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Carpenter J, Kinder D, Smith D, Ersek M, Wachterman M, Thorpe J, Sullivan DR, Bailey J, Shreve S, Kutney-Lee A. Nursing Home Star Ratings and End-Of-Life Care Quality: Lessons Learned From the Veterans Health Administration. J Am Med Dir Assoc 2024:105121. [PMID: 38950589 DOI: 10.1016/j.jamda.2024.105121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/17/2024] [Accepted: 05/24/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES More than 25% of deaths among older adults occur in nursing homes. Thus, assessments of nursing home quality, including the widely used 5-star rating systems, should reflect quality of end-of-life (EOL) care. Our objective was to examine the associations between Veterans Affairs (VA) nursing home star ratings and quality of EOL care as measured by the VA's Bereaved Family Survey (BFS). DESIGN National, retrospective observational study. SETTING AND PARTICIPANTS VA nursing homes, known as Community Living Centers (CLCs). All veterans who died in a CLC from October 2018 to September 2019 whose next of kin completed a BFS. METHODS Using linked VA data sources, we examined the BFS-Performance Measure (BFS-PM) (ie, the % of BFS respondents who provided an "excellent" overall rating) by the Overall Star Rating and domain star ratings (unannounced survey, staffing, and quality) for the 133 CLCs in our sample. Logistic and linear regression was used to examine the associations between CLC Overall Star Rating and individual-level BFS outcomes. Outcomes included the BFS-PM (primary), the 3 BFS factor scores of Respectful Care and Communication, Emotional and Spiritual Support, and Death Benefits, and 2 symptom management items. RESULTS Differences in the BFS-PM by CLC star rating were small to none and not statistically significant across all star rating domains. The relationship between a higher CLC Overall Star Rating and odds of an "excellent" BFS global rating was not statistically significant. Similarly, no significant associations were observed between a higher CLC Overall Star Rating and scores on the BFS factor scores and symptom management items. CONCLUSIONS AND IMPLICATIONS Our findings suggest that the current CLC star rating system is not sufficient to assess the quality of EOL care. BFS scores, or a comparative EOL quality of care measure, should be integrated into CLC quality rating systems.
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Affiliation(s)
- Joan Carpenter
- University of Maryland School of Nursing, Baltimore, MD, USA; Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
| | - Daniel Kinder
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Dawn Smith
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Mary Ersek
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Melissa Wachterman
- Veterans Affairs Boston Health Care System, Section of General Internal Medicine, Boston, MA, USA; Dana Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, MA, USA
| | - Joshua Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jennifer Bailey
- Office of Geriatrics and Extended Care, Department of Veterans Affairs, Seattle, WA, USA
| | - Scott Shreve
- Palliative and Hospice Care Program, Department of Veterans Affairs, Seattle, WA, USA; Penn State College of Medicine, Hershey, PA, USA
| | - Ann Kutney-Lee
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Leland NE, Prusynski RA, Shore AD, Cary MP, Falvey J, Mroz T, Saliba D. Skilled nursing facility staffing shortages: Sources, strategies, and impacts on staff who stayed. Health Serv Res 2024. [PMID: 38924096 DOI: 10.1111/1475-6773.14355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To examine skilled nursing facility (SNF) staffing shortages across job roles during the COVID-19 pandemic. We aimed to capture the perspectives of leaders on the breadth of staffing shortages and their implications on staff that stayed throughout the pandemic in order to provide recommendations for policies and practices used to strengthen the SNF workforce moving forward. STUDY SETTING AND DESIGN For this qualitative study, we engaged a purposive national sample of SNF leaders (n = 94) in one-on-one interviews between January 2021 and December 2022. DATA SOURCE AND ANALYTIC SAMPLE Using purposive sampling (i.e., Centers for Medicare & Medicaid quality rating, region, ownership) to capture variation in SNF organizations, we conducted in-depth, semi-structured qualitative interviews, guided a priori by the Institute of Medicine's Model of Healthcare System Framework. Interviews were conducted via phone, audio-recorded, and transcribed. Rigorous rapid qualitative analysis was used to identify emergent themes, patterns, and relationships. PRINCIPAL FINDINGS SNF leaders consistently described staffing shortages spanning all job roles, including direct care (e.g., activities, nursing, social services), support services (e.g., laundry, food, environmental services), administrative staff, and leadership. Ascribed sources of shortages were multidimensional (e.g., competing salaries, family caregiving needs, burnout). The impact of shortages was felt by all staff that stayed. In addition to existing job duties, those remaining staff experienced re-distribution of essential day-to-day operational tasks (e.g., laundry) and allocation of new COVID-19 pandemic-related activities (e.g., screening). Cross-training was used to cover a wide range of job duties, including patient care. CONCLUSIONS Policies are needed to support SNF staff across roles beyond direct care staff. These policies must address the system-wide drivers perpetuating staffing shortages (i.e., pay differentials, burnout) and leverage strategies (i.e., cross-training, job role flexibility) that emerged from the pandemic to ensure a sustainable SNF workforce that can meet patient needs.
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Affiliation(s)
- Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Amanda D Shore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael P Cary
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Jason Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tracy Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Debra Saliba
- Geriatrics Research Education and Clinical Center, Greater Los Angeles Veterans Administration, Los Angeles, California, USA
- Borun Center, Division of Geriatrics, University of California, Los Angeles, California, USA
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3
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Walker VL, Britson VLS, Arends RF, Rees JG, Junge FM. Evolution of Telehealth Program to Meet Current Needs of Post-Acute and Long-Term Care Communities. J Am Med Dir Assoc 2024; 25:105079. [PMID: 38871008 DOI: 10.1016/j.jamda.2024.105079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
This article describes a telehealth program initially created to reduce transfers to acute care from the nursing home and its evolution into a robust program that includes Behavioral Health, a Medical Director program, and telenursing.
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Affiliation(s)
- Victoria L Walker
- Avel eCare, Senior Care, Sioux Falls, SD, USA; Department of Family Medicine, University of South Dakota Sanford School of Medicine, Vermillion, SD, USA
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Sharma H, Xu L. Occupational Injuries in the US Nursing Homes. Med Care 2024; 62:346-351. [PMID: 38546387 DOI: 10.1097/mlr.0000000000001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Workplace injuries adversely affect worker well-being and may worsen staffing shortages and turnover in nursing homes. A better understanding of the trends in injuries in nursing homes including organizational factors associated with injuries can help improve our efforts in addressing worker injuries. OBJECTIVE To summarize the trends in injuries and organizational correlates of injuries in US nursing homes. RESEARCH DESIGN We combine national injury tracking data from the Occupational Safety and Health Administration (2016-2019) with nursing home characteristics from Nursing Home Compare. Our outcomes include the proportion of nursing homes reporting any injuries, the mean number of injuries, and the mean number of injuries or illnesses with days away from work, or job transfer or restriction, or both (DART). We descriptively summarize trends in injuries over time. We also estimate the association between nursing home characteristics and injuries using multivariable regressions. RESULTS We find that approximately 93% of nursing homes reported at least 1 occupational injury in any given year. Injuries had a substantial impact on productivity with 4.1 DART injuries per 100 full-time employees in 2019. Higher bed size, occupancy, RN staffing, and chain ownership are associated with increased DART rates whereas higher overall nursing home star ratings and for-profit status are associated with decreased DART rates. CONCLUSIONS A high proportion of nursing homes report occupational injuries that can affect staff well-being, productivity, and quality of care. Injury prevention policies should target the types of injuries occurring in nursing homes and OSHA should monitor nursing homes reporting high and repeated injuries.
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Affiliation(s)
- Hari Sharma
- Department of Health Management and Policy, University of Iowa, Iowa City, IA
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Kiljunen O, Savela RM, Välimäki T, Kankkunen P. Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review. Res Nurs Health 2024. [PMID: 38522016 DOI: 10.1002/nur.22382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/23/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Identifying ways to ensure resident safety is increasingly becoming a priority in residential settings and nursing homes. The aim of this qualitative systematic review was to identify, describe, and assess research evidence on managers' perceptions regarding the barriers and facilitators of daily resident and patient safety work in residential settings and nursing homes. A qualitative systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Published studies were sought through academic databases: Academic Search Premier, CINAHL, PubMed (MEDLINE), Scopus, SocINDEX, and Web of Science Core Collection in April 2023. Finally, 12 studies were included. The results of the included studies were synthesized using thematic synthesis after data extraction. According to the results, (1) competent staff and material resources; (2) management and culture; (3) communication, networks, optimal use of expertise; and (4) effective use of guidelines, rules, and regulations play a significant role in the success of resident and patient safety work. The findings revealed that promoting resident safety should not be seen solely as the responsibility of individual residential or nursing home personnel, as it requires multiprofessional cooperation and access to wider networks. Staff and managers must be receptive to learning, changing, and improving safety. Moreover, to ensure resident safety, it is essential to ensure that the organizations support safety work in residential and nursing home units.
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Affiliation(s)
- Outi Kiljunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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6
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Min D, Park S, Kim S, Park HO. Patient Safety in Nursing Homes From an Ecological Perspective: An Integrated Review. J Patient Saf 2024; 20:77-84. [PMID: 38126786 DOI: 10.1097/pts.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The aims of the study were to identify the systemic factors affecting the characteristics and safety of older adults living in nursing homes and the resulting resident outcomes and to explore the relationship between them through an integrated literature review. METHODS A literature search was conducted from April 22 to May 6, 2021, in the PubMed, Embase, Cochrane CENTRAL, CIHNAL, RISS, NDL, and KoreaMed databases. The following key words and MeSH terms were used for the search: "nursing home," "skilled nursing facility," "long-term care facility," and "patient safety" or "safety." RESULTS Forty-seven qualifying articles were finally selected. Three domains were derived as personal factors, 12 as facility factors, and one as a policy factor. The interrelationships between them could result in positive or negative resident outcomes. The relationship between them was also reconstructed from an ecological perspective. CONCLUSIONS The results demonstrated that the safety and quality of life of older adults living in nursing homes were affected by both individual and institutional factors.
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Affiliation(s)
- Deulle Min
- From the Department of Nursing, College of Medicine, Wonkwang University, Iksan
| | - Seungmi Park
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju
| | - Suhee Kim
- School of Nursing and Research Institute of Nursing Science, Hallym University
| | - Hye Ok Park
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
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7
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Min D, Kim S. Development and validation of the resident safety activity questionnaire for long-term care facility staff. Geriatr Nurs 2024; 56:278-284. [PMID: 38402807 DOI: 10.1016/j.gerinurse.2024.02.019] [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: 10/21/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
This study developed and tested a questionnaire to evaluate the safety activities supporting older adult residents' quality of care among long-term care facility staff. The process included item construction, expert review and pilot testing, testing of reliability and validation with 268 staff from 12 targeted facilities in South Korea. The final questionnaire yielded 28 items across six domains: proactive activities for emergency situations, comfort management, prevention of infections, staff training and communication, sufficient goods and equipment, and adequate personnel. These factors explained 73.48 % of the total variance. The fit indices in the confirmatory factor analysis were acceptable, and the total Cronbach's ⍺ was 0.952 (sub-domains: 0.823 - .895), indicating high reliability. The findings suggest the reliability and validity of the newly-developed Resident Safety Activity Questionnaire, enabling an accurate evaluation of the safety of long-term care facility residents and serving as an indicator for improving care quality in such establishments.
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Affiliation(s)
- Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Suhee Kim
- School of Nursing and Research Institute of Nursing Science, Hallym University, Chuncheon, Republic of Korea.
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8
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Blatter C, Osińska M, Simon M, Zúñiga F. The relationship between nursing home staffing and resident safety outcomes: A systematic review of reviews. Int J Nurs Stud 2024; 150:104641. [PMID: 37992653 DOI: 10.1016/j.ijnurstu.2023.104641] [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: 12/22/2022] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Resident safety is an important topic for nursing home practice with up to 33 % of residents subjected to an adverse event. In spite of a large evidence base examining the relationship between nursing home staffing and resident outcomes, the findings of several systematic reviews remain inconclusive and contradicting, possibly due to methodological shortcomings. OBJECTIVE The main aim of this review was to provide a comprehensive overview of the literature on nursing home staffing and its relationship with resident safety outcomes. DESIGN We undertook a systematic review of reviews. We searched Medline, CINAHL and Embase by the end of November 2022. Reviews were included if they assessed the relationship between nursing home staffing and resident safety outcomes using objective measures and data at resident level. Quality appraisal was conducted using the SIGN-checklist, but we did not exclude any reviews based on quality assessment. We used a narrative approach, tables and figures to summarize the findings. RESULTS We included 13 systematic reviews published between 2006 and 2022 building on primary evidence from 1977 to 2022. Twelve reviews investigated the relationship between nurse staffing and resident safety outcomes (187 unique primary studies), and one review focused on allied health professionals (28 primary studies). Five reviews originated as work to inform governmental recommendations on staffing. We found diverse approaches used to investigate the staffing-outcome relationship with regard to design, timeframe, operationalization, data-source and theoretical rationales guiding the studies. The most prominently reported resident safety outcomes were pressure ulcers and urinary tract infections. Commonly reported staffing measures included number and level of education of nursing home staff. Based on narrative summaries, staffing seems to have a favorable relationship with resident safety outcomes, but logic models explaining the mechanisms of this relationship were sparsely reported. CONCLUSIONS The existing literature shows methodological limitations that demand a change in research on the staffing-outcome relationship in the nursing home setting. Our work highlights the need for carefully designed primary studies that address the pertinent shortcomings by design, timeframe, operationalization, data-source and theoretical rationales. These future studies will allow to carefully examine the causal relationship between selected staffing measures and resident safety outcomes in further detail and serve as legitimate evidence bases to inform action plans for clinical practice and to evaluate staffing policies.
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Affiliation(s)
- Catherine Blatter
- Institute of Nursing Science, University of Basel, Switzerland. https://twitter.com/cathblatter
| | | | - Michael Simon
- Institute of Nursing Science, University of Basel, Switzerland. https://twitter.com/msimoninfo
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Davila H, Mills WL, Clark V, Hartmann CW, Sullivan JL, Mohr DC, Baughman AW, Berlowitz DR, Pimentel CB. Quality Improvement Efforts in VA Community Living Centers Following Public Reporting of Performance. J Aging Soc Policy 2024; 36:118-140. [PMID: 37014929 DOI: 10.1080/08959420.2023.2196913] [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: 04/04/2022] [Accepted: 01/12/2023] [Indexed: 04/06/2023]
Abstract
For two decades, the U.S. government has publicly reported performance measures for most nursing homes, spurring some improvements in quality. Public reporting is new, however, to Department of Veterans Affairs nursing homes (Community Living Centers [CLCs]). As part of a large, public integrated healthcare system, CLCs operate with unique financial and market incentives. Thus, their responses to public reporting may differ from private sector nursing homes. In three CLCs with varied public ratings, we used an exploratory, qualitative case study approach involving semi-structured interviews to compare how CLC leaders (n = 12) perceived public reporting and its influence on quality improvement. Across CLCs, respondents said public reporting was helpful for transparency and to provide an "outside perspective" on CLC performance. Respondents described employing similar strategies to improve their public ratings: using data, engaging staff, and clearly defining staff roles vis-à-vis quality improvement, although more effort was required to implement change in lower performing CLCs. Our findings augment those from prior studies and offer new insights into the potential for public reporting to spur quality improvement in public nursing homes and those that are part of integrated healthcare systems.
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Affiliation(s)
- Heather Davila
- Center for Access and Delivery Research & Evaluation, Iowa City Department of Veterans Affairs (VA) Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Whitney L Mills
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI, USA
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Valerie Clark
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Jennifer L Sullivan
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI, USA
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, MA, USA
| | - Amy W Baughman
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School,Boston, MA, USA
| | - Dan R Berlowitz
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Camilla B Pimentel
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
- New England Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
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Xie F, Li X, Li X, Hou Z, Bai J. Control and guidance: a comparative study of building and planning standards for age-friendly built environment in the UK and China. Front Public Health 2023; 11:1272624. [PMID: 38186718 PMCID: PMC10768031 DOI: 10.3389/fpubh.2023.1272624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
The crux of building and planning standards for age-friendly built environment in all countries resides in the regulation of age-friendly built environment practices, yet there exist variations in the representation of content dimensions. The UK is distinguished by its discretionary approach to guidance, whereas China exhibits a highly controlled disposition. Control and guidance may appear to be antithetical, it is essential to recognize that the building and planning standards for age-friendly built environment in both countries never deviate from the legal constraints while providing guidance in achieving age-friendly environments, thus striking a delicate balance between control and guidance. The study examines the standard systems of national standards, local standards and organizational standards, as well as the three dimensions of foundation standards, generic standards and specialized standards. The analysis of building and planning standards for age-friendly built environment in the UK and China scrutinizes the disparities between control and guidance, identifying similarities and differences in the building and planning standard system and content dimensions of the two countries. This analysis serves as a valuable reference for the development of building and planning standards for age-friendly built environment in China.
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Affiliation(s)
- Fan Xie
- School of Architecture, Southeast University, Nanjing, China
| | - Xiangfeng Li
- School of Architecture, Southeast University, Nanjing, China
- Key Laboratory of Urban and Architectural Heritage Conservation of Ministry of Education, Southeast University, Nanjing, China
| | - Xiaoming Li
- The Bartlett School of Architecture, University College London (UCL), London, United Kingdom
| | - Zhulin Hou
- School of Architecture, Southeast University, Nanjing, China
| | - Jing Bai
- School of Architecture, Southeast University, Nanjing, China
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Min D, Yu SY. Long-term Care Facility Staff's Experience of Safety Activities: A Qualitative Study. West J Nurs Res 2023; 45:1008-1016. [PMID: 37737156 DOI: 10.1177/01939459231201086] [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: 09/23/2023]
Abstract
BACKGROUND Ensuring the safety and quality of care is paramount in long-term care facilities due to residents' vulnerability. OBJECTIVE We explored the experiences of long-term care facility staff (eg, registered nurses [RNs], certified nursing assistants [CNAs], care workers, social workers, and physical therapists) in safety activities, aiming to understand their meaning and nature. METHODS We conducted qualitative focus group interviews with 25 participants, specifically addressing safety issues in long-term care facilities through the use of open-ended questions. We transcribed the data and conducted thematic analysis. RESULTS Participants engaged in discussions about various challenges, including assisting residents in maintaining physical comfort, managing behavioral and psychological symptoms of dementia, ensuring medication safety, implementing infection control practices, and providing adequate training on fire prevention, evacuation, and response protocols. Themes identified were "physical comfort," "managing dementia symptoms," "drug administration," "infection control," and "fire prevention." CONCLUSIONS The staff emphasized the safety of residents as their highest priority. Considering the lack of registered nurses in long-term care facilities, ongoing training and supervision are necessary to ensure that other long-term care facility staff can perform safety activities.
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Affiliation(s)
- Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Soo-Young Yu
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
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12
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Leland NE, Rouch SA, Prusynski RA, Shore AD, Kaufman H, Hoover LP, Mroz TM, Freburger JK, Saliba D. Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers-A Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6959. [PMID: 37887697 PMCID: PMC10606322 DOI: 10.3390/ijerph20206959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19. Given concerns about the unintended consequence of these events, this study protocol will examine how organizations responded to these policies and whether there were changes in SNF and HHA access, care delivery, and outcomes from the perspectives of leadership, staff, patients, and families. We will conduct a two-phase multiple case study guided by the Institute of Medicine's Model of Healthcare Systems. Phase I will include three cases for each setting and a maximum of fifty administrators per case. Phase II will include a subset of Phase I organizations, which are grouped into three setting-specific cases. Each Phase II case will include a maximum of four organizations. Semi-structured interviews will explore the perspectives of frontline staff, patients, and family caregivers (Phase II). Thematic analysis will be used to examine the impact of payment policy and COVID-19 on organizational operations, care delivery, and patient outcomes. The results of this study intend to develop evidence addressing concerns about the unintended consequences of the PAC payment policy during the COVID-19 pandemic.
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Affiliation(s)
- Natalie E. Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Stephanie A. Rouch
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
- The Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Rachel A. Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Amanda D. Shore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Hannah Kaufman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Lorelei P. Hoover
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Tracy M. Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Janet K. Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA;
| | - Debra Saliba
- Veterans Affairs (VA) Greater Los Angeles Geriatrics Research Education and Clinical Center (GRECC), Los Angeles, CA 90095, USA;
- Borun Center, University of California, Los Angeles, CA 90095, USA
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Indarwati R, Efendi F, Fauziningtyas R, Fauziah A, Sudarsiwi NP. Efforts to Improve the Safety Culture of the Elderly in Nursing Homes: A Qualitative Study. Risk Manag Healthc Policy 2023; 16:393-400. [PMID: 36936883 PMCID: PMC10015942 DOI: 10.2147/rmhp.s399826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction The attention to building a safety culture in nursing homes is relatively less when compared to hospitals. Good patient safety will improve the quality of health services and minimize incidents related to patient safety. This study aims to look at efforts that can be made to improve safety culture in nursing homes. Materials and Methods The research design uses phenomenological qualitative with in-depth interviews. Purposive sampling was used with interpretive phenomenological analysis. Participants were 29 staff from four government and private institutions in East Java, Indonesia. Results The sub-themes resulting from the research efforts to improve the safety culture of the elderly in nursing homes are the provision of new staff orientation, training, improvement of infrastructure, and procurement of security staff. Conclusion The analysis shows that efforts to improve safety culture can be carried out with various strategies by paying attention to risk assessment steps, patient risk identification, and management, incident reporting, and analysis, the ability to learn from incidents and their follow-up, as well as implementing solutions to minimize risks and prevent them from occurring injury. Safety culture plays an essential role in improving the quality of care.
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Affiliation(s)
- Retno Indarwati
- Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia
- Correspondence: Retno Indarwati, Email
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia
| | - Rista Fauziningtyas
- Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia
| | - Anis Fauziah
- Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia
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Kim KA, Lee J, Kim D, Min D. Patient safety measurement tools used in nursing homes: a systematic literature review. BMC Health Serv Res 2022; 22:1376. [PMCID: PMC9675074 DOI: 10.1186/s12913-022-08814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background An increase in the number of older adults has highlighted the important issue of the safety of residents in nursing homes. This review aimed to review previous studies on patient safety of older adults living in nursing homes, analyze the tools used to measure it, and identify factors affecting patient safety of older adult residents in nursing homes. Methods A literature search was conducted using EMBASE, PubMed, CINHAL, and COCHRANE. The main search terms were “nursing home” or “skilled nursing facility” or “long-term care facility” and “patient safety.” In total, 13,586 articles were identified. Two authors independently assessed the quality of each selected study using the Crowe Critical Appraisal Tool. Results Twenty-five studies were included in the analysis. There were a total of seven tools used to measure patient safety in nursing homes: the Nursing Home Survey on Patient Safety Culture (10 studies) and Hospital Survey on Patient Safety Culture (nine studies). Furthermore, the Nursing Home Survey on Patient Safety Culture-China, Safety Attitudes Questionnaire, Safety Attitudes Questionnaire in a Skilled Nursing Facility, Safety Attitudes Questionnaire-Ambulatory Version, and Modified Stanford Patient Safety Culture Survey Instrument were used in one study each. The most used tool among them was the Nursing Home Survey on Patient Safety Culture. Most tools used to measure patient safety in nursing homes were related to patient safety culture and employee attitudes. Conclusion Organizational factors, such as the staff education system and the composition of appropriate personnel, should be strengthened to establish a patient safety culture in nursing homes, for which policy support is crucial.
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Affiliation(s)
- Kyoung-A Kim
- grid.256155.00000 0004 0647 2973Department of Nursing, College of Nursing, Gachon University, 21936 Incheon, Republic of Korea
| | - Jungeun Lee
- grid.448830.30000 0004 7639 4990College of Nursing, Cheju Halla University, Jeju, Republic of Korea
| | - Dahee Kim
- grid.410899.d0000 0004 0533 4755The Graduate School, Wonkwang University, Iksan, Republic of Korea
| | - Deulle Min
- grid.410899.d0000 0004 0533 4755Department of Nursing, College of Medicine, Wonkwang University, 460, Iksandae-ro, 54538 Iksan, Jeonbuk Republic of Korea
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Park Y, Min D. Registered Nurses' perspective of systemic factors affecting nursing home care quality decline: A qualitative descriptive study. Nurs Open 2022; 10:1900-1908. [PMID: 36373815 PMCID: PMC9912408 DOI: 10.1002/nop2.1474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
AIM A growing number of older people are living in nursing homes worldwide, but their safety and quality of care are not guaranteed. This study explores registered nurses' (RNs) perspectives on systemic factors affecting the quality of care and safety decline of nursing home. DESIGN Qualitative descriptive study. METHODS In this study, semi-structured interviews were conducted with 10 RNs working in six nursing homes, who were chosen through purposive sampling. Data were collected from 1 August-19 September 2019, and analysed using thematic analysis. RESULTS The following five themes were derived: lack of sufficient number of RNs, poor work conditions, unclear job descriptions for RNs, no official position of nursing director and absence of transition care system. PATIENT OR PUBLIC CONTRIBUTION All reports of RNs affecting resident safety and quality of care decline were related to systemic factors. Therefore, improving quality of care in nursing homes should be supported by changes in systemic factors, such as maintaining an appropriate number of RNs and improving their working conditions.
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Affiliation(s)
- Yunhee Park
- Department of Nursing, College of MedicineWonkwang UniversityIksanKorea
| | - Deulle Min
- Department of Nursing, College of MedicineWonkwang UniversityIksanKorea
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Xu D, Lewis T, Rurka M, Arling G. Approach to systematically examine the usefulness of quality measures in practice: Minnesota's nursing home quality indicators and scoring approach. BMJ Qual Saf 2022; 32:319-329. [PMID: 36192147 DOI: 10.1136/bmjqs-2021-014384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Healthcare quality measurement systems, which use aggregated patient-level quality measures to assess organisational performance, have been introduced widely. Yet, their usefulness in practice has received scant attention. Using Minnesota nursing home quality indicators (QIs) as a case example, we demonstrate an approach for systematically evaluating QIs in practice based on: (a) parsimony and relevance, (b) usability in discriminating between facilities, (c) actionability and (d) construct validity. METHODS We analysed 19 risk-adjusted, facility-level QIs over the 2012-2019 period. Parsimony and relevance of QIs were evaluated using scatter plots, Pearson correlations, literature review and expert opinions. Discrimination between facilities was assessed by examining facility QI distributions and the impact of the distributions on scoring. Actionability of QIs was assessed through QI trends over time. Construct validity was assessed through exploratory factor analysis of domain structure for grouping the QIs. RESULTS Correlation analysis and qualitative assessment led to redefining one QI, adding one improvement-focused QI, and combining two highly correlated QIs to improve parsimony and clinical relevance. Ten of the QIs displayed normal distributions which discriminated well between the best and worst performers. The other nine QIs displayed poor discrimination; they had skewed distributions with ceiling or floor effects. We recommended scoring approaches tailored to these distributions. One QI displaying substantial improvement over time was recommended for retirement (physical restraint use). Based on factor analysis, we grouped the 18 final QIs into four domains: incontinence (4 QIs), physical functioning (4 QIs), psychosocial care (4 QIs) and care for specific conditions (6 QIs). CONCLUSION We demonstrated a systematic approach for evaluating QIs in practice by arriving at parsimonious and relevant QIs, tailored scoring to different QI distributions and a meaningful domain structure. This approach could be applied in evaluating quality measures in other health or long-term care settings.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
| | - Teresa Lewis
- Nursing Facility Rates and Policy Division, Minnesota Department of Human Services, Saint Paul, Minnesota, USA
| | - Marissa Rurka
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Greg Arling
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
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17
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Nhongo D, Holt A, Flenady T, Rebar A, Bail K. Nurse staffing and adverse events in residential aged care: Retrospective multi-site analysis. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wu AW, McIntyre J. Patient safety in long-term care facilities and the COVID-19 pandemic. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211059871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Albert W. Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John McIntyre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Orth J, Li Y, Simning A, Zimmerman S, Temkin-Greener H. Nursing Home Residents With Dementia: Association Between Place of Death and Patient Safety Culture. THE GERONTOLOGIST 2021; 61:1296-1306. [PMID: 33206175 PMCID: PMC8809190 DOI: 10.1093/geront/gnaa188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing homes (NHs) care for 70% of Americans dying with dementia. Many consider deaths in NHs rather than hospitals as preferable for most of these residents. NH characteristics such as staff teamwork, communication, and other components of patient safety culture (PSC), together with state minimum NH nurse staffing requirements, may influence location of death. We examined associations between these variables and place of death (NH/hospital) among residents with dementia. RESEARCH DESIGN AND METHODS Cross-sectional study of 11,957 long-stay NH residents with dementia, age 65+, who died in NHs or hospitals shortly following discharge from one of 800 U.S. NHs in 2017. Multivariable logistic regression systematically estimated effects of PSC on odds of in-hospital death among residents with dementia, controlling for resident, NH, county, and state characteristics. Logistic regressions also determined moderating effects of state minimum NH nurse staffing requirements on relationships between key PSC domains and location of death. RESULTS Residents with dementia in NHs with higher PSC scores in communication openness had lower odds of in-hospital death. This effect was stronger in NHs located in states with higher minimum NH nurse staffing requirements. DISCUSSION AND IMPLICATIONS Promoting communication openness in NHs across nursing disciplines may help avoid unnecessary hospitalization at the end of life, and merits particular attention as NHs address nursing staff mix while adhering to state staffing requirements. Future research to better understand unintended consequences of staffing requirements is needed to improve end-of-life care in NHs.
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Affiliation(s)
- Jessica Orth
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York, USA
| | - Adam Simning
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York, USA
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, New York, USA
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research and The Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York, USA
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Alcusky M, Baek J, Tjia J, McManus DD, Lapane KL. Geographic Variation in Anticoagulant Use and Resident, Nursing Home, and County Characteristics Associated With Treatment Among US Nursing Home Residents. J Am Med Dir Assoc 2021; 22:164-172.e9. [PMID: 33357746 DOI: 10.1016/j.jamda.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To quantify geographic variation in anticoagulant use and explore what resident, nursing home, and county characteristics were associated with anticoagulant use in a clinically complex population. DESIGN A repeated cross-sectional design was used to estimate current oral anticoagulant use on December 31, 2014, 2015, and 2016. SETTING AND PARTICIPANTS Secondary data for United States nursing home residents during the period 2014-2016 were drawn from the Minimum Data Set 3.0 and Medicare Parts A and D. Nursing home residents (≥65 years) with a diagnosis of atrial fibrillation and ≥6 months of Medicare fee-for-service enrollment were eligible for inclusion. Residents in a coma or on hospice were excluded. METHODS Multilevel logistic models evaluated the extent to which variation in anticoagulant use between counties could be explained by resident, nursing home, and county characteristics and state of residence. Proportional changes in cluster variation (PCVs), intraclass correlation coefficients (ICCs), and adjusted odds ratios (aORs) were estimated. RESULTS Among 86,736 nursing home residents from 11,860 nursing homes and 1694 counties, 45% used oral anticoagulants. The odds of oral anticoagulant use were 18% higher in 2016 than 2014 (aOR: 1.18; 95% confidence interval: 1.14-1.22). Most states had counties in the highest (51.3-58.9%) and lowest (31.1%-41.4%) deciles of anticoagulant use. Compared with the null model, adjustment for resident characteristics explained one-third of the variation between counties (PCV: 34.8%). The full model explained 65.5% of between-county variation. Within-county correlation was a small proportion (ICC < 2.2%) of total variation. CONCLUSIONS AND IMPLICATIONS In this older adult population at high risk for ischemic stroke, less than half of the residents received treatment with anticoagulants. Variation in treatment across counties was partially attributable to the characteristics of residents, nursing homes, and counties. Comparative evidence and refinement of predictive algorithms specific to the nursing home setting may be warranted.
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Affiliation(s)
- Matthew Alcusky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Li Y, Cheng Y, Hu X, Zhang L. Transcultural adaptation and psychometric evaluation of the mainland China version of Nursing Home Survey on Patient Safety Culture Questionnaire: a cross-sectional survey based on 50 nursing homes in China. BMJ Open 2021; 11:e043994. [PMID: 34158294 PMCID: PMC8220463 DOI: 10.1136/bmjopen-2020-043994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To provide a validated Chinese-language measurement of the Nursing Home Survey on Patient Safety Culture (NHSOPS) in mainland China. The primary goal is to carry out a transcultural adaptation of the NHSOPS Questionnaire into Chinese and evaluate its psychometric properties. DESIGN A psychometric evaluation study is constructed. First, the 'translation-back-translation-cultural adaptation' and the pretesting procedure were followed to introduce the NHSOPS. Second, a cross-sectional survey was used to assess the psychometric properties for the mainland China version of the NHSOPS (M-NHSOPS), and a test-retest survey was then applied. SETTING AND PARTICIPANTS The survey was carried out among 1397 nursing home staff from 50 nursing homes in Southwest China. OUTCOME MEASURES Exploratory factor analysis (EFA) was used to assess the potential structure, and confirmatory factor analysis (CFA) was then applied. Reliability was assessed by the content validity index, Cronbach's α and the test-retest value. RESULTS Among the 1397 respondents, 1211 were included (86.7%). EFA was used, and a nine-factor structure was explored. Five factors (Cronbach's α >0.6) were selected into the new structure for the M-NHSOPS. Moreover, data showed that it was suitable for CFA, and convergent validity and discriminant validity were satisfactory. On the other hand, M-NHSOPS contains five dimensions and 22 items. The overall Cronbach's α value was 0.883; the values of each dimension ranged from 0.648 to 0.913. Additionally, content validity showed significant performance. Eventually, test-retest reliability was 0.892, and each dimension was 0.713, 0.809, 0.924, 0.795 and 0.859, respectively (p<0.001). CONCLUSIONS M-NHSOPS has acceptable reliability and satisfactory validity among staff of nursing homes in Southwest China, and further verification among samples in other regions of mainland China is required.
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Affiliation(s)
- Yaqin Li
- School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yufei Cheng
- Core Facilities, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Longhao Zhang
- 'Double First-Class' Construction Office, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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JIANG H, LIANG Y, LIU X, YE D, PENG M, CHEN Y, CHEN S, CHEN W, LI H, ZHANG S. The Risk Factors-Based Nursing Case Management Could Effectively Reduce the Incidence of Pressure Sores in Hospitalized Patients. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:566-572. [PMID: 34178804 PMCID: PMC8214607 DOI: 10.18502/ijph.v50i3.5601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/21/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND To explore the effects of risk factors-based nursing management on the occurrence of pressure sores in hospitalized patients. METHODS From Jan 2018 to Jun 2018, 289 hospitalized patients were divided into pressure sores group [100] and control group [189] for retrospective analysis. Overall, 260 hospitalized patients from Jun 2018 to Dec 2018 were followed up for nursing intervention. Overall 130 patients received risk factors-based nursing case management were in the intervention group, whereas 130 patients who received routine nursing care were in the control group. The chi-square test and t-test were used to compare the count data and the measurement data between groups, respectively. RESULTS Age, body weight and proportions of patients with impaired nutritional intake, diabetes or stroke in pressure sores group were higher than those in normal group (P<0.05). Hospital stay and operative time in pressure sores group was longer than those in normal group (P<0.05). The frequency of assistant activity in pressure sores group was significantly lower than that in control group (P<0.05).In addition, the score of uroclepsia in pressure sores group was lower than that in normal group (P<0.05). Patients in the intervention group showed lower risk for pressure sores and more satisfied than patients in control group (P<0.001). CONCLUSION Advanced age, high body weight, diabetes and stroke, long hospital stay, long operative time, poor nutritional status and severe uroclepsia were independent risk factors of pressure sores. Risk factors-based nursing case management can effectively reduce the occurrence and risk of pressure sores for hospitalized patients.
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Affiliation(s)
- Hong JIANG
- Department of Nursing, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
- Department of Nursing, Cancer Hospital of Shantou University, Medical College, Shantou, 515031, P.R. China
| | - Yanwen LIANG
- Department of Nursing, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
| | - Xinmei LIU
- Department of Nursing, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
| | - Donghong YE
- Department of Nursing, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
| | - Mengmiao PENG
- Department of Nursing, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
| | - Yun CHEN
- Department of Pharmacy, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
- Clinical Pharmacy Research Center, Shantou University Medical College, Shantou, 515031, P.R. China
| | - Shuang CHEN
- Department of Pharmacy, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
- Clinical Pharmacy Research Center, Shantou University Medical College, Shantou, 515031, P.R. China
| | - Wanying CHEN
- Department of Pharmacy, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
- Clinical Pharmacy Research Center, Shantou University Medical College, Shantou, 515031, P.R. China
| | - Haiyan LI
- Department of Nursing, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
| | - Shuyao ZHANG
- Department of Pharmacy, Guangzhou Red Cross Hospital, Ji-Nan University, Guangzhou, 510220, P.R. China
- Clinical Pharmacy Research Center, Shantou University Medical College, Shantou, 515031, P.R. China
- Corresponding Author:
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Communication on Safe Caregiving between Community Nurse Case Managers and Family Caregivers. Healthcare (Basel) 2021; 9:healthcare9020205. [PMID: 33672971 PMCID: PMC7918419 DOI: 10.3390/healthcare9020205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022] Open
Abstract
Dependent elderly individuals are usually cared for at home by untrained family members who are unaware of the risks involved. In this setting, communication on safe caregiving is key. The aim of this study is to describe the factors influencing the process followed by community nurse case managers to provide communication on safe caregiving to family members caring for dependent elderly individuals. A phenomenological study, by focus group, was done in urban healthcare facilities. Key informants were seven community nurses, case managers with more than 12 years’ experience. We did a thematic analysis and we identified the units of meaning to which the most relevant discourses were assigned. The concepts expressed were grouped until subcategories were formed, which were then condensed into categories. Four categories of analysis emerged: communication-related aspects; professional skills of nurse case managers; communication on safety and the caregiving role. To planner interventions, for the prevention of adverse events at home, is essential to consider these aspects: nurses’ professional communication skills, factors inherent to safe caregiving, the characteristics of the home where care is provided, the personal and family circumstances of the caregiver, and whether or not the caregiver’s role has been assumed by the family caregivers.
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Dellefield ME, Madrigal CB, Verkaaik C, Close J. Nursing surveillance and immediate jeopardy in Veteran Health Administration community living centers unannounced survey program 2018 to 2019. Nurs Outlook 2021; 69:182-192. [PMID: 33541725 DOI: 10.1016/j.outlook.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The VA Community Living Center (CLC) Unannounced Survey Program aims to assess standards of care set by the government to protect residents. PURPOSE To describe patterns of practice failures in nursing surveillance causing or having potential to cause immediate jeopardy, as defined by the Centers for Medicare and Medicaid Services. METHODS Using CLC survey data consisting of 200 statements of deficiency (SODs) for 2018 to 2019, we collected a SOD sample (n = 20) of immediate jeopardy events. They were described using descriptive statistics and discourse content analysis. FINDINGS We identified clinical events, their duration, work shift, and nursing skill mix for each SOD. Most to least common themes about failures in nursing surveillance were acquisition/transfer of information; decision-making; and early recognition of problems. DISCUSSION Our analysis of nursing surveillance failures in CLC immediate jeopardy SODs provides insight into opportunities for registered nurses and the nursing skill mix to reduce avoidable harms.
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Affiliation(s)
- Mary Ellen Dellefield
- Department of Nursing and Patient Care Services, VA San Diego Healthcare System, San Diego, CA.
| | - Caroline B Madrigal
- Center of Innovation in Long-term Services and Supports, Providence VA Medical Center, Providence, RI
| | - Catherine Verkaaik
- Department of Nursing and Patient Care Services, VA San Diego Healthcare System, San Diego, CA
| | - Jackie Close
- Department of Nursing and Patient Care Services, VA San Diego Healthcare System, San Diego, CA
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Salerno S, Dahlerus C, Messana J, Wisniewski K, Tong L, Hirth RA, Affholter J, Gremel G, Wu Y, Zhu J, Roach J, Balovlenkov Rn E, Andress J, Li Y. Evaluating national trends in outcomes after implementation of a star rating system: Results from dialysis facility compare. Health Serv Res 2020; 56:123-131. [PMID: 33184854 DOI: 10.1111/1475-6773.13600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine which factors are driving improvement in the Dialysis Facility Compare (DFC) star ratings and to test whether nonclinical facility characteristics are associated with observed longitudinal changes in the star ratings. DATA SOURCES Data were collected from eligible patients in over 6,000 Medicare-certified dialysis facilities from three annual star rating and individual measure updates, publicly released on DFC in October 2015, October 2016, and April 2018. STUDY DESIGN Changes in the star rating and individual quality measures were investigated across three public data releases. Year-to-year changes in the star ratings were linked to facility characteristics, adjusting for baseline differences in quality measure performance. DATA COLLECTION Data from publicly reported quality measures, including standardized mortality, hospitalization, and transfusion ratios, dialysis adequacy, type of vascular access for dialysis, and management of mineral and bone disease, were extracted from annual DFC data releases. PRINCIPAL FINDINGS The proportion of four- and five-star facilities increased from 30.0% to 53.4% between October 2015 and April 2018. Quality improvement was driven by the domain of care containing the dialysis adequacy and hypercalcemia measures. Additionally, independently owned facilities and facilities belonging to smaller dialysis organizations had significantly lower odds of year-to-year improvement than facilities belonging to either of the two large dialysis organizations (Odds Ratio [OR]: 0.736, 95% Confidence Interval [CI]: 0.631-0.856 and OR: 0.797, 95% CI: 0.723-0.879, respectively). CONCLUSIONS The percentage of four- and five-star facilities has increased markedly over a three-year time period. These changes were driven by improvement in the specific quality measures that may be most directly under the control of the dialysis facility.
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Affiliation(s)
- Stephen Salerno
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Claudia Dahlerus
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph Messana
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Karen Wisniewski
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lan Tong
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard A Hirth
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jordan Affholter
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Garrett Gremel
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - YiFan Wu
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Ji Zhu
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jesse Roach
- The Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
| | | | - Joel Andress
- The Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
| | - Yi Li
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
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Tamara Konetzka R, Yan K, Werner RM. Two Decades of Nursing Home Compare: What Have We Learned? Med Care Res Rev 2020; 78:295-310. [PMID: 32538264 DOI: 10.1177/1077558720931652] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Approximately two decades ago, federally mandated public reporting began for U.S. nursing homes through a system now known as Nursing Home Compare. The goals were to provide information to enable consumers to choose higher quality nursing homes and to incent providers to improve the quality of care delivered. We conduct a systematic review of the literature on responses to Nursing Home Compare and its effectiveness in meeting these goals. We find evidence of modest but meaningful response by both consumers and providers. However, we also find evidence that some improvement in scores does not reflect true quality improvement, that disparities by race and income have increased, that risk-adjustment of the measures is likely inadequate, and that several key domains of quality are not represented. Our results support moderate success of Nursing Home Compare in achieving intended goals but also reveal the need for continued refinement.
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Affiliation(s)
| | - Kevin Yan
- The University of Chicago, Chicago, IL, USA
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Shippee TP, Ng W, Bowblis JR. Does Living in a Higher Proportion Minority Facility Improve Quality of Life for Racial/Ethnic Minority Residents in Nursing Homes? Innov Aging 2020; 4:igaa014. [PMID: 32529052 PMCID: PMC7272785 DOI: 10.1093/geroni/igaa014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives The proportion of racial/ethnic minority older adults in nursing homes (NHs) has increased dramatically and will surpass the proportion of white adults by 2030.Yet, little is known about minority groups’ experiences related to the quality of life (QOL). QOL is a person-centered measure, capturing multiple aspects of well-being. NH quality has been commonly measured using clinical care indicators, but there is growing recognition for the need to include QOL. This study examines the role of individual race/ethnicity, facility racial/ethnic composition, and the interaction of both for NH resident QOL. Research Design and Methods We used a unique state-level data set that includes self-reported QOL surveys with a random sample of long-stay Minnesota NH residents, using a multidimensional measure of QOL. These surveys were linked to resident clinical data from the Minimum Dataset 3.0 and facility-level characteristics. Minnesota is one of the two states in the nation that collects validated QOL measures, linked to data on resident and detailed facility characteristics. We used mixed-effects models, with random intercepts to model summary QOL score and individual domains. Results We identified significant racial disparities in NH resident QOL. Minority residents report significantly lower QOL scores than white residents, and NHs with higher proportion minority residents have significantly lower QOL scores. Minority residents have significantly lower adjusted QOL than white residents, whether they are in low- or high-minority facilities, indicating a remaining gap in individual care needs. Discussion and Implications The findings highlight system-level racial disparities in NH residents QOL, with residents who live in high-proportion minority NHs facing the greatest threats to their QOL. Efforts need to focus on reducing racial/ethnic disparities in QOL, including potential public reporting (similar to quality of care) and resources and attention to provision of culturally sensitive care in NHs to address residents’ unique needs.
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Affiliation(s)
- Tetyana P Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Weiwen Ng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - John R Bowblis
- Department of Economics, Farmer School of Business, Miami University, Oxford, Ohio
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28
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Perceived Patient Safety Culture in Nursing Homes Associated With "Nursing Home Compare" Performance Indicators. Med Care 2019; 57:641-647. [PMID: 31259786 DOI: 10.1097/mlr.0000000000001142] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The safety and quality of care provided to nursing home residents is a significant concern. Little is known whether fostering patient safety culture helps improve the safety and quality of nursing home care. METHODS This study determined the associations of nursing home patient safety culture performance, as reported by administrators, directors of nursing, and unit leaders in a large national sample of free-standing nursing homes, with several "Nursing Home Compare" performance indicators. We conducted the survey in 2017 using the Agency for Healthcare Research and Quality Survey on Patient Safety Culture for nursing homes to collect data on 12 core domains of safety culture scores. Survey data were linked to other nursing home files for multivariable regression analyses. RESULTS Overall, 818 of the 2254 sampled nursing homes had at least 1 completed survey returned for a response rate of 36%. After adjustment for nursing home, market, and state covariates, every 10 percentage points increase in overall positive response rate for safety culture was associated with 0.56 fewer health care deficiencies (P=0.001), 0.74 fewer substantiated complaints (P=0.004), reduced fines by $2285.20 (P=0.059), and 20% increased odds of being designated as 4-star or 5-star (vs. 1 to 3 star) facilities (odds ratio roughly=1.20, P<0.05). CONCLUSIONS Efforts to improve nursing home performance in patient safety culture have the potential to improve broad safety and quality of care measures encapsulated in the Nursing Home Compare publication.
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30
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Kapoor A, Field T, Handler S, Fisher K, Saphirak C, Crawford S, Fouayzi H, Johnson F, Spenard A, Zhang N, Gurwitz JH. Adverse Events in Long-term Care Residents Transitioning From Hospital Back to Nursing Home. JAMA Intern Med 2019; 179:1254-1261. [PMID: 31329223 PMCID: PMC6646976 DOI: 10.1001/jamainternmed.2019.2005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Transition from hospital to nursing home is a high-risk period for adverse events in long-term care (LTC) residents. Adverse events include harms from medical care, including failure to provide appropriate care. OBJECTIVE To report the incidence, type, severity, and preventability of adverse events in LTC residents transitioning from hospital back to the same LTC facility. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of LTC residents discharged from hospital back to LTC from March 1, 2016, to December 31, 2017, and followed up for 45 days. In a random sample of 32 nursing homes located in 6 New England states, 555 LTC residents were selected, contributing 762 transitions from hospital back to the same LTC facility. MAIN OUTCOMES AND MEASURES The main outcome was an adverse event within the 45-day period after transition from hospital back to nursing home. Trained nurse abstractors reviewed nursing home records for the period, and then 2 physicians independently reviewed each potential adverse event to determine whether harm occurred and to characterize the type, severity, and preventability of each event. When reviewers disagreed, they met to reach consensus. RESULTS Of the 555 individual residents, 365 (65.6%) were female, and the mean (SD) age at the time of discharge was 82.2 (11.5) years. Five hundred twenty (93.7%) were non-Hispanic white, 21 (3.8%) were non-Hispanic black, 9 (1.6%) were Hispanic, and 5 (0.9%) were of other non-Hispanic race/ethnicity. In the cohort, there were 379 adverse events among 762 discharges. One hundred ninety-seven events (52.0%) related to resident care, with pressure ulcers, skin tears, and falls with injury representing the most common types of events in this category. Health care-acquired infections (108 [28.5%]) and adverse drug events (64 [16.9%]) were the next most common. One hundred ninety-eight (52.2%) adverse events were characterized as less serious. However, 145 (38.3%) events were deemed serious, 28 (7.4%) life-threatening, and 8 (2.1%) fatal. In terms of preventability, 267 (70.4%) adverse events were found to be preventable or ameliorable, with less serious events more often considered preventable or ameliorable (146 [73.7%]) compared with more severe events (121 [66.9%]). In addition, resident care-related adverse events such as fall with injury, skin tear, and pressure ulcer were more commonly deemed preventable (173 of 197 [87.8%]) compared with adverse drug events (39 of 64 [60.9%]) or health care-acquired infections (49 of 108 [45.4%]). CONCLUSIONS AND RELEVANCE Adverse events developed in nearly 4 of 10 of discharges from hospital back to LTC. Most were preventable or ameliorable. Standardized reporting of events and better coordination and information transfer across settings are potential ways to prevent adverse events in LTC residents.
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Affiliation(s)
- Alok Kapoor
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Terry Field
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Steven Handler
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kimberly Fisher
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | | | - Sybil Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
| | | | | | | | - Ning Zhang
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts.,School of Public Health and Health Sciences, University of Massachusetts, Amherst
| | - Jerry H Gurwitz
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, Worcester, Massachusetts
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31
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Burke RE, Werner RM. Quality measurement and nursing homes: measuring what matters. BMJ Qual Saf 2019; 28:520-523. [PMID: 30996036 DOI: 10.1136/bmjqs-2019-009447] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA .,Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel M Werner
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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