Assessment of eHealth capabilities and utilization in residential care settings

Contextual Factors and Adoption of Strategies Related to Opioid Prescribing Practices in Healthcare Settings: Cross-Sectional Study

This study aimed to examine the association between different contextual factors (e.g., facility size, rurality, and perceived needs) and the adoption of a policy or strategy related to opioid prescribing practices in healthcare settings. Cross-sectional survey data was collected from a convenience sample of physicians (N = 68). Logistic regression models were used to examine the effects of contextual factors on the dependent variables. Less than half reported having a policy restricting opioid prescribing practices, and 81% reported having one or more strategies for the safe use of chronic opioid therapy. After adjusting for other contextual factors, small practice size was positively associated with having a policy restricting opioid prescribing practices. This exploratory study provides insights for further investigation of how various contextual factors can influence policy adoption in different healthcare settings and practices to address major public health threats.

Exploring the Mediating Role of Social Support and Fall Efficacy on the Association Between Falls and Physical Activity: A Cross-Sectional Study in an Assisted-Living Population

Mobility restriction as a consequence of a fall is a major issue in assisted-living facilities. Although many factors are related to falling, little is known about the relationship between falls, social support, falls efficacy, and physical activity. The authors examined the relationship between falls and the Social Support Questionnaire, the Activities-specific Balance Confidence scale, and physical activity simultaneously in 81 older adults (66-94 years) using structural equation modeling. The structural equation model revealed that being older was associated with lower falls efficacy and a higher number of falls, and higher falls efficacy was associated with a higher number of steps per day. The development of a structural equation model illustrating the mediating effects of social support and falls efficacy on the relationship between falls and physical activity can help health care professionals in predicting risk factors of falls that may be compromised by residing in an assisted-living facility.

The Use of Health Information Exchange to Augment Patient Handoff in Long-Term Care: A Systematic Review

BACKGROUND

Legislation aimed at increasing the use of a health information exchange (HIE) in healthcare has excluded long-term care facilities, resulting in a vulnerable patient population that can benefit from the improvement of communication and reduction of waste.

OBJECTIVE

The purpose of this review is to provide a framework for future research by identifying themes in the long-term care information technology sector that could function to enable the adoption and use of HIE mechanisms for patient handoff between long-term care facilities and other levels of care to increase communication between providers, shorten length of stay, reduce 60-day readmissions, and increase patient safety.

METHODS

The authors conducted a systematic search of literature through CINAHL, PubMed, and Discovery Services for Texas A&M University Libraries. Search terms used were ("health information exchange" OR "healthcare information exchange" OR "HIE") AND ("long term care" OR "long-term care" OR "nursing home" OR "nursing facility" OR "skilled nursing facility" OR "SNF" OR "residential care" OR "assisted living"). Articles were eligible for selection if they were published between 2010 and 2017, published in English, and published in academic journals. All articles were reviewed by all reviewers and literature not relevant to the research objective was excluded.

RESULTS

Researchers selected and reviewed 22 articles for common themes. Results concluded that the largest facilitator and barrier to the adoption of HIE mechanisms is workflow integration/augmentation and the organizational structure/culture, respectively. Other identified facilitator themes were enhanced communication, increased effectiveness of care, and patient safety. The additional barriers were missing/incomplete data, inefficiency, and market conditions.

CONCLUSION

The long-term care industry has been left out of incentives from which the industry could have benefited tremendously. Organizations that are not utilizing health information technology mechanisms, such as electronic health records and HIEs, are at a disadvantage as insurers switch to capitated forms of payment that rely on reduced waste to generate a profit.

Factors Associated With Injurious Falls in Residential Care Facilities

Objective: Despite a growing literature on the epidemiology of falls, little is known about injurious falls in residential care facilities (RCFs). Addressing this gap, this study examined demographic, interpersonal, institutional, and community factors associated with injurious falls in RCFs. Method: We conducted analyses using a nationally representative sample ( n = 733,309) of RCF residents (2010) examining whether or not a resident experienced a fall that resulted in any injury (past year). Results: Overall, 15% of RCF residents experienced an injurious fall. Residents needing assistance with activities of daily living were more likely to experience injurious falls (adjusted-OR = 1.85), whereas males (adjusted-OR = 0.74) and those residing in smaller facilities (adjusted-OR = 0.68) were less likely. Other resident sociodemographic characteristics, payment status, social connectedness, and rurality were not significant independent predictors. Discussion: Research further exploring multifactorial fall prevention screening and treatment programs in RCFs is recommended for reducing injurious falls in this understudied setting.