTCFocus) from 2013 to 2017. We summarized the characteristics of nursing homes as well as turnover trends over time. Next, we used pooled OLS and facility fixed effects regressions to examine the relationship between wages and turnover adjusting for nursing home and resident characteristics.
Results
Among the 396 nursing homes in Iowa, average hourly wage was $27.0 for registered nurse (RNs), $21.6 for licensed practical nurses (LPNs), and $14.1 for certified nurse aides (CNAs) during 2013 to 2017. Average turnover rates were increasing over time for all staff types and in 2017, turnover rates were 46.0% for RNs, 44.4% for LPNs, and 64.7% for CNAs. In both pooled OLS and facility fixed effects regressions, higher wages were associated with lower turnover of CNAs but not LPNs or RNs. The magnitude of the effect of wages on turnover for CNAs was lower in facility fixed effects regressions.
Discussion and Implications
We found significant relationship between hourly wages and turnover for CNAs but not for LPNs or RNs. Focusing on higher wages alone may not lead to lower turnover of all types of nursing staff in nursing homes. We should also focus on non-wage factors related to turnover.
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Affiliation(s)
- Hari Sharma
- Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Lili Xu
- Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
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Krein SL, Turnwald M, Anderson B, Maust DT. "Sometimes it's not about the money... it's the way you treat people...": A Qualitative Study of Nursing Home Staff Turnover. J Am Med Dir Assoc 2022; 23:1178-1184. [PMID: 34990586 DOI: 10.1016/j.jamda.2021.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/19/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To better understand and compare resident family and nursing home staff experiences and perceptions of licensed and unlicensed direct care staff turnover. DESIGN Descriptive qualitative design. SETTING AND PARTICIPANTS Nursing home resident family members and direct care registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants (CNAs), and administrative staff. METHODS We conducted semistructured interviews with family members and nursing home staff between September 2019 and July 2020. Using a rapid analysis approach, we compared family member, direct care RNs, LPNs, CNAs, and administrative staff experiences and perceptions related to staff turnover, ways to reduce turnover, and strategies for minimizing disruptions. RESULTS We completed interviews with 17 family members, 25 direct care RNs, LPNs, and CNAs, and 6 administrative staff from 13 nursing homes primarily located in southeastern Michigan. Family members had mixed experiences with turnover, but commonly described the need for consistent, personalized care to ensure safe, high-quality resident care. Direct care RNs, LPNs, and CNAs expressed a similar viewpoint and frustration with not being able to provide the care they would like because of turnover or short staffing. Although better wages were mentioned, all groups also identified the importance of staff feeling appreciated and supported as critical for decreasing turnover. Adequate training and strategies to acclimate new staff to resident preferences were also noted as approaches for minimizing care disruptions during turnover. CONCLUSIONS AND IMPLICATIONS Our findings largely confirm those of others regarding potential contributing factors and consequences of staff turnover. However, our findings also provide a clear message about important areas on which to focus. This includes identifying ways to effectively provide consistent, person-centered care for residents in the context of staffing inconsistencies and the need for a more people-oriented work environment for nursing home staff to reduce turnover and minimize disruptions in resident care.
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Affiliation(s)
- Sarah L Krein
- Center for Clinical Management Research, Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Molly Turnwald
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Barry Anderson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Donovan T Maust
- Center for Clinical Management Research, Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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14
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Lee J. Nursing home nurses' turnover intention: A systematic review. Nurs Open 2021; 9:22-29. [PMID: 34811952 PMCID: PMC8685779 DOI: 10.1002/nop2.1051] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/04/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
Aim This review aimed to examine and describe the published research on nursing home (NH) nurses' turnover intentions in their workplace. Design This study is a systematic review following PRISMA guidelines. Methods An electronic search was conducted for English and Korean articles to identify research studies published between 2009–2019 using CINAHL, PubMed, Cochrane Library, PsycINFO, RISS, and DBpia. Results A total of six studies met the inclusion criteria and revealed NH nurses' turnover intentions. The factors influencing NH nurses' turnover intentions were identified and classified as individual and organizational factors. Among the various factors above, this study found that job satisfaction was the most influential factor in nurses' turnover intentions. Therefore, further efforts are required to increase NH nurses' job satisfaction to decrease turnover intention.
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Affiliation(s)
- Jiyeon Lee
- College of Nursing, Catholic University of Pusan, Busan, Korea
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15
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Kierkegaard P, Micocci M, McLister A, Tulloch JSP, Parvulescu P, Gordon AL, Buckle P. Implementing lateral flow devices in long-term care facilities: experiences from the Liverpool COVID-19 community testing pilot in care homes- a qualitative study. BMC Health Serv Res 2021; 21:1153. [PMID: 34696803 PMCID: PMC8544628 DOI: 10.1186/s12913-021-07191-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/30/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction Antigen-based lateral flow devices (LFDs) offer the potential of widespread rapid testing. The scientific literature has primarily focused on mathematical modelling of their use and test performance characteristics. For these tests to be implemented successfully, an understanding of the real-world contextual factors that allow them to be integrated into the workplace is vital. To address this gap in knowledge, we aimed to explore staff’s experiences of integrating LFDs into routine practice for visitors and staff testing with a view to understand implementation facilitators and barriers. Methods Semi-structured interviews and thematic analysis. Results We identified two main themes and five subthemes. The main themes included: visitor-related testing factors and staff-related testing factors. Subthemes included: restoring a sense of normality, visitor-related testing challenges, staff-related testing challenges, and pre-pilot antecedent factors. Conclusion Our study demonstrates that the real-world implementation of LFDs to test visitors and staff faces significant challenges as a result of several contextual factors negatively affecting the work practice and environment. More comprehensive studies are needed to identify and inform effective implementation strategies to ensure that LFDs can be adopted in an agile way that better supports an already exhausted and morally depleted workforce.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK. .,CRUK Convergence Science Centre, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Massimo Micocci
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Anna McLister
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - John S P Tulloch
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Paula Parvulescu
- Public Health Department, Liverpool City Council, Liverpool, Cunard Building, Water Street, Liverpool, L3 1DS, UK
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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16
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Loomer L, Grabowski DC, Yu H, Gandhi A. Association between nursing home staff turnover and infection control citations. Health Serv Res 2021; 57:322-332. [PMID: 34490625 DOI: 10.1111/1475-6773.13877] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 08/20/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the association between nursing home staff turnover and the presence and scope of infection control citations. DATA SOURCES Secondary data for all US nursing homes between March 31, 2017, through December 31, 2019 were obtained from Payroll-Based Journal (PBJ), Nursing Home Compare, and Long-Term Care: Facts on Care in the US (LTC Focus). STUDY DESIGN We estimated the association between nurse turnover and the probability of an infection control citation and the scope of the citation while controlling for nursing home fixed effects. Our turnover measure is the percent of the facility's nursing staff hours that were provided by new staff (less than 60 days of experience in the last 180 days) during the 2 weeks prior to the health inspection. We calculated turnover for all staff together and separately for registered nurses, licensed practical nurses (LPNs), and certified nursing assistants. DATA COLLECTION/EXTRACTION METHODS We linked nursing homes standard inspection surveys to 650 million shifts from the PBJ data. We excluded any nursing home with incomplete or missing staffing data. Our final analytic sample included 12,550 nursing homes with 30,536 surveys. PRINCIPAL FINDINGS Staff turnover was associated with an increased likelihood of an infection control citation (average marginal effect [AME] = 0.12 percentage points [pp]; 95% confidence interval [CI]: 0.05, 0.18). LPN (AME = 0.06 pp; 95% CI: 0.01, 0.11) turnover was conditionally associated with an infection control citation. Conditional on having at least an isolated citation for infection control, staff turnover was positively associated with receiving a citation coded as a "pattern" (AME = 0.21 pp; 95% CI: 0.10, 0.32). Conditional of having at least a pattern citation, staff turnover was positively associated with receiving a widespread citation (AME = 0.21 pp; 95% CI: 0.10, 0.32). CONCLUSIONS Turnover was positively associated with the probability of an infection control citation. Staff turnover should be considered an important factor related to the spread of infections within nursing homes.
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Affiliation(s)
- Lacey Loomer
- Department of Economics and Health Care Management, Labovitz School of Business and Economics, University of Minnesota Duluth, Duluth, Minnesota, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Huizi Yu
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Ashvin Gandhi
- UCLA Anderson School of Management, Los Angeles, California, USA
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17
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Castle NG. Measuring Caregiver Retention in Nursing Homes. THE GERONTOLOGIST 2021; 61:e118-e128. [PMID: 33524130 DOI: 10.1093/geront/gnab012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Retention of nursing home caregivers is examined. This represents the concept of continuously employing the same caregivers in the same facility for a defined period of time. In this research, several measures of caregiver retention are examined and the utility of these measures for practitioners and policy makers is discussed. RESEARCH DESIGN AND METHODS A survey of nursing home administrators conducted in 2016 was used to collect staffing data from 2,898 facilities. This was matched with Nursing Home Compare and the Certification and Survey Provider Enhanced Reporting data. The association of four measures of retention for each of three types of caregivers with six quality indicators was examined. RESULTS The descriptive statistics show rates of retention at 5 years for nurse aides (NAs), registered nurses (RNs), and licensed practical nurses to be low. The regression estimates show some support for the relationship that high caregiver retention is associated with better overall quality. The relationship was strongest for NAs and RNs. Support was also found for the notion that different measures of retention were more/less associated with quality. The 3- and 5-year retention measures had the strongest associations with the quality indicators. DISCUSSION AND IMPLICATIONS The findings presented provide some evidence that caregiver retention may be an important metric that can be used as a means of improving quality of care in nursing homes. However, the findings also show practitioners and policy makers should be more nuanced in the use of caregiver retention metrics.
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Affiliation(s)
- Nicholas G Castle
- Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, USA
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18
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Gandhi A, Yu H, Grabowski DC. High Nursing Staff Turnover In Nursing Homes Offers Important Quality Information. Health Aff (Millwood) 2021; 40:384-391. [PMID: 33646872 PMCID: PMC7992115 DOI: 10.1377/hlthaff.2020.00957] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nursing staff turnover has long been considered an important indicator of nursing home quality. However, turnover has never been reported on the Nursing Home Compare website, likely because of the lack of adequate data. On July 1, 2016, the Centers for Medicare and Medicaid Services began collecting auditable payroll-based daily staffing data for US nursing homes. We used 492 million nurse shifts from these data to calculate a novel turnover metric representing the percentage of hours of nursing staff care that turned over annually at each of 15,645 facilities. Mean and median annual turnover rates for total nursing staff were roughly 128 percent and 94 percent, respectively. Turnover rates were correlated with facility location, for-profit status, chain ownership, Medicaid patient census, and star ratings. Disseminating facilities' nursing staff turnover rates on Nursing Home Compare could provide important quality information for policy makers, payers, and consumers, and it may incentivize efforts to reduce turnover.
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Affiliation(s)
- Ashvin Gandhi
- Ashvin Gandhi is an assistant professor at the University of California Los Angeles Anderson School of Management, in Los Angeles, California
| | - Huizi Yu
- Huizi Yu is an undergraduate student at the University of California Los Angeles
| | - David C Grabowski
- David C. Grabowski is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts
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19
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Doshi S, Wish JB. Strategies to Reduce Rehospitalization in Patients with CKD and Kidney Failure. Clin J Am Soc Nephrol 2021; 16:328-334. [PMID: 32660962 PMCID: PMC7863646 DOI: 10.2215/cjn.02300220] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Readmissions in patients with nondialysis-dependent CKD and kidney failure are common and are associated with significant morbidity, mortality, and economic consequences. In 2013, the Centers for Medicare and Medicaid Services implemented the Hospital Readmissions Reduction Program in an attempt to reduce high hospitalization-associated costs. Up to 50% of all readmissions are deemed avoidable and present an opportunity for intervention. We describe factors that are specific to the patient, the index hospitalization, and underlying conditions that help identify the "high-risk" patient. Early follow-up care, developing volume management strategies, optimizing nutrition, obtaining palliative care consultations for seriously ill patients during hospitalization and conducting goals-of-care discussions with them, instituting systematic advance care planning during outpatient visits to avoid unwanted hospitalizations and intensive treatment at the end of life, and developing protocols for patients with incident or prevalent cardiovascular conditions may help prevent avoidable readmissions in patients with kidney disease.
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Affiliation(s)
- Simit Doshi
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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20
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White EM, Wetle TF, Reddy A, Baier RR. Front-line Nursing Home Staff Experiences During the COVID-19 Pandemic. J Am Med Dir Assoc 2020; 22:199-203. [PMID: 33321076 PMCID: PMC7685055 DOI: 10.1016/j.jamda.2020.11.022] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for nursing homes, where staff have faced rapidly evolving circumstances to care for a vulnerable resident population. Our objective was to document the experiences of these front-line health care professionals during the pandemic. DESIGN Electronic survey of long-term care staff. This report summarizes qualitative data from open-ended questions for the subset of respondents working in nursing homes. SETTING AND PARTICIPANTS A total of 152 nursing home staff from 32 states, including direct-care staff and administrators. METHODS From May 11 through June 4, 2020, we used social media and professional networks to disseminate an electronic survey with closed- and open-ended questions to a convenience sample of long-term care staff. Four investigators identified themes from qualitative responses for staff working in nursing homes. RESULTS Respondents described ongoing constraints on testing and continued reliance on crisis standards for extended use and reuse of personal protective equipment. Administrators discussed the burden of tracking and implementing sometimes confusing or contradictory guidance from numerous agencies. Direct-care staff expressed fears of infecting themselves and their families, and expressed sincere empathy and concern for their residents. They described experiencing burnout due to increased workloads, staffing shortages, and the emotional burden of caring for residents facing significant isolation, illness, and death. Respondents cited the presence or lack of organizational communication and teamwork as important factors influencing their ability to work under challenging circumstances. They also described the demoralizing impact of negative media coverage of nursing homes, contrasting this with the heroic public recognition given to hospital staff. CONCLUSIONS AND IMPLICATIONS Nursing home staff described working under complex and stressful circumstances during the COVID-19 pandemic. These challenges have added significant burden to an already strained and vulnerable workforce and are likely to contribute to increased burnout, turnover, and staff shortages in the long term.
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Affiliation(s)
- Elizabeth M White
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Terrie Fox Wetle
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Ann Reddy
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Rosa R Baier
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, RI, USA
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21
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Holmes SD, Resnick B, Galik E, Kusmaul N. Developing and Testing A Model of the Assisted Living Environment. JOURNAL OF AGING AND ENVIRONMENT 2020; 35:62-76. [PMID: 34423332 PMCID: PMC8378798 DOI: 10.1080/26892618.2020.1793439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The assisted living (AL) environment plays an important role in supporting residents' satisfaction and helping them to age in place. The AL environment is multidimensional and has many interrelated components including staffing (e.g. direct care workers, nursing, activity staff), services provided (e.g. medical, mental health, pharmacy), amenities offered at the setting (e.g. beauty salon, library, exercise facilities), and the physical environment. Evidence suggests that aspects of the AL environment can enhance or detract from the physical function, well-being, social engagement, and behavioral outcomes among residents. The purpose of this study was to develop and test a multidimensional AL environment measurement model that includes indicators of staffing, services, amenities, and the physical environment. Baseline data was used from a study testing the Dissemination and Implementation of Function Focused Care in AL. A total of 54 AL facilities across three states were included in the sample. Settings ranged in size from 31 to 164 beds with an average size of 82.2 (SD=26.2) beds and the majority were for profit facilities (n=41, 74.5%). Structural equation modeling was used to test the proposed model. Results showed that the model fit the data (χ2/df=1.861, p<.05; CFI=.858, RMSEA=.126). Having a comprehensive AL environment measurement model will advance future research that explores the impact of the environment on resident outcomes. Findings from this study will inform interventions and programs designed to modify AL environments to optimize residents' satisfaction with AL.
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Affiliation(s)
- Sarah D. Holmes
- University of Maryland, Baltimore, School of Pharmacy, 220 N. Arch Street, Baltimore, Maryland 21201
| | - Barbara Resnick
- University of Maryland, Baltimore, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201
| | - Elizabeth Galik
- University of Maryland, Baltimore, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201
| | - Nancy Kusmaul
- University of Maryland Baltimore County, Department of Social Work, 1000 Hilltop Circle, Baltimore, MD 21250
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22
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Huang SS, Bowblis JR. Is the Quality of Nursing Homes Countercyclical? Evidence From 2001 Through 2015. THE GERONTOLOGIST 2020; 59:1044-1054. [PMID: 30535145 DOI: 10.1093/geront/gny148] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To examine whether nursing homes (NHs) provide better quality when unemployment rates rise (countercyclical) and explore mechanisms contributing to the relationship between quality and unemployment rates. RESEARCH DESIGN AND METHODS The study uses the data on privately owned, freestanding NHs in the continental United States that span a period from 2001 through 2015. The empirical analysis relies on panel fixed-effect regressions with the key independent variable being the county-level unemployment rate. NH quality is measured using deficiencies, outcomes, and care process measures. We also examine nursing staff levels, as well as employee turnover and retention. RESULTS NHs have better quality when unemployment rates increase. Higher unemployment rates are associated with fewer deficiencies and lower deficiency scores. This countercyclical relationship is also found among other quality measures. In terms of mechanisms, we find higher nursing staff levels, lower employee turnover, and better workforce retention when unemployment rates rise. Improvement in staffing is likely contributing to better quality during recessions. Interestingly, these effects predominately occur in for-profit NHs for deficiencies and staffing levels. DISCUSSIONS AND IMPLICATIONS NH quality is countercyclical. With near record-low unemployment rates in 2018, regulatory agencies should pay close attention to NH quality when and where the local economy registers strong growth. On the other hand, the finding of the unemployment rate-staffing/turnover relationship also suggests that policies increasing staffing and reducing employee turnover may not only improve NH quality but also have the potential to smooth quality fluctuations between business cycles.
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Affiliation(s)
- Sean Shenghsiu Huang
- Department of Health Systems Administration, School of Nursing and Health Studies, Georgetown University, Washington, DC
| | - John R Bowblis
- Department of Economics, Farmer School of Business.,Scripps Gerontology Center, Miami University, Oxford, Ohio
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23
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Davila H, Johnson DR, Sullivan JL. Prioritizing LTSS Quality: Exploring the Views of Older Adults, Families, and Professionals. J Aging Soc Policy 2020; 33:247-267. [PMID: 32286922 DOI: 10.1080/08959420.2020.1750542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We conducted a cross-sectional survey involving 349 older adults, family members, and long-term services and supports (LTSS) professionals in Minnesota to assess their views on priorities for residential LTSS quality. We found considerable agreement among the three groups on the highest priorities to ensure the wellbeing of older adults who use LTSS: safety, dignity, and staffing. Relationships were also viewed as a high priority. However, older adults prioritized the physical environment over professionals, and they expressed more varied opinions on priorities overall. Older adults also consistently rated autonomy/choice as less important than other quality domains, a finding worth further exploration.
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Affiliation(s)
- Heather Davila
- Postdoctoral Fellow, Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - David R Johnson
- Professor, Department of Organizational Leadership, Policy, and Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jennifer L Sullivan
- Investigator, Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Research Assistant Professor, Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
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24
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Ozkaynak M, Reeder B, Drake C, Ferrarone P, Trautner B, Wald H. Characterizing Workflow to Inform Clinical Decision Support Systems in Nursing Homes. THE GERONTOLOGIST 2019; 59:1024-1033. [PMID: 30124814 DOI: 10.1093/geront/gny100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical decision support systems (CDSS) hold promise to influence clinician behavior at the point of care in nursing homes (NHs) and improving care delivery. However, the success of these interventions depends on their fit with workflow. The purpose of this study was to characterize workflow in NHs and identify implications of workflow for the design and implementation of CDSS in NHs. RESEARCH DESIGN AND METHODS We conducted a descriptive study at 2 NHs in a metropolitan area of the Mountain West Region of the United States. We characterized clinical workflow in NHs, conducting 18 observation sessions and interviewing 15 staff members. A multilevel work model guided our data collection and framework method guided data analysis. RESULTS The qualitative analysis revealed specific aspects of multilevel workflow in NHs: (a) individual, (b) work group/unit, (c) organization, and (d) industry levels. Data analysis also revealed several additional themes regarding workflow in NHs: centrality of ongoing relationships of staff members with the residents to care delivery in NHs, resident-centeredness of care, absence of memory aids, and impact of staff members' preferences on work activities. We also identified workflow-related differences between the two settings. DISCUSSION AND IMPLICATIONS Results of this study provide a rich understanding of the characteristics of workflow in NHs at multiple levels. The design of CDSS in NHs should be informed by factors at multiple levels as well as the emergent processes and contextual factors. This understanding can allow for incorporating workflow considerations into CDSS design and implementation.
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Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado-Denver, Anschutz Medical Campus, Aurora
| | - Blaine Reeder
- College of Nursing, University of Colorado-Denver, Anschutz Medical Campus, Aurora
| | - Cynthia Drake
- School of Medicine, University of Colorado-Denver, Anschutz Medical Campus, Aurora
| | - Peter Ferrarone
- School of Medicine, University of Colorado-Denver, Anschutz Medical Campus, Aurora
| | | | - Heidi Wald
- School of Medicine, University of Colorado-Denver, Anschutz Medical Campus, Aurora.,SCL Health, Broomfield, Colorado
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25
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Eaton J, Cloyes K, Paulsen B, Madden C, Ellington L. Certified nursing assistants as agents of creative caregiving in long‐term care. Int J Older People Nurs 2019; 15:e12280. [DOI: 10.1111/opn.12280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/31/2019] [Accepted: 09/08/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kristin Cloyes
- College of Nursing University of Utah Salt Lake City UT USA
| | - Brooke Paulsen
- College of Nursing University of Utah Salt Lake City UT USA
| | - Connie Madden
- College of Nursing University of Utah Salt Lake City UT USA
| | - Lee Ellington
- College of Nursing University of Utah Salt Lake City UT USA
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26
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Knutsen Glette M, Kringeland T, Røise O, Wiig S. Hospital physicians' views on discharge and readmission processes: a qualitative study from Norway. BMJ Open 2019; 9:e031297. [PMID: 31462486 PMCID: PMC6720230 DOI: 10.1136/bmjopen-2019-031297] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore hospital physicians' views on readmission and discharge processes in the interface between hospitals and municipalities. DESIGN Qualitative case study. SETTING The Norwegian healthcare system. PARTICIPANTS Fifteen hospital physicians (residents and consultants) from one hospital, involved in the treatment and discharge of patients. RESULTS The results of this study showed that patients were being discharged earlier, with more complex medical conditions, than they had been previously, and that discharges sometimes were perceived as premature. Insufficient capacity at the hospital resulted in pressure to discharge patients, but the primary healthcare service of the area was not always able to assume care of these patients. Communication between levels of the healthcare service was limited. The hospital stay summary was the most important, and sometimes only, form of communication between levels. The discharge process was described as complicated and was affected by healthcare personnel, by patients themselves and by aspects of the primary healthcare service. Early hospital discharges, poor communication between healthcare services and inadequacies in the discharge process were perceived to affect hospital readmissions. CONCLUSION The results of this study provide a better understanding of hospital physicians' views on the discharge and hospital readmission processes in the interface between the hospital and the primary healthcare service. The study also identifies discrepancies in governmental requirements, reform regulations and current practices in municipalities and hospitals.
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Affiliation(s)
- Malin Knutsen Glette
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences - Haugesund Campus, Haugesund, Norway
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Tone Kringeland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences - Haugesund Campus, Haugesund, Norway
| | - Olav Røise
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Siri Wiig
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
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Burke RE, Canamucio A, Glorioso TJ, Barón AE, Ryskina KL. Transitional Care Outcomes in Veterans Receiving Post-Acute Care in a Skilled Nursing Facility. J Am Geriatr Soc 2019; 67:1820-1826. [PMID: 31074844 DOI: 10.1111/jgs.15971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/18/2019] [Accepted: 04/12/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND As the veteran population ages, more veterans are receiving post-acute care in skilled nursing facilities (SNFs). However, the outcomes of these transitions across Veterans Affairs (VA) and non-VA settings are unclear. OBJECTIVE To measure adverse outcomes in veterans transitioning from hospital to SNF in VA and non-VA hospitals and SNFs. DESIGN Retrospective observational study using the 2012 to 2014 Residential History File, which concatenates VA, Medicare, and Medicaid data into longitudinal episodes of care for veterans. SETTING VA and non-VA hospitals and SNFs in four categories: non-VA SNFs, VA-contracted SNFs, VA Community Living Centers (CLCs), and State Veterans Homes. PARTICIPANTS Veterans, aged 65 years or older, who were acutely hospitalized and discharged to an SNF; one transition was randomly selected per patient. MEASUREMENTS Adverse "transitional care" outcomes were a composite of hospital readmission, emergency department visit, or mortality within 7 days of hospital discharge. RESULTS More than four in five veteran transitions (81.7%) occurred entirely outside the VA system. The overall 7-day outcome rate was 10.7% in the 388 339 veterans included. Adverse outcomes were lowest in VA hospital-CLC transitions (7.5%; 95% confidence interval [CI] = 7.1%-7.8%) and highest in non-VA hospital to VA-contracted nursing home transitions (17.5%; 95% CI = 16.0%-18.9%) in unadjusted analysis. In multivariate analyses adjusted for patient and hospital characteristics, VA hospitals had lower adverse outcome rates than non-VA hospitals (odds ratio [OR] = 0.80; 95% CI = 0.74-0.86). In comparison to VA hospital-VA CLC transitions, non-VA hospital to VA-contracted nursing homes (OR = 2.51; 95% CI = 2.09-3.02) and non-VA hospital to CLC (OR = 2.25; 95% CI = 1.81-2.79) had the highest overall adverse outcome rates. CONCLUSION Most veteran hospital-SNF transitions occur outside the VA, although adverse transitional care outcomes are lowest inside the VA. These findings raise important questions about the VA's role as a provider and payer of post-acute care in SNFs. J Am Geriatr Soc 67:1820-1826, 2019.
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Affiliation(s)
- Robert E Burke
- Center for Health Equity Promotion and Research, Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anne Canamucio
- Center for Health Equity Promotion and Research, Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Thomas J Glorioso
- Center of Innovation for Veteran-Centered and Value-Driven Care, Denver VA Medical Center, Denver, Colorado
| | - Anna E Barón
- Center of Innovation for Veteran-Centered and Value-Driven Care, Denver VA Medical Center, Denver, Colorado.,Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Kira L Ryskina
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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28
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Zúñiga F, Chu CH, Boscart V, Fagertun A, Gea-Sánchez M, Meyer J, Spilsbury K, Devi R, Haunch K, Zheng N, McGilton KS. Recommended Common Data Elements for International Research in Long-Term Care Homes: Exploring the Workforce and Staffing Concepts of Staff Retention and Turnover. Gerontol Geriatr Med 2019; 5:2333721419844344. [PMID: 31192274 PMCID: PMC6540698 DOI: 10.1177/2333721419844344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/26/2019] [Indexed: 11/21/2022] Open
Abstract
The aim of this review is to develop a common data element for the concept of staff retention and turnover within the domain of workforce and staffing. This domain is one of four core domains identified by the WE-THRIVE (Worldwide Elements to Harmonize Research in Long-Term Care Living Environments) group in an effort to establish an international, person-centered long-term care research infrastructure. A rapid review identified different measurement methods to assess either turnover or retention at facility level or intention to leave or stay at the individual staff level. The selection of a recommended measurement was guided by the WE-THRIVE group’s focus on capacity rather than deficits, the expected availability of internationally comparable data, and the goal to provide a short, ecologically viable measurement. We therefore recommend to measure staff’s intention to stay with a single item, at the individual staff level. This element, we argue, is an indicator of staff stability, which is important for reduced organizational cost and improved productivity, positive work environment, and better resident–staff relationships and quality of care.
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Affiliation(s)
| | | | - Veronique Boscart
- Conestoga College, Kitchener, Ontario, Canada.,Toronto Rehabilitation Institute, Ontario, Canada
| | - Anette Fagertun
- Centre for Care Research west, Western Norway University of Applied Sciences, Bergen, Norway
| | | | | | | | | | | | - Nancy Zheng
- University of Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, Ontario, Canada
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29
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Rivera-Hernandez M, Rahman M, Mukamel DB, Mor V, Trivedi AN. Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Black and Hispanic Patients. J Gerontol A Biol Sci Med Sci 2019; 74:689-697. [PMID: 29697778 PMCID: PMC6477650 DOI: 10.1093/gerona/gly089] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/19/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Understanding and addressing racial and ethnic disparities in the quality of post-acute care in skilled nursing facilities is an important health policy issue, particularly as the Medicare program initiates value-based payments for these institutions. METHODS Our final cohort included 649,187 Medicare beneficiaries in either the fee-for-service or Medicare Advantage programs, who were 65 and older and were admitted to a skilled nursing facility following an acute hospital stay, from 8,375 skilled nursing facilities. We examined the quality of care in skilled nursing facilities that disproportionately serve minority patients compared to non-Hispanic whites. Three measures, all calculated at the level of the facility, were used to assess quality of care in skilled nursing facilities: (a) 30-day rehospitalization rate; (b) successful discharge from the facility to the community; and (c) Medicare five-star quality ratings. RESULTS We found that African American post-acute patients are highly concentrated in a small number of institutions, with 28% of facilities accounting for 80% of all post-acute admissions for African American patients. Similarly, just 20% of facilities accounted for 80% of all admissions for Hispanics. Skilled nursing facilities with higher fractions of African American patients had worse performance for three publicly reported quality measures: rehospitalization, successful discharge to the community, and the star rating indicator. CONCLUSIONS Efforts to address disparities should focus attention on institutions that disproportionately serve minority patients and monitor unintended consequences of value-based payments to skilled nursing facilities.
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Affiliation(s)
- Maricruz Rivera-Hernandez
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI,Address correspondence to: Maricruz Rivera-Hernandez, PhD, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Box G-S121-6, Providence, RI 02912. E-mail:
| | - Momotazur Rahman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
| | - Dana B Mukamel
- Department of Medicine, Division of General Internal Medicine, iTEQC Research Program, Irvine, CA
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI,Providence VA Medical Center, RI
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI,Providence VA Medical Center, RI
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30
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Gupta S, Zengul FD, Davlyatov GK, Weech-Maldonado R. Reduction in Hospitals' Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958018817994. [PMID: 30894035 PMCID: PMC6429649 DOI: 10.1177/0046958018817994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role in lowering readmissions. Although having a hospital-based skilled nursing facility (HBSNF) in a hospital could help in improving care for patients needing short-term skilled nursing or rehabilitation services, little is known about HBSNFs' association with hospitals' readmission rates. This study seeks to examine the association between HBSNFs and hospitals' readmission rates. Data sources included 2007-2012 American Hospital Association Annual Survey, Area Health Resources Files, the Centers for Medicare and Medicaid Services (CMS) Medicare cost reports, and CMS Hospital Compare. The dependent variables were 30-day risk-adjusted readmission rates for acute myocardial infarction (AMI), congestive heart failure, and pneumonia. The independent variable was the presence of HBSNF in a hospital (1 = yes, 0 = no). Control variables included organizational and market factors that could affect hospitals' readmission rates. Data were analyzed using generalized estimating equation (GEE) models with state and year fixed effects and standard errors corrected for clustering of hospitals over time. Propensity score weights were used to control for potential selection bias of hospitals having a skilled nursing facility (SNF). GEE models showed that the presence of HBSNFs was associated with lower readmission rates for AMI and pneumonia. Moreover, higher SNFs to hospitals ratio in the county were associated with lower readmission rates. These findings can inform policy makers and hospital administrators in evaluating HBSNFs as a potential strategy to lower hospitals' readmission rates.
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Affiliation(s)
- Shivani Gupta
- 1 The University of Southern Mississippi, Hattiesburg, USA
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31
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Min A, Hong HC. Effect of nurse staffing on rehospitalizations and emergency department visits among short-stay nursing home residents: A Cross-sectional study using the US Nursing Home Compare database. Geriatr Nurs 2019; 40:160-165. [DOI: 10.1016/j.gerinurse.2018.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 12/24/2022]
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32
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Nursing home leaders' and nurses' experiences of resources, staffing and competence levels and the relation to hospital readmissions - a case study. BMC Health Serv Res 2018; 18:955. [PMID: 30541632 PMCID: PMC6292004 DOI: 10.1186/s12913-018-3769-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background Thirty-day hospital readmissions represent an international challenge leading to increased prevalence of adverse events, reduced quality of care and pressure on healthcare service’s resources and finances. There is a need for a broader understanding of hospital readmissions, how they manifest, and how resources in the primary healthcare service may affect hospital readmissions. The aim of the study was to examine how nurses and nursing home leaders experienced the resource situation, staffing and competence level in municipal healthcare services, and if and how they experienced these factors to influence hospital readmissions. Method The study was conducted as a comparative case study of two municipalities affiliated with the same hospital, chosen for historical differences in readmission rates. Nurses and leaders from four nursing homes participated in focus groups and interviews. Data were analyzed within and across cases. Results The analysis resulted in four common themes, with some variation in each municipality, describing nurses’ and leaders’ experience of the nursing home resource situation, staffing level and competence and their perception of factors affecting hospital readmissions. The nursing home patients were described as becoming increasingly complex with a subsequent need for increased nurse competence. There was variation in competence and staffing between nursing homes, but capacity building was an overall focus. Economic limitations and attempts at saving through cost-cutting were present, but not perceived as affecting patient care and the availability of medical equipment. Several factors such as nurse competence and staffing, physician coverage, and adequate communication and documentation, were recognized as factors affecting hospital readmissions across the municipalities. Conclusion Several factors related to nurses’ and leaders’ experience of the resource situation, staffing and competence level were suggested to affect hospital readmissions and the municipalities were similar in their answers regarding these factors. Patients were perceived as more complex with higher patient mortality forcing long-term nursing homes to shift towards an acute care or palliative function, and short-term nursing homes to function as “small hospitals”, requiring higher nurse competence. Staffing, competence and physician coverage did not seem to have adjusted to the new patient group in some nursing homes. Electronic supplementary material The online version of this article (10.1186/s12913-018-3769-3) contains supplementary material, which is available to authorized users.
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33
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Plaku-Alakbarova B, Punnett L, Gore RJ. Nursing Home Employee and Resident Satisfaction and Resident Care Outcomes. Saf Health Work 2018; 9:408-415. [PMID: 30559988 PMCID: PMC6284169 DOI: 10.1016/j.shaw.2017.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/08/2017] [Accepted: 12/09/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes. METHODS Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression. RESULTS A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0-100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid. CONCLUSION Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.
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Affiliation(s)
- Bora Plaku-Alakbarova
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPHNEW), University of Massachusetts Lowell, Lowell, MA, USA
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34
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Silver BC, Grabowski DC, Gozalo PL, Dosa D, Thomas KS. Increasing Prevalence of Assisted Living as a Substitute for Private-Pay Long-Term Nursing Care. Health Serv Res 2018. [PMID: 30066481 DOI: 10.1111/1475‐6773.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Given the tremendous growth in assisted living (AL) over the past 20 years, it is important to understand how expansion has affected the demand for long-term care (LTC) provided in nursing homes (NHs). We estimated the effect of a change in county-level AL beds on the prevalence of private-pay residents and private-pay resident days at the NH-level. DATA SOURCES National census of large AL providers (25+ beds), and Minimum Data Set combined with Medicare enrollment records and claims from 2007 and 2014. STUDY DESIGN Retrospective longitudinal analysis of LTC markets. PRINCIPAL FINDINGS Mean AL beds per county increased from 285 to 324, while NHs exhibited a decrease in private-pay residents (20.1 to 17.7 percent) and resident days (21.3 to 17.5 percent). An increase of 1,000 AL beds at the county level is associated with a reduction of 0.44 percentage points in private-pay resident days but is not significantly associated with percent of private-pay residents. CONCLUSIONS These results suggest that increases in AL capacity have potentially allowed NH residents to delay or decrease their privately financed lengths of stay. As demand for AL continues to grow, it will be important to assess the effects on other LTC sectors.
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Affiliation(s)
- Benjamin C Silver
- Health Care Financing and Payment, RTI International, Waltham, MA.,Brown University School of Public Health, Providence, RI
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Pedro L Gozalo
- Brown University School of Public Health, Providence, RI
| | - David Dosa
- Brown University School of Public Health, Providence, RI.,Department of Veterans Affairs Medical Center, Providence, RI
| | - Kali S Thomas
- Brown University School of Public Health, Providence, RI.,Department of Veterans Affairs Medical Center, Providence, RI
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35
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Silver BC, Grabowski DC, Gozalo PL, Dosa D, Thomas KS. Increasing Prevalence of Assisted Living as a Substitute for Private-Pay Long-Term Nursing Care. Health Serv Res 2018; 53:4906-4920. [PMID: 30066481 DOI: 10.1111/1475-6773.13021] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Given the tremendous growth in assisted living (AL) over the past 20 years, it is important to understand how expansion has affected the demand for long-term care (LTC) provided in nursing homes (NHs). We estimated the effect of a change in county-level AL beds on the prevalence of private-pay residents and private-pay resident days at the NH-level. DATA SOURCES National census of large AL providers (25+ beds), and Minimum Data Set combined with Medicare enrollment records and claims from 2007 and 2014. STUDY DESIGN Retrospective longitudinal analysis of LTC markets. PRINCIPAL FINDINGS Mean AL beds per county increased from 285 to 324, while NHs exhibited a decrease in private-pay residents (20.1 to 17.7 percent) and resident days (21.3 to 17.5 percent). An increase of 1,000 AL beds at the county level is associated with a reduction of 0.44 percentage points in private-pay resident days but is not significantly associated with percent of private-pay residents. CONCLUSIONS These results suggest that increases in AL capacity have potentially allowed NH residents to delay or decrease their privately financed lengths of stay. As demand for AL continues to grow, it will be important to assess the effects on other LTC sectors.
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Affiliation(s)
- Benjamin C Silver
- Health Care Financing and Payment, RTI International, Waltham, MA.,Brown University School of Public Health, Providence, RI
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Pedro L Gozalo
- Brown University School of Public Health, Providence, RI
| | - David Dosa
- Brown University School of Public Health, Providence, RI.,Department of Veterans Affairs Medical Center, Providence, RI
| | - Kali S Thomas
- Brown University School of Public Health, Providence, RI.,Department of Veterans Affairs Medical Center, Providence, RI
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36
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Jacobsen JML, Schnelle JF, Saraf AA, Long EA, Vasilevskis EE, Kripalani S, Simmons SF. Preventability of Hospital Readmissions From Skilled Nursing Facilities: A Consumer Perspective. THE GERONTOLOGIST 2018; 57:1123-1132. [PMID: 27927728 DOI: 10.1093/geront/gnw132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/21/2016] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study A structured interview was conducted with Medicare patients readmitted to a private, tertiary teaching hospital from skilled nursing facilities (SNFs) to assess their perspectives of readmission preventability and their role in the readmission. Design and Methods Data were collected at Vanderbilt University Medical Center using a 6-item interview administered at the bedside to Medicare beneficiaries with unplanned hospital readmissions from 23 SNFs within 60 days of a previous hospital discharge. Mixed analytical methods were applied, including a content analysis that evaluated factors contributing to hospital readmission as perceived by consumers. Results Among 208 attempted interviews, 156 were completed, of which 53 (34%) respondents rated their readmission as preventable. 28.3% of the 53 consumers attributed the readmission to hospital factors, 52.8% attributed it to the SNF, and 18.9% believed both sites could have prevented the readmission. The primary driver of the readmission was a family member/caregiver in 31 cases and the patient in 24 of the 156 cases, amounting to 55 (35.3%) consumer-driven readmissions. Contributing factors included: premature hospital discharge (16.3%); poor discharge planning (16.3%); a clinical issue not resolved in the hospital (14.3%); inadequate treatment at the SNF (69.4%); improper medication management at the SNF (20.4%); and poor decision-making regarding the transfer (14.3%). Conclusions and Implications Interviewing readmitted patients provides information relevant to reducing readmissions that may otherwise be omitted from hospital and SNF records. Consumers identified quality issues at both the hospital and SNF and perceived themselves as initiating a significant number of readmissions.
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Affiliation(s)
- J Mary Lou Jacobsen
- Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville
| | - John F Schnelle
- Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville
| | - Avantika A Saraf
- Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emily A Long
- Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eduard E Vasilevskis
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville.,Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandra F Simmons
- Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville
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37
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Snyder CR, Dahal A, Frogner BK. Occupational mobility among individuals in entry-level healthcare jobs in the USA. J Adv Nurs 2018; 74:1628-1638. [DOI: 10.1111/jan.13577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Cyndy R. Snyder
- Department of Family Medicine; University of Washington School of Medicine; Center for Health Workforce Studies; Seattle Washington USA
| | - Arati Dahal
- Department of Family Medicine; University of Washington School of Medicine; Center for Health Workforce Studies; Seattle Washington USA
| | - Bianca K. Frogner
- Department of Family Medicine; University of Washington School of Medicine; Center for Health Workforce Studies; Seattle Washington USA
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38
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Frogner BK. The Health Care Job Engine: Where Do They Come From and What Do They Say About Our Future? Med Care Res Rev 2017; 75:219-231. [PMID: 29148322 DOI: 10.1177/1077558716688156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health care has been cited as a job engine for the U.S. economy. This study used the Current Population Survey to examine the sector and occupation shifts that underlie this growth trend. Health care has had a cyclical relationship with retail trade, leisure and hospitality, education, and professional services. The entering workforce has been increasingly taking on low-skilled occupations. The exiting workforce has not been necessarily retiring or going back to school, but appeared to be leaving without a job, with potentially more child care duties, and with high rates of disability and poverty levels. This study also found that the number of workers staying in health care has been slowly declining over time. As the United States moves toward team-based care, more attention should be paid to the needs of the lower skilled workers to reduce turnover and ensure delivery of quality care.
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39
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Lerner NB, Trinkoff A, Storr CL, Han K, Yang BK. Leadership tenure is related to aide turnover in US assisted living facilities: Cross-sectional secondary data analysis. Appl Nurs Res 2017; 36:33-36. [DOI: 10.1016/j.apnr.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/26/2017] [Indexed: 10/19/2022]
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40
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Guo B, Zhao L, Gao Y, Peng X, Zhu Y. The status of professional identity and professional self-efficacy of nursing students in China and how the medical documentaries affect them: A quasi-randomized controlled trial. Int J Nurs Sci 2017; 4:152-157. [PMID: 31406735 PMCID: PMC6626100 DOI: 10.1016/j.ijnss.2017.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/14/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Professional identity and self-efficacy are important for the education and career development of students. However, how to improve these factors among Chinese nursing students needs further study. This quasi-randomized control trial was designed to explore the effect of medical documentaries on professional self-efficacy and identity among nursing students in Chinese technical schools. METHODS A total of 277 nursing students were enrolled in this study and divided into an experimental group (n = 135) and a control group (n = 142). The experimental group was invited to watch Chinese medical documentaries, whereas the control group remained on a waiting list. A self-designed general questionnaire, along with professional identity and professional self-efficacy questionnaires, was completed by the nursing students. RESULTS No significant change in professional self-efficacy was observed (-3.55 ± 14.23, P = 0.173) in the experimental group, while professional identity significantly declined (-6.24 ± 12.85, P = 0.002) after the intervention. No significant change was found in the two aspects in the control group. CONCLUSION Medical documentaries negatively affect professional identity but do not affect professional self-efficacy. Further researches should be conducted to explore the real reasons.
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Affiliation(s)
- Bingmei Guo
- School of Nursing, Shandong University, Jinan, People's Republic of China
- Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Lin Zhao
- School of Nursing, Shandong University, Jinan, People's Republic of China
| | - Yuanpeng Gao
- School of Nursing, Shandong University, Jinan, People's Republic of China
| | - Xue Peng
- School of Nursing, Shandong University, Jinan, People's Republic of China
| | - Yun Zhu
- Party Committee Office, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
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41
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Burke RE, Cumbler E, Coleman EA, Levy C. Post-acute care reform: Implications and opportunities for hospitalists. J Hosp Med 2017; 12:46-51. [PMID: 28125831 DOI: 10.1002/jhm.2673] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nearly all practicing hospitalists have firsthand experience discharging patients to post-acute care (PAC), which is provided by inpatient rehabilitation facilities, skilled nursing facilities, or home healthcare providers. Many may not know that PAC is poised to undergo transformative change, spurred by recent legislation resulting in a range of reforms. These reforms have the potential to fundamentally reshape the relationship between hospitals and PAC providers. They have important implications for hospitalists and will open up opportunities for hospitalists to improve healthcare value. In this article, the authors explore the reasons for PAC reform and the scope of the reforms. Then they describe the implications for hospitalists and hospitalists' opportunities to Choose Wisely and improve healthcare value for the rapidly growing number of vulnerable older adults transitioning to PAC after hospital discharge.
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Affiliation(s)
- Robert E Burke
- Research Section, Denver VA Medical Center, Denver, CO, USA
- Hospital Medicine Section, Denver VA Medical Center, Denver, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ethan Cumbler
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Eric A Coleman
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cari Levy
- Research Section, Denver VA Medical Center, Denver, CO, USA
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO, USA
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Rahimi M, Fadayevatan R, Abedi HA. Care Instability in Nursing Homes; A Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e21515. [PMID: 27186382 PMCID: PMC4867158 DOI: 10.5812/ircmj.21515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/10/2014] [Accepted: 09/01/2014] [Indexed: 11/16/2022]
Abstract
Background: The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Objectives: This study was performed to assess the caring conditions in nursing homes. Patients and Methods: This study was conducted with a qualitative approach using conventional qualitative content analysis. The study was conducted on 23 Iranian participants including 14 elders and 9 caregivers. Data was collected with unstructured interviews and continued to the point of data saturation. Analysis of data was performed continually and concurrently with data collection through a comparative method. Results: Three themes emerged from 595 open codes including care as unpleasant task, sustained care and insufficient resources. Ten subthemes indicated participants’ experiences and understanding of caring conditions in a nursing home. Conclusions: The prevailing given care was the routine one with a focus on physical aspects, although there was some psychological care given to the older people. The findings of this research are guidelines for managers and care planners in nursing homes who should pay attention to physical and psychological care needs of older people. In addition, it is important to pay close attention to the needs of caregivers and provision of instructions for treatment, supervision and education of caregivers and medical students to provide a better care.
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Affiliation(s)
- Majid Rahimi
- Department of Gerontology, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Reza Fadayevatan
- Iranian Research Center of Aging, Department of Gerontology, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
- Corresponding Author: Reza Fadayevatan, Iranian Research Center of Aging, Department of Gerontology, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran. Tel: +98-2122180004, E-mail:
| | - Heidar Ali Abedi
- Department of Nursing Midwifery, Islamic Azad University, Isfahan Branch, Khorasghan, IR Iran
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Economic evaluation of registered nurse tenure on nursing home resident outcomes. Appl Nurs Res 2016; 29:89-95. [PMID: 26856495 DOI: 10.1016/j.apnr.2015.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 04/20/2015] [Accepted: 05/09/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Little is known about the economic implications of nursing home (NH) registered nurse (RN) tenure on resident outcomes. This study evaluated the cost-effectiveness of two nurse workforce scenarios focusing on RN tenure (high versus low), and the associated transfers from NH to the hospital. METHODS A decision tree was constructed to compare the incremental costs and effects of RN tenure scenarios on NH resident transfers to the hospital under two NH staffing scenarios: high versus low levels of RN tenure. Three outcomes were modeled: 1) dollars per hospitalization avoided, 2) dollars per hospitalization and death avoided, and 3) dollars per death avoided. RESULTS The total costs of care for the low tenure scenario were $34,108 per month compared to the high tenure scenario at $29,442 per month. Effectiveness of the high tenure was greater across all 3 outcomes (incremental effectiveness ranged from 0.925 to 0.974 depending on outcome), indicating that high tenure was the dominant strategy (that is less costly and more effective). CONCLUSIONS Higher RN tenure was a dominant strategy across the 3 outcomes. This was a fairly robust finding despite the variations in the model and uncertainty in the input parameters. Aligning quality outcomes with cost effectiveness is imperative to driving the direction of health policy in the United States. Better prevention of hospitalizations by having an experienced RN workforce will not only improve resident quality of care but will allow NHs to realize the value of retaining a skilled workforce.
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Harden JT, Burger SG. They Are Called Nursing Homes for a Reason: RN Staffing in Long-Term Care Facilities. J Gerontol Nurs 2015; 41:15-20. [DOI: 10.3928/00989134-20151116-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chen IH, Brown R, Bowers BJ, Chang WY. Job Demand and Job Satisfaction in Latent Groups of Turnover Intention Among Licensed Nurses in Taiwan Nursing Homes. Res Nurs Health 2015; 38:342-56. [DOI: 10.1002/nur.21667] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/10/2022]
Affiliation(s)
- I-Hui Chen
- Assistant Professor, Department of Nursing; Asia University; 500 Lioufeng Rd., Wufeng District, Taichung 41354 Taiwan
| | - Roger Brown
- Professor, School of Nursing; University of Wisconsin; Madison Wisconsin
| | - Barbara J. Bowers
- Professor, School of Nursing; University of Wisconsin; Madison Wisconsin
| | - Wen-Yin Chang
- Professor, Graduate Institute of Nursing, College of Nursing; Taipei Medical University; Taipei Taiwan
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Nurse workforce characteristics and infection risk in VA Community Living Centers: a longitudinal analysis. Med Care 2015; 53:261-7. [PMID: 25634087 DOI: 10.1097/mlr.0000000000000316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine effects of workforce characteristics on resident infections in Veterans Affairs (VA) Community Living Centers (CLCs). DATA SOURCES A 6-year panel of monthly, unit-specific data included workforce characteristics (from the VA Decision Support System and Payroll data) and characteristics of residents and outcome measures (from the Minimum Data Set). STUDY DESIGN A resident infection composite was the dependent variable. Workforce characteristics of registered nurses (RN), licensed practical nurses (LPN), nurse aides (NA), and contract nurses included: staffing levels, skill mix, and tenure. Descriptive statistics and unit-level fixed effects regressions were conducted. Robustness checks varying workforce and outcome parameters were examined. PRINCIPAL FINDINGS Average nursing hours per resident day was 4.59 hours (SD=1.21). RN tenure averaged 4.7 years (SD=1.64) and 4.2 years for both LPN (SD=1.84) and NA (SD=1.72). In multivariate analyses RN and LPN tenure were associated with decreased infections by 3.8% (incident rate ratio [IRR]=0.962, P<0.01) and 2% (IRR=0.98, P<0.01) respectively. Robustness checks consistently found RN and LPN tenure to be associated with decreased infections. CONCLUSIONS Increasing RN and LPN tenure are likely to reduce CLC resident infections. Administrators and policymakers need to focus on recruiting and retaining a skilled nursing workforce.
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Bonner A, Tappen R, Herndon L, Ouslander J. The INTERACT Institute: Observations on Dissemination of the INTERACT Quality Improvement Program Using Certified INTERACT Trainers. THE GERONTOLOGIST 2014; 55:1050-7. [PMID: 25378465 DOI: 10.1093/geront/gnu103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/30/2014] [Indexed: 11/13/2022] Open
Abstract
Unnecessary hospitalizations of vulnerable nursing home (NH) residents can lead to hospital-acquired conditions, morbidity, mortality, and excess health care expenditures. Previous research has shown that a substantial percentage of these hospitalizations are preventable. Interventions to reduce acute care transfers (INTERACT) is a quality improvement program that has been adopted by many NHs throughout the United States. The original INTERACT toolkit was first created in a project supported by the Centers for Medicare and Medicaid Services. The toolkit was further refined and tested in a collaborative quality improvement project involving 30 NHs in 3 states, which resulted in a 17% reduction in all-cause hospitalizations. This study was limited because it was not randomized or controlled. Nevertheless, the data provide evidence that the program, even in the absence of strong regulatory oversight or financial incentives, is feasible to implement and that more active program engagement is associated with higher reductions in hospitalization. This paper describes dissemination of the INTERACT program using a pragmatic and relatively low cost model to prepare certified INTERACT Trainers in collaboration with several professional organizations.
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Affiliation(s)
- Alice Bonner
- Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts.
| | - Ruth Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida
| | - Laurie Herndon
- Massachusetts Senior Care Foundation, Newton Lower Falls, Massachusetts
| | - Joseph Ouslander
- Charles E. Schmidt College of Medicine, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida
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Abstract
Older adults are vulnerable to experiencing physiologic changes that may permanently decrease functional abilities when transferring from the nursing home (NH) to the acute care setting. Making the right decision about who and when to transfer from the nursing home (NH) to acute care is critical for optimizing quality care. The specific aims of this study were to identify the common signs and symptoms exhibited by NH residents at the time of transfer to acute care and to identify strategies used to prevent transfer of NH residents. Using survey methodology, this descriptive study found change in level of consciousness, chest pressure/tightness, shortness of breath, decreased oxygenation, and muscle or bone pain were the highest ranked signs/symptoms requiring action. Actions to prevent transfer focused on stabilizing resident conditions and included hydration, oxygen, antibiotics, medications, symptom management, and providing additional physical assistance. When transfer was warranted, actions concentrated on the practical tasks of getting the residents transferred.
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McGilton KS, Tourangeau A, Kavcic C, Wodchis WP. Determinants of regulated nurses' intention to stay in long-term care homes. J Nurs Manag 2014; 21:771-81. [PMID: 23865929 DOI: 10.1111/jonm.12130] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 12/01/2022]
Abstract
AIM To examine determinants of intent to stay among regulated nurses employed in long-term care facilities. BACKGROUND Elderly persons living in long-term care have increasingly complex care needs, putting greater demands on health-care providers. Indeed, regulated nursing staff employed in long-term care facilities represent the largest group of health-care providers who intend to leave their current jobs. METHODS Survey responses from 155 nurses from 12 long-term care facilities were analyzed to test the impact of six predictors on intent to stay. RESULTS Intention to stay was positively associated with lower burnout, higher job satisfaction, older nurses and resident relationships. Work relationships were negatively associated with intention to stay. Leadership support was not a significant predictor. CONCLUSION Most predictors were correlated with intention to stay as hypothesized. Further research is warranted to investigate the influence of management practices and work relationships on regulated nursing staff's intent to stay in long-term care. IMPLICATIONS FOR NURSING MANAGEMENT To retain qualified nursing staff and ensure quality of care, long-term care administrators should focus on creating a work environment that reduces burnout, increases job satisfaction, and enables nurses to foster relationships with residents. Recommendations for long-term care administrators include: (1) provide opportunities for self-scheduling, full-time work and benefits; (2) develop models of care that enhance resident relationships; (3) examine existing regulated nursing staff responsibilities and adjust to minimize burnout.
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Kripalani S, Theobald CN, Anctil B, Vasilevskis EE. Reducing hospital readmission rates: current strategies and future directions. Annu Rev Med 2013; 65:471-85. [PMID: 24160939 PMCID: PMC4104507 DOI: 10.1146/annurev-med-022613-090415] [Citation(s) in RCA: 362] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.
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Affiliation(s)
- Sunil Kripalani
- Department of Medicine, Vanderbilt University, Nashville, TN
| | - Cecelia N Theobald
- Department of Medicine, Vanderbilt University, Nashville, TN
- Department of Veterans Affairs, VA National Quality Scholars Program
| | - Beth Anctil
- Office of Transition Management, Vanderbilt University Medical Center, Nashville, TN
| | - Eduard E Vasilevskis
- Department of Medicine, Vanderbilt University, Nashville, TN
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
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