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Sison SDM, John J, Mac C, Ruopp M, Driver JA. Coordinated-Transitional Care (C-TraC) for Veterans from Subacute Rehabilitation to Home. J Am Med Dir Assoc 2023; 24:1334-1340. [PMID: 37302797 DOI: 10.1016/j.jamda.2023.05.007] [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: 01/04/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To adapt a successful acute care transitional model to meet the needs of veterans transitioning from post-acute care to home. DESIGN Quality improvement intervention. SETTING AND PARTICIPANTS Veterans discharged from a subacute care unit in the VA Boston Healthcare System's skilled nursing facility. METHODS We used the Replicating Effective Programs framework and Plan-Do-Study-Act cycles to adapt the Coordinated-Transitional Care (C-TraC) program to the context of transitions from a VA subacute care unit to home. The major adaptation of this registered nurse-driven, telephone-based intervention was combining the roles of discharge coordinator and transitional care case manager. We report the details of the implementation, its feasibility, and results of process measures, and describe its preliminary impact. RESULTS Between October 2021 and April 2022, all 35 veterans who met eligibility criteria in the VA Boston Community Living Center (CLC) participated; none were lost to follow-up. The nurse case manager delivered core components of the calls with high fidelity-review of red flags, detailed medication reconciliation, follow-up with primary care physician, and discharge services were discussed and documented in 97.9%, 95.9%, 86.8%, and 95.9%, respectively. CLC C-TraC interventions included care coordination, patient and caregiver education, connecting patients to resources, and addressing medication discrepancies. Nine medication discrepancies were discovered in 8 patients (22.9%; average of 1.1 discrepancies per patient). Compared with a historical cohort of 84 veterans, more CLC C-TraC patients received a post-discharge call within 7 days (82.9% vs 61.9%; P = .03). There was no difference between rates of attendance to appointments and acute care admissions post-discharge. CONCLUSIONS AND IMPLICATIONS We successfully adapted the C-TraC transitional care protocol to the VA subacute care setting. CLC C-TraC resulted in increased post-discharge follow-up and intensive case management. Evaluation of a larger cohort to determine its impact on clinical outcomes such as readmissions is warranted.
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Affiliation(s)
- Stephanie Denise M Sison
- Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Joyanne John
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA
| | - Chi Mac
- Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA
| | - Marcus Ruopp
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA.
| | - Jane A Driver
- Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA
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Toles M, Preisser JS, Colón-Emeric C, Naylor MD, Weinberger M, Zhang Y, Hanson LC. Connect-Home transitional care from skilled nursing facilities to home: A stepped wedge, cluster randomized trial. J Am Geriatr Soc 2023; 71:1068-1080. [PMID: 36625769 PMCID: PMC10089938 DOI: 10.1111/jgs.18218] [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: 08/11/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Skilled nursing facility (SNF) patients and their caregivers who transition to home experience complications and frequently return to acute care. We tested the efficacy of the Connect-Home transitional care intervention on patient and caregiver preparedness for care at home, and other patient and caregiver-reported outcomes. METHODS We used a stepped wedge, cluster-randomized trial design to test the intervention against standard discharge planning (control). The setting was six SNFs and six home health offices in one agency. Participants were 327 dyads of patients discharged from SNF to home and their caregivers; 11.1% of dyads in the control condition and 81.2% in the intervention condition were enrolled after onset of COVID-19. Patients were 63.9% female and mean age was 76.5 years. Caregivers were 73.7% female and mean age was 59.5 years. The Connect-Home intervention includes tools, training, and technical assistance to deliver transitional care in SNFs and patients' homes. Primary outcomes measured at 7 days included patient and caregiver measures of preparedness for care at home, the Care Transitions Measure-15 (patient) and the Preparedness for Caregiving Scale (caregiver). Secondary outcomes measured at 30 and 60 days included the McGill Quality of Life Questionnaire, Life Space Assessment, Zarit Caregiver Burden Scale, Distress Thermometer, and self-reported number of patient days in the ED or hospital in 30 and 60 days following SNF discharge. RESULTS The intervention was not associated with improvement in patient or caregiver outcomes in the planned analyses. Post-hoc analyses that distinguished between pre- and post-pandemic effects suggest the intervention may be associated with increased patient preparedness for discharge and decreased number of acute care days. CONCLUSIONS Connect-Home transitional care did not improve outcomes in the planned statistical analysis. Post-hoc findings accounting for COVID-19 impact suggest SNF transitional care has potential to increase patient preparedness and decrease return to acute care.
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Affiliation(s)
- Mark Toles
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John S. Preisser
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cathleen Colón-Emeric
- School of Medicine, Duke University and Geriatric Research Education and Clinical Center at the Durham VA Medical Center, Durham, North Carolina
| | - Mary D. Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Morris Weinberger
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ying Zhang
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura C. Hanson
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Bernardini B, Baratto L, Pizzi C, Biggeri A, Cerina G, Colantonio V, Corsini C, Ghirmai S, Pagani M, Fracchia S, Gardella M, Catelan D, Malosio ML, Malagamba E. A multicenter prospective study validated a nomogram to predict individual risk of dependence in ambulation after rehabilitation. J Clin Epidemiol 2023; 154:97-107. [PMID: 36403886 DOI: 10.1016/j.jclinepi.2022.10.021] [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: 03/15/2022] [Revised: 08/24/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To develop the Functional Risk Index for Dependence in Ambulation (FRIDA) score, a nomogram to predict individual risk of dependence in ambulation at discharge from postacute rehabilitation and validate its performance temporally and spatially. STUDY DESIGN AND SETTING We analyzed the database of a multicenter prospective observational quality cohort study conducted from January 2012 to March 2016, including data from 8,796 consecutive inpatients who underwent rehabilitation after stroke, hip fracture, lower limb joint replacement, debility, and other neurologic, orthopedic, or miscellaneous conditions. RESULTS A total of 3,026 patients (34.4%) were discharged dependent in ambulation. In the training set of 5,162 patients (58.7%), Lasso-regression selected advanced age, premorbid disability, and eight indicators of medical and functional adverse syndromes at baseline to establish the FRIDA score. At the temporal validation obtained on an external set of 3,234 patients (41.3%), meta-analyses showed that the FRIDA score had good and homogeneous discrimination (summary area under the curve 0.841, 95% confidence interval = 0.826-0.855, I2 = 0.00%) combined with accurate calibration (summary Log O/E ratio 0.017, 95% confidence interval -0.155 to 0.190). These performances remained stable at spatial validation obtained on 3,626 patients, with substantial heterogeneity of estimates across nine facilities. Decision curve analyses showed that a FRIDA score-supported strategy far outperformed the usual "treat all" approach in each impairment categories. CONCLUSION The FRIDA score is a new clinically useful tool to predict an individual risk for dependence in ambulation at rehabilitation discharge in many different disabilities, and may also reflect well the case-mix composition of the rehabilitation facilities.
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Affiliation(s)
- Bruno Bernardini
- IRCCS Humanitas Research Hospital, Neurocenter-Neurorehabilitation Unit, Rozzano, Milan, Italy.
| | - Luigi Baratto
- Department of Rehabilitation, La Colletta Hospital, Arenzano, Italy
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Annibale Biggeri
- Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence (FI), Florence, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua (PD), Padua, Italy
| | - Giovanna Cerina
- IRCCS Humanitas Research Hospital, Neurocenter-Neurorehabilitation Unit, Rozzano, Milan, Italy
| | - Viviana Colantonio
- IRCCS Humanitas Research Hospital, Neurocenter-Neurorehabilitation Unit, Rozzano, Milan, Italy
| | - Carla Corsini
- IRCCS Humanitas Research Hospital, Neurocenter-Neurorehabilitation Unit, Rozzano, Milan, Italy
| | - Sara Ghirmai
- IRCCS Humanitas Research Hospital, Neurocenter-Neurorehabilitation Unit, Rozzano, Milan, Italy
| | - Marco Pagani
- IRCCS Humanitas Research Hospital, Neurocenter-Neurorehabilitation Unit, Rozzano, Milan, Italy
| | - Stefania Fracchia
- Geriatric Internal Medicine Unit, Garbagnate Hospital, Garbagnate Milanese, Milan, Italy
| | - Marisa Gardella
- Department of Rehabilitation, La Colletta Hospital, Arenzano, Italy
| | - Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua (PD), Padua, Italy
| | - Maria Luisa Malosio
- Institute of Neuroscience, National Research Council (CNR), Milan, Italy; Laboratory of Pharmacology and Pathology of the Nervous System, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elisa Malagamba
- Department of Health Services of Liguria Region, Genoa, Italy
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Chou WH, Covinsky K, Zhao S, Boscardin WJ, Finlayson E, Suskind AM. Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study. J Am Geriatr Soc 2022; 70:2948-2957. [PMID: 35696283 PMCID: PMC9588579 DOI: 10.1111/jgs.17928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term functional and cognitive outcomes in nursing home residents after procedures are poorly understood. Our objective was to evaluate these outcomes after suprapubic tube (SPT) placement. METHODS We performed a retrospective, cohort study in the nursing home setting. Participants were long-term nursing home residents who underwent SPT placement from 2014 to 2016 in the United States. SPT placements were identified in Medicare Inpatient, Outpatient, and Carrier files using International Classification of Diseases and Current Procedural Terminology codes. Residents were identified through the Minimum Data Set (MDS) 3.0 for Nursing Home Residents. MDS Activities of Daily Living (MDS-ADL) and Brief Interview for Mental Status (BIMS) scores were used to assess function and cognition, respectively. Outcomes of interest were worsening MDS-ADL and BIMS scores at 1 year postoperatively, 30-day postoperative complications, and 1-year mortality. Functional and cognitive trajectories were modeled to 1 year postoperatively using mixed-effect spline models. RESULTS From 2014 to 2016, 9647 residents with a mean age of 80.9 (SD 8.1) years underwent SPT placement. At 1 year postoperatively, 37.6% of residents died, while of survivors, 33.7% had worsening MDS-ADL and 36.2% worsened BIMS. Residents had steeper postoperative rates of functional decline compared to relatively stable preoperative trends that never recovered to baseline status. However, robustly characterizing an association between SPT placement and functional decline would require a propensity score matched cohort without SPT placement. Decline in cognitive status was not clearly associated with SPT placement, suggesting either the natural course of a vulnerable population or limitations of BIMS scores. CONCLUSIONS Outcomes important to older adults, such as functional ability and cognitive status, do not show improvement after SPT placement. These findings emphasize that this "minor" procedure should be considered with caution in this population and primarily for palliation.
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Affiliation(s)
| | - Kenneth Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Shoujun Zhao
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - W. John Boscardin
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Anne M. Suskind
- Department of Urology, University of California, San Francisco, San Francisco, CA
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Northwood M, Turcotte LA, McArthur C, Egbujie BA, Berg K, Boscart VM, Heckman GA, Hirdes JP, Wagg AS. Changes in Urinary Continence After Admission to a Complex Care Setting: A Multistate Transition Model. J Am Med Dir Assoc 2022; 23:1683-1690.e2. [PMID: 35870485 DOI: 10.1016/j.jamda.2022.06.019] [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: 03/09/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To examine changes in urinary continence for post-acute, Complex Continuing Care hospital patients from time of admission to short-term follow-up, either in hospital or after discharge to long-term care or home with services. DESIGN Retrospective cohort study of patients in Complex Continuing Care hospitals using clinical data collected with interRAI Minimum Data Set 2.0 and interRAI Resident Assessment Instrument Home Care. SETTING AND PARTICIPANTS Adults aged 18 years and older, admitted to Complex Continuing Care hospitals in Ontario, Canada, between 2009 and 2015 (n = 78,913). METHODS A multistate transition model was used to characterize the association between patient characteristics measured at admission and changes in urinary continence state transitions (continent, sometimes continent, and incontinent) between admission and follow-up. RESULTS The cohort included 27,896 patients. At admission, 9583 (34.3%) patients belonged to the continent state, 6441 (23.09%) patients belonged to the sometimes incontinent state, and the remaining 11,872 (42.6%) patients belonged to the incontinent state. For patients who were continent at admission, the majority (62.7%) remained continent at follow-up. However, nearly a quarter (23.9%) transitioned to the sometimes continent state, and an additional 13.4% became incontinent at follow-up. Several factors were associated with continence state transitions, including cognitive impairment, rehabilitation potential, stroke, Parkinson's disease, Alzheimer's disease and related dementias, and hip fracture. CONCLUSIONS AND IMPLICATIONS This study suggests that urinary incontinence is a prevalent problem for Complex Continuing Care hospital patients and multiple factors are associated with continence state transitions. Standardized assessment of urinary incontinence is helpful in this setting to identify patients in need of further assessment and patient-centered intervention and as a quality improvement metric to examine changes in continence from admission to discharge.
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Affiliation(s)
| | - Luke A Turcotte
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Katherine Berg
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Adrian S Wagg
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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Toles M, Colón-Emeric C, Hanson LC, Naylor M, Weinberger M, Covington J, Preisser JS. Transitional care from skilled nursing facilities to home: study protocol for a stepped wedge cluster randomized trial. Trials 2021; 22:120. [PMID: 33546737 PMCID: PMC7863858 DOI: 10.1186/s13063-021-05068-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Skilled nursing facility (SNF) patients are medically complex with multiple, advanced chronic conditions. They are dependent on caregivers and have experienced recent acute illnesses. Among SNF patients, the rate of mortality or acute care use is over 50% within 90 days of discharge, yet these patients and their caregivers often do not receive the quality of transitional care that prepares them to manage serious illnesses at home. Methods The study will test the efficacy of Connect-Home, a successfully piloted transitional care intervention targeting seriously ill SNF patients discharged to home and their caregivers. The study setting will be SNFs in North Carolina, USA, and, following discharge, in patients’ home. Using a stepped wedge cluster randomized trial design, six SNFs will transition at randomly assigned intervals from standard discharge planning to the Connect-Home intervention. The SNFs will contribute data for patients (N = 360) and their caregivers (N = 360), during both the standard discharge planning and Connect-Home time periods. Connect-Home is a two-step intervention: (a) SNF staff create an individualized Transition Plan of Care to manage the patient’s illness at home; and (b) a Connect-Home Activation RN visits the patient’s home to implement the written Transition Plan of Care. A key feature of the trial includes training of the SNF and Home Care Agency staff to complete the transition plan rather than using study interventionists. The primary outcomes will be patient preparedness for discharge and caregiver preparedness for caregiving role. With the proposed sample and using a two-sided test at the 5% significance level, we have 80% power to detect a 18% increase in the patient’s preparedness for discharge score. We will employ linear mixed models to compare observations between intervention and usual care periods to assess primary outcomes. Secondary outcomes include (a) patients’ quality of life, functional status, and days of acute care use and (b) caregivers’ burden and distress. Discussion Study results will determine the efficacy of an intervention using existing clinical staff to (a) improve transitional care for seriously ill SNF patients and their caregivers, (b) prevent avoidable days of acute care use in a population with persistent risks from chronic conditions, and (c) advance the science of transitional care within end-of-life and palliative care trajectories of SNF patients and their caregivers. While this study protocol was being implemented, the COVID-19 pandemic occurred and this protocol was revised to mitigate COVID-related risks of patients, their caregivers, SNF staff, and the study team. Thus, this paper includes additional material describing these modifications. Trial registration ClinicalTrials.gov NCT03810534. Registered on January 18, 2019.
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Affiliation(s)
- M Toles
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - C Colón-Emeric
- School of Medicine and the Durham VA GRECC, Duke University, Durham, USA
| | - L C Hanson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - M Weinberger
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - J Covington
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - J S Preisser
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Chandra A, Takahashi PY, McCoy RG, Hanson GJ, Chaudhry R, Storlie CB, Roellinger DL, Rahman PA, Naessens JM. Use of a Computerized Algorithm to Evaluate the Proportion and Causes of Potentially Preventable Readmissions Among Patients Discharged to Skilled Nursing Facilities. J Am Med Dir Assoc 2020; 22:1060-1066. [PMID: 33243602 DOI: 10.1016/j.jamda.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 07/31/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Older patients discharged to skilled nursing facilities (SNFs) for post-acute care are at high risk for hospital readmission. Yet, as in the community setting, some readmissions may be preventable with optimal transitional care. This study examined the proportion of 30-day hospital readmissions from SNFs that could be considered potentially preventable readmissions (PPRs) and evaluated the reasons for these readmissions. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Post-acute practice of an integrated health care delivery system serving 11 SNFs in the US Midwest. Patients discharged from the hospital to an SNF and subsequently readmitted to the hospital within 30 days from January 1, 2009, through November 31, 2016. METHODS A computerized algorithm evaluated the relationship between initial and repeat hospitalizations to determine whether the repeat hospitalization was a PPR. We assessed for changes in PPR rates across the system over the study period and evaluated the readmission categories to identify the most prevalent PPR categories. RESULTS Of 11,976 discharges to SNFs for post-acute care among 8041 patients over the study period, 16.6% resulted in rehospitalization within 30 days, and 64.8% of these rehospitalizations were considered PPRs. Annual proportion of PPRs ranged from 58.2% to 66.4% [mean (standard deviation) 0.65 (0.03); 95% confidence interval CI 0.63-0.67; P = .36], with no discernable trend. Nearly one-half (46.2%) of all 30-day readmissions were classified as potentially preventable medical readmissions related to recurrence or continuation of the reason for initial admission or to complications from the initial hospitalization. CONCLUSIONS AND IMPLICATIONS For this cohort of patients discharged to SNFs, a computerized algorithm categorized a large proportion of 30-day hospital readmissions as potentially preventable, with nearly one-half of those linked to the reason for the initial hospitalization. These findings indicate the importance of improvement in postdischarge transitional care for patients discharged to SNFs.
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Affiliation(s)
- Anupam Chandra
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Paul Y Takahashi
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rozalina G McCoy
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Gregory J Hanson
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rajeev Chaudhry
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Curtis B Storlie
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Parvez A Rahman
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - James M Naessens
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Improving Care Transitions for Hospitalized Veterans Discharged to Skilled Nursing Facilities: A Focus on Polypharmacy and Geriatric Syndromes. Geriatrics (Basel) 2019; 4:geriatrics4010019. [PMID: 31023987 PMCID: PMC6473365 DOI: 10.3390/geriatrics4010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 11/17/2022] Open
Abstract
Geriatric syndromes and polypharmacy are common in older patients discharged to skilled nursing facilities (SNFs) and increase 30-day readmission risk. In a U.S.A. Department of Veterans Affairs (VA)-funded Quality Improvement study to improve care transitions from the VA hospital to area SNFs, Veterans (N = 134) were assessed for geriatric syndromes using standardized instruments as well as polypharmacy, defined as five or more medications. Warm handoffs were used to facilitate the transfer of this information. This paper describes the prevalence of geriatric syndromes, polypharmacy, and readmission rates. Veterans were prescribed an average of 14.7 medications at hospital discharge. Moreover, 75% of Veterans had more than two geriatric syndromes, some of which began during hospitalization. While this effort did not reduce 30-day readmissions, the high prevalence of geriatric syndromes and polypharmacy suggests that future efforts targeting these issues may be necessary to reduce readmissions among Veterans discharged to SNF.
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van Seben R, Reichardt LA, Aarden JJ, van der Schaaf M, van der Esch M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. The Course of Geriatric Syndromes in Acutely Hospitalized Older Adults: The Hospital-ADL Study. J Am Med Dir Assoc 2018; 20:152-158.e2. [PMID: 30270027 DOI: 10.1016/j.jamda.2018.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To establish the prevalence and course of geriatric syndromes from hospital admission up to 3 months postdischarge and to determine the probability to retain geriatric syndromes over the period from discharge until 3 months postdischarge, once they are present at admission. DESIGN Prospective multicenter cohort study conducted between October 2015 and June 2017. SETTING AND PARTICIPANTS Acutely hospitalized patients aged 70 years and older recruited from internal, cardiology, and geriatric wards of 6 Dutch hospitals. MEASURES Cognitive impairment, depressive symptoms, apathy, pain, malnutrition, incontinence, dizziness, fatigue, mobility impairment, functional impairment, fall risk, and fear of falling were assessed at admission, discharge, and 1, 2, and 3 months postdischarge. Generalized estimating equations analysis were performed to analyze the course of syndromes and to determine the probability to retain syndromes. RESULTS A total of 401 participants [mean age (standard deviation) 79.7 (6.7)] were included. At admission, a median of 5 geriatric syndromes were present. Most prevalent were fatigue (77.2%), functional impairment (62.3%), apathy (57.5%), mobility impairment (54.6%), and fear of falling (40.6%). At 3 months postdischarge, an average of 3 syndromes were present, of which mobility impairment (52.7%), fatigue (48.1%), and functional impairment (42.5%) were most prevalent. Tracking analysis showed that geriatric syndromes that were present at admission were likely to be retained. The following 6 geriatric syndromes were most likely to stay present postdischarge: mobility impairment, incontinence, cognitive impairment, depressive symptoms, functional impairment, and fear of falling. IMPLICATIONS Acutely hospitalized older adults exhibit a broad spectrum of highly prevalent geriatric syndromes. Moreover, patients are likely to retain symptoms that are present at admission postdischarge. Our study underscores the need to address a wide range of syndromes at admission, the importance of communication on syndromes to the next care provider, and the need for adequate follow-up care and syndrome management postdischarge.
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Affiliation(s)
- Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
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Onder G, Giovannini S, Sganga F, Manes-Gravina E, Topinkova E, Finne-Soveri H, Garms-Homolová V, Declercq A, van der Roest HG, Jónsson PV, van Hout H, Bernabei R. Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects. Aging Clin Exp Res 2018; 30:1015-1021. [PMID: 29340963 DOI: 10.1007/s40520-018-0893-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/04/2018] [Indexed: 02/07/2023]
Abstract
AIM Drugs may interact with geriatric syndromes by playing a role in the continuation, recurrence or worsening of these conditions. Aim of this study is to assess the prevalence of interactions between drugs and three common geriatric syndromes (delirium, falls and urinary incontinence) among older adults in nursing home and home care in Europe. METHODS We performed a cross-sectional multicenter study among 4023 nursing home residents participating in the Services and Health for Elderly in Long-TERm care (Shelter) project and 1469 home care patients participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Exposure to interactions between drugs and geriatric syndromes was assessed by 2015 Beers criteria. RESULTS 790/4023 (19.6%) residents in the Shelter Project and 179/1469 (12.2%) home care patients in the IBenC Project presented with one or more drug interactions with geriatric syndromes. In the Shelter project, 288/373 (77.2%) residents experiencing a fall, 429/659 (65.1%) presenting with delirium and 180/2765 (6.5%) with urinary incontinence were on one or more interacting drugs. In the IBenC project, 78/172 (45.3%) participants experiencing a fall, 80/182 (44.0%) presenting with delirium and 36/504 (7.1%) with urinary incontinence were on one or more interacting drugs. CONCLUSION Drug-geriatric syndromes interactions are common in long-term care patients. Future studies and interventions aimed at improving pharmacological prescription in the long-term care setting should assess not only drug-drug and drug-disease interactions, but also interactions involving geriatric syndromes.
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Affiliation(s)
- Graziano Onder
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
| | - Silvia Giovannini
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Federica Sganga
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Ester Manes-Gravina
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | | | - Vjenka Garms-Homolová
- Department of Economics and Law, HTW Berlin University of Applied Sciences, Berlin, Germany
| | - Anja Declercq
- LUCAS & Center for Sociological Research, KU Leuven, Leuven, Belgium
| | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Pálmi V Jónsson
- Department of Geriatrics, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hein van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto Bernabei
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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van Seben R, Reichardt LA, Essink DR, van Munster BC, Bosch JA, Buurman BM. “I Feel Worn Out, as if I Neglected Myself”: Older Patients’ Perspectives on Post-hospital Symptoms After Acute Hospitalization. THE GERONTOLOGIST 2018; 59:315-326. [DOI: 10.1093/geront/gnx192] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Dirk R Essink
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, the Netherlands
| | - Barbara C van Munster
- Department of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, the Netherlands
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