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Downer B, Wickliff M, Malagaris I, Li CY, Lee MJ. Achieving Functional Goals During a Skilled Nursing Facility Stay: A National Study of Medicare Beneficiaries. Am J Phys Med Rehabil 2024; 103:333-339. [PMID: 38112630 PMCID: PMC10947948 DOI: 10.1097/phm.0000000000002382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES The aims of the study are to describe the frequency that functional goals are documented on the Minimum Data Set and to identify resident characteristics associated with meeting or exceeding discharge goals. METHODS We selected Medicare fee-for-service beneficiaries admitted to a skilled nursing facility within 3 days of hospital discharge from October 1, 2018, to December 31, 2019 ( N = 1,228,913). The admission Minimum Data Set was used to describe the discharge goal scores for seven self-care and 16 mobility items. We used the eight self-care and mobility items originally included in a publicly reported quality measure to calculate total scores for discharge goals, admission performance, and discharge performance ( n = 371,801). RESULTS For all self-care items, more than 70% of residents had a goal score of 1-6 points documented on the admission Minimum Data Set. Chair/bed-to-chair transfer had the highest percentage of residents with a score of 1-6 points (77.1%) and walking up/down 12 steps had the lowest (23.2%). Approximately 44% of residents had a discharge performance score that met or exceeded their goal score. Older age, urinary incontinence, and cognitive impairment had the lowest odds of meeting or exceeding discharge goals. CONCLUSIONS Assessing a resident's functional goals is important to providing patient-centered care. This information may help skilled nursing facilities determine whether a resident has made meaningful functional improvements.
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Affiliation(s)
- Brian Downer
- Department of Population Health and Health Disparities. School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
- Sealy Center on Aging. University of Texas Medical Branch, Galveston, TX
| | - Megan Wickliff
- Department of Population Health and Health Disparities. School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
| | - Ioannis Malagaris
- Office of Biostatistics. University of Texas Medical Branch, Galveston, TX
| | - Chih-Ying Li
- Department of Occupational Therapy. School of Health Professions, University of Texas Medical Branch, Galveston, TX
| | - Mi Jung Lee
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, TX
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Vellani S, Maradiaga Rivas V, Nicula M, Lucchese S, Kruizinga J, Sussman T, Kaasalainen S. Palliative Approach to Care Education for Multidisciplinary Staff of Long-Term Care Homes: A Pretest Post-Test Study. Gerontol Geriatr Med 2023; 9:23337214231158470. [PMID: 36845318 PMCID: PMC9947670 DOI: 10.1177/23337214231158470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
This study used a single-group pre-test and post-test design to evaluate an educational workshop for multidisciplinary staff working in long-term care homes on implementing a palliative approach to care and perceptions about advanced care planning conversations. Two outcomes were measured to assess the preliminary efficacy of the educational workshop at baseline and 1-month post-intervention. Knowledge regarding implementing a palliative approach to care was assessed using the End-of-Life Professional Caregivers Survey and changes in staff perception toward ACP conversations were assessed using the Staff Perceptions Survey. Findings suggest that staff experienced an improvement in self-reported knowledge regarding a palliative approach to care (p ≤ .001); and perceptions of knowledge, attitude, and comfort related to advance care planning discussions (p ≤ .027). The results indicate that educational workshops can assist in improving multidisciplinary staff's knowledge about a palliative approach to care and comfort in carrying out advance care planning discussions with residents, family care partners, and among long-term care staff.
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Affiliation(s)
- Shirin Vellani
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Maria Nicula
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | - Stephanie Lucchese
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | - Julia Kruizinga
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | - Tamara Sussman
- Faculty of Arts, School of Social Work,
McGill University, Montreal, QC, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada,Sharon Kaasalainen, Faculty of Health
Sciences, School of Nursing, McMaster University, 1280 Main Street West,
Hamilton, ON L8S 4L8, Canada.
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Yu BC, Han M, Ko GJ, Yang JW, Kwon SH, Chung S, Hong YA, Hyun YY, Cho JH, Yoo KD, Bae E, Park WY, Sun IO, Kim D, Kim H, Hwang WM, Song SH, Shin SJ. Effect of shared decision-making education on physicians' perceptions and practices of end-of-life care in Korea. Kidney Res Clin Pract 2021; 41:242-252. [PMID: 34974652 PMCID: PMC8995478 DOI: 10.23876/j.krcp.21.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.
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Affiliation(s)
- Byung Chul Yu
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Miyeun Han
- Division of Nephrology, Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Gang-Jee Ko
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Soon Hyo Kwon
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sungjin Chung
- Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu Ah Hong
- Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Young Youl Hyun
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jang-Hee Cho
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eunjin Bae
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Woo Yeong Park
- Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - In O Sun
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Dongryul Kim
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunsuk Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Won Min Hwang
- Division of Nephrology, Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Sang Heon Song
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Sung Joon Shin
- Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Republic of Korea
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Kaasalainen S, Sussman T, Nicula M, Lawrence J, Thompson G, McCleary L, Wickson-Griffiths A, You JJ. Evaluating the Implementation of the Conversation Starter Kit in Long Term Care. SAGE Open Nurs 2021; 7:23779608211051824. [PMID: 34746381 PMCID: PMC8564126 DOI: 10.1177/23779608211051824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Advance care planning can improve the quality of life for residents in
long-term care homes and reduce stress for families. However, care home
staff and families often lack knowledge about advance care planning, making
it especially difficult for residents with dementia to communicate their
care plan wishes. A Conversation Starter Kit may increase advance care
planning awareness among staff and families. Objectives This study evaluated an advance care planning intervention, the Conversation
Starter Kit booklet, for use in long term care homes. Methods Data were collected at three long-term care homes in southern Ontario. We
collected data from 55 residents who were able to make decisions on their
own paired with 11 family members of these residents. We also collected data
from 24 family members of residents who were unable to make decisions on
their own. This study used a quasi-experimental, one group pre/post design.
Quantitative surveys were administered before and after a three-month
advance care planning intervention. An additional structured interview was
completed at the end of the intervention period, which included both closed
and open-ended questions to assess perceptions about the booklet's use or
non-use. Results Residents reported more engagement in advance care planning after completing
the Conversation Starter Kit booklet, particularly related to asking
questions to health care providers about health care decisions. Family
members reported feeling very certain that they would be able to make
decisions on behalf of the resident but felt less certain after completing
the booklet, implying the booklet raised their awareness of the types of
decisions they might need to make, hopefully prompting them to be more
prepared for decisions in the future. Conclusions An advance care planning intervention – The Conversation Starter Kit booklet
- appears acceptable and easy to use for residents and family
members/friends in long-term care and can improve resident engagement in
advance care planning. Although using the booklet may decrease efficacy for
decision making among family members of long-term care residents, it may
highlight the importance of more actionable engagement in advance care
planning among residents, their families/friends, and staff.
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Affiliation(s)
| | - Tamara Sussman
- Faculty of Arts, School of Social Work, McGill University, Montreal, QC, Canada
| | - Maria Nicula
- Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | - Jack Lawrence
- Faculty of Arts, School of Social Work, McGill University, Montreal, QC, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba,Winnipeg, MB, Canada
| | - Lynn McCleary
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | | | - John J You
- Division of General Internal and Hospitalist Medicine, Credit Valley Hospital, Mississauga, Ontario, Canada
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Buck K, Nolte L, Sellars M, Sinclair C, White BP, Kelly H, Macleod A, Detering KM. Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators. Health Expect 2021; 24:1312-1325. [PMID: 33932311 PMCID: PMC8369087 DOI: 10.1111/hex.13264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/25/2021] [Accepted: 04/02/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) conversations may result in preferences for medical care being documented. OBJECTIVE To explore the uptake and quality of advance care directives (ACDs) among older Australians accessing health and aged care services, by overall ACP documentation prevalence, person-level predictors and ACD quality indicators. DESIGN AND SETTING National multi-centre health record audit in general practices (GP), hospitals and residential aged care facilities (RACF). PARTICIPANTS A total of 4187 people aged ≥65 years attending their GP (n = 676), admitted to hospital (n = 1122) or residing in a RACF (n = 2389). MAIN OUTCOME MEASURES ACP documentation prevalence by setting and type including person-completed ACDs and non-ACD documents (completed by a health professional or someone else); person-level predictors and quality indicators of ACDs. RESULTS Overall ACP documentation prevalence was 46.5% (29.2% weighted). ACD prevalence was 25.3% (14.2% weighted). Unweighted ACD prevalence was higher in RACFs (37.7%) than in hospitals (11.1%) and GPs (5.5%). 35.8% of ACP documentation was completed by a health professional (9.7% weighted), and 18.1% was completed by someone else (10.6% weighted). Having an ACD was positively associated with being female, older, having two or more medical conditions, receiving palliative care, being divorced/separated and being in a RACF. Only 73% of ACDs included full name, signature, document date and witnessing. CONCLUSIONS AND CONTRIBUTION Low ACP documentation prevalence and a lack of accessible, person-completed and quality ACDs represent an important ACP implementation issue. Low prevalence is complicated by poor document quality and a higher prevalence of documents being completed by someone other than the person.
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Affiliation(s)
- Kimberly Buck
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
| | - Linda Nolte
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
| | - Marcus Sellars
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
- Department of Health Services Research & PolicyResearch School of Population HealthAustralian National UniversityACTAustralia
| | - Craig Sinclair
- Australian Research Council Centre of Excellence in Population Ageing ResearchUniversity of New South WalesSydneyNSWAustralia
- Neuroscience Research Australia (NeuRA)SydneyAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Ben P. White
- Australian Centre for Health Research LawFaculty of LawQueensland University of TechnologyBrisbaneQldAustralia
| | - Helana Kelly
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
| | - Ashley Macleod
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
| | - Karen M. Detering
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
- Faculty of Health, Arts and InnovationSwinburne UniversityHawthornVic.Australia
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Detering KM, Sinclair C, Buck K, Sellars M, White BP, Kelly H, Nolte L. Organisational and advance care planning program characteristics associated with advance care directive completion: a prospective multicentre cross-sectional audit among health and residential aged care services caring for older Australians. BMC Health Serv Res 2021; 21:700. [PMID: 34271934 PMCID: PMC8283952 DOI: 10.1186/s12913-021-06523-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Advance care planning (ACP) and advance care directive (ACD) completion improve outcomes for patients, family, clinicians and the healthcare system. However, uptake remains low. Despite increasing literature regarding organisational-level ACP characteristics leading to success, there is a lack of data measuring the impact of these factors on ACD prevalence. Methods A prospective multi-centre, cross-sectional audit of health records among older Australians accessing general practices (GP), hospitals and residential aged care facilities (RACF) was undertaken to describe organisational and ACP-program characteristics across services, document ACD prevalence, and assess organisation-level predictors of ACD prevalence. Organisational-level data included general and ACP-program characteristics. Patient/resident data included demographics and presence of ACDs. Results One hundred organisations (GP = 15, hospitals = 27, RACFs = 58) participated, contributing data from 4187 patient/resident health records. Median prevalence of ACDs across organisations was 19.4%, (range = 0–100%). In adjusted models, organisational sector type was the strongest predictor of ACD prevalence, with higher rates in RACFs (unadjusted 28.7%, adjusted 20.6%) than hospitals (unadjusted 6.4%, adjusted 5.8%) or GPs (unadjusted 2.5%, adjusted 6.6%). RACFs in regional and rural/remote areas had higher prevalence than metropolitan organisations. Organisations supported by government funding and those that were Not For Profit had higher prevalence than those that were privately funded, and organisations with an ACP program that had been implemented at least 3 years before data collection had higher prevalence than those with either no program or a more recent program. Conclusions The median ACD prevalence was low, with substantial variation across organisations. Sector type was the strongest predictor, being highest in RACFs. Low prevalence rates, overall and in particular sectors, have implications for improvements. Further research into organisational factors associated with ACP/ACD completion is required.
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Affiliation(s)
- Karen M Detering
- Advance Care Planning Australia, Austin Health, Melbourne, Australia.,Faculty of Health, Arts and Innovation, Swinburne University of Technology, Hawthorn, Australia
| | - Craig Sinclair
- Centre of Excellence in Population Ageing Research, University of New South Wales, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Kimberly Buck
- Advance Care Planning Australia, Austin Health, Melbourne, Australia
| | - Marcus Sellars
- Advance Care Planning Australia, Austin Health, Melbourne, Australia.,Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, Canberra, Australia
| | - Ben P White
- Australian Centre for Health Research Law, Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | - Helana Kelly
- Advance Care Planning Australia, Austin Health, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Linda Nolte
- Advance Care Planning Australia, Austin Health, Melbourne, Australia.
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