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Yakusheva O, Lee KA, Keller A, Weiss ME. Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients. Med Care 2024; 62:21-29. [PMID: 38060342 DOI: 10.1097/mlr.0000000000001945] [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: 12/18/2023]
Abstract
BACKGROUND Home health care (HHC) services following hospital discharge provide essential continuity of care to mitigate risks of posthospitalization adverse outcomes and readmissions, yet patients from racial and ethnic minority groups are less likely to receive HHC visits. OBJECTIVE To examine how the association of nurse assessments of patients' readiness for discharge with referral to HHC services at the time of hospital discharge differs by race and ethnic minority group. RESEARCH DESIGN Secondary data analysis from a multisite study of the implementation of discharge readiness assessments in 31 US hospitals (READI Randomized Clinical Trial: 09/15/2014-03/31/2017), using linear and logistic models adjusted for patient demographic/clinical characteristics and hospital fixed effects. SUBJECTS All Medicare patients in the study's intervention arm (n=14,684). MEASURES Patient's race/ethnicity and discharge disposition code for referral to HHC (vs. home) from electronic health records. Patient's Readiness for Hospital Discharge Scale (RHDS) score (0-10 scale) assessed by the discharging nurse on the day of discharge. RESULTS Adjusted RHDS scores were similar for non-Hispanic White (8.21; 95% CI: 8.18-8.24), non-Hispanic Black (8.20; 95% CI: 8.12-8.28), Hispanic (7.92; 95% CI: 7.81-8.02), and other race/ethnicity patients (8.09; 95% CI: 8.01-8.17). Non-Hispanic Black patients with low RHDS scores (6 or less) were less likely than non-Hispanic White patients to be discharged with an HHC referral (Black: 26.8%, 95% CI: 23.3-30.3; White: 32.6%, 95% CI: 31.1-34.1). CONCLUSIONS Despite similar RHDS scores, Black patients were less likely to be discharged with HHC. A better understanding of root causes is needed to address systemic structural injustice in health care settings.
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Affiliation(s)
- Olga Yakusheva
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| | - Kathryn A Lee
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
| | - Abiola Keller
- Marquette University College of Nursing, Milwaukee, WI
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Rahemi Z, Malatyali A, Bacsu JDR, Sefcik JS, Petrovsky DV, Baker ZG, Ma KPK, Smith ML, Adams SA. Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels. J Appl Gerontol 2023; 42:2294-2303. [PMID: 37525608 PMCID: PMC10828104 DOI: 10.1177/07334648231191667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
This study examined the impact of advance care planning (ACP) on healthcare utilization among older adults with normal cognition and impaired cognition/dementia. Using datasets from the Health and Retirement Study, we conducted a cross-sectional study on 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. ACP measures included a living will and durable power of attorney for healthcare. Healthcare utilization was measured using the days spent in hospitals, hospice care, nursing homes, and home care. Of the participants, 77.8% had normal cognition, and 22% had impaired cognition/dementia. The proportion of impaired cognition/dementia was higher among racially minoritized participants, single/widowed participants, and those who lived alone and were less educated. The results showed that having an ACP was associated with longer stays in hospitals, nursing homes, and home healthcare in all participants.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University, Greenville, SC, USA
| | - Ayse Malatyali
- Nursing Systems Department, College of Nursing, University of Central Florida, Orlando, FL, USA
| | | | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Darina V Petrovsky
- School of Nursing, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Zachary G Baker
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, USA
| | - Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Matthew L Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Swann A Adams
- Department of Biobehavioral and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
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Williams A, Kesten KS. Engaging Older Adults and Families Using the IDEAL Discharge Protocol: A Quality Improvement Initiative to Improve Outcomes and Reduce Readmissions. J Gerontol Nurs 2023; 49:13-19. [PMID: 37768584 DOI: 10.3928/00989134-20230915-04] [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: 09/29/2023]
Abstract
Older adults have challenges understanding newly prescribed medications after discharge and must be more adherent with medications and follow up with their primary care provider. A collaborative discharge process is critical to improving patient outcomes and reducing avoidable readmission rates. This quality improvement (QI) initiative engaged 44 patients and families in the IDEAL Discharge Protocol-an evidence-based collaborative care process focused on discussion, education, and post-discharge follow up. Post-discharge follow up resulted in the completion of 52.2% of follow-up calls and 45.5% of follow-up appointments scheduled, and a 4% reduction in readmission rates. Medication adherence was assessed and found to be 93.3%, and 100% of participants received education while engaged in the study. The IDEAL Discharge Protocol aided in improving the discharge process to better equip patients with the tools to transition home successfully after discharge. [Journal of Gerontological Nursing, 49(10), 13-19.].
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Kennedy EE, Davoudi A, Hwang S, Freda PJ, Urbanowicz R, Bowles KH, Mowery DL. Identifying Barriers to Post-Acute Care Referral and Characterizing Negative Patient Preferences Among Hospitalized Older Adults Using Natural Language Processing. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2023; 2022:606-615. [PMID: 37128417 PMCID: PMC10148308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Our objective was to detect common barriers to post-acute care (B2PAC) among hospitalized older adults using natural language processing (NLP) of clinical notes from patients discharged home when a clinical decision support system recommended post-acute care. We annotated B2PAC sentences from discharge planning notes and developed an NLP classifier to identify the highest-value B2PAC class (negative patient preferences). Thirteen machine learning models were compared with Amazon's AutoGluon deep learning model. The study included 594 acute care notes from 100 patient encounters (1156 sentences contained 11 B2PAC) in a large academic health system. The most frequent and modifiable B2PAC class was negative patient preferences (18.3%). The best supervised model was Extreme Gradient Boosting (F1: 0.859), but the deep learning model performed better (F1: 0.916). Alerting clinicians of negative patient preferences early in the hospitalization can prompt interventions such as patient education to ensure patients receive the right level of care and avoid negative outcomes.
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Affiliation(s)
- Erin E Kennedy
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, PA
| | - Anahita Davoudi
- University of Pennsylvania, Institute for Biomedical Informatics, Philadelphia, PA
| | - Sy Hwang
- University of Pennsylvania, Institute for Biomedical Informatics, Philadelphia, PA
| | - Philip J Freda
- University of Pennsylvania, Institute for Biomedical Informatics, Philadelphia, PA
- Cedars-Sinai Medical Center, Department of Computational Biomedicine, Los Angeles, California
| | - Ryan Urbanowicz
- University of Pennsylvania, Institute for Biomedical Informatics, Philadelphia, PA
- Cedars-Sinai Medical Center, Department of Computational Biomedicine, Los Angeles, California
| | - Kathryn H Bowles
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, PA
| | - Danielle L Mowery
- University of Pennsylvania, Institute for Biomedical Informatics, Philadelphia, PA
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Hsu YH, Lee TH, Chung KP, Tung YC. Determining the factors influencing the selection of post-acute care models by patients and their families: a qualitative content analysis. BMC Geriatr 2023; 23:179. [PMID: 36978003 PMCID: PMC10045930 DOI: 10.1186/s12877-023-03889-z] [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: 06/14/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND This study conducted in-depth interviews to explore the factors that influence the choice of a post-acute care (PAC) model (inpatient rehabilitation hospital, skilled nursing facility, home health, and outpatient rehabilitation) among stroke patients and their families. METHODS We conducted semi-structured, in-depth interviews of 21 stroke patients and their families at four hospitals in Taiwan. Content analysis was used in this qualitative study. RESULTS Results revealed five main factors that influence respondents' choice of PAC: (1) medical professionals' suggestions, (2) health care accessibility, (3) continuity and coordination of care, (4) willingness and prior experience of patients and their relatives and friends, and (5) economic factors. CONCLUSIONS This study identifies five main factors that affect the choice of PAC models among stroke patients and their families. We suggest that policymakers establish comprehensive health care resources based on the needs of patients and families. Health care providers shall provide professional recommendations and adequate information to support decision-making, which aligns with the preferences and values of patients and their families. From this research, we hope to improve the accessibility of PAC services in order to enhance the quality of care for stroke patients.
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Affiliation(s)
- Ya-Hui Hsu
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Stroke Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Wong YG, Hang JA, Francis-Coad J, Hill AM. Using comprehensive geriatric assessment for older adults undertaking a facility-based transition care program to evaluate functional outcomes: a feasibility study. BMC Geriatr 2022; 22:598. [PMID: 35850671 PMCID: PMC9294817 DOI: 10.1186/s12877-022-03255-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/22/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The study aimed to evaluate the feasibility of using a comprehensive geriatric assessment (CGA) in a residential transition care setting to measure older adults' functional outcomes. METHODS A convenience sample of older adults (n = 10) and staff (n = 4) was recruited. The feasibility of using assessment tools that comprise a CGA to comprehensively measure function in physical, cognitive, social and emotional domains was evaluated pre- and post-rehabilitation. RESULTS 10 older adults (mean ± SD age = 78.9 ± 9.1, n = 6 male) completed a CGA performed using assessments across physical, cognitive, social and emotional domains. The CGA took 55.9 ± 7.3 min to complete. Staff found CGA using the selected assessment tools to be acceptable and suitable for the transition care population. Older adults found the procedure to be timely and 60% found the assessments easy to comprehend. Participating in CGA also assisted older adults in understanding their present state of health. The older adults demonstrated improvements across all assessed domains including functional mobility (de Morton Mobility Index; baseline 41.5 ± 23.0, discharge 55.0 ± 24.0, p = 0.01) and quality of life (EQ-5D-5L; baseline 59.0 ± 21.7, discharge 78.0 ± 16.0, p < 0.01). CONCLUSIONS Incorporating CGA to evaluate functional outcomes in transition care using a suite of assessment tools was feasible and enabled a holistic assessment.
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Affiliation(s)
- Ying Git Wong
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Jo-Aine Hang
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Jacqueline Francis-Coad
- School of Allied Health, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Anne-Marie Hill
- School of Allied Health, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
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Sefcik JS, Petrovsky DV, Huang L, Behrens LL, Naylor MD, Hodgson NA, Hirschman KB. Predictors of change over time in satisfaction with outdoor activities ratings among long-term care services and supports recipients. Geriatr Nurs 2022; 45:153-159. [PMID: 35472750 PMCID: PMC9353871 DOI: 10.1016/j.gerinurse.2022.03.007] [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: 01/19/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify predictors of change in older adults' satisfaction with outdoor activities ratings over the first two years of enrollment in long-term services and supports (LTSS). METHODS Self-rated satisfaction with outdoor activities (not at all satisfied to extremely satisfied) was the primary outcome of this secondary data analysis. Mixed-effects linear regression modeling with a backward elimination process was used for analyses. RESULTS In the final model (N = 453) older LTSS recipients at baseline had lower ratings of satisfaction with outdoor activities over time, whereas younger recipients had higher ratings over time. Those who moved into a residential facility at baseline had an increase in outdoor activity satisfaction ratings over time compared to older adults who received home and community-based services that had a decrease. DISCUSSION LTSS clinicians can use these findings to support older adults with decision-making around enrollment into LTSS, address preferences, and develop person-centered care interventions for outdoor activity.
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Affiliation(s)
- Justine S Sefcik
- Drexel University College of Nursing and Health Professions, 1601 Cherry St., Room 377, Philadelphia, PA 19102, United States.
| | - Darina V Petrovsky
- Rutgers University School of Nursing and Institute for Health, Health Care Policy, and Aging Research, 112 Paterson St, New Brunswick, NJ, 08901, United States
| | - Liming Huang
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States
| | - Liza L Behrens
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA 16803, United States
| | - Mary D Naylor
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States
| | - Karen B Hirschman
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States
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‘Is my journey destination home?’ Exploring the experiences of older adults who undertake a transition care programme: a qualitative study. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Transition care programmes (TCP) provide older adults with goal-oriented rehabilitation after hospitalisation. However, limited research has focused on understanding older adults' experiences when undertaking TCP. Using a phenomenological approach, we explored the lived experience of older adults undertaking a TCP at a transition care facility in Australia. A purposive sample (N = 33 participants: 16 older adults, four family members and 13 staff) was recruited. Semi-structured interviews were undertaken at three time-points during admission and inductive thematic analysis was utilised. Older adults reflected on their TCP experiences through an emotional lens through which they deliberated, ‘is my destination home?’ Fear of losing independence and uncertainty about their discharge destination strongly influenced older adults' perspectives regarding their TCP experience. Emotional responses, both positive and negative, were influenced by expectations prior to admission, level of family support and staff behaviour. Staff and family concurred that many older adults were confused about their admission to the facility and initially were unprepared to engage in the rehabilitation provided. Older adults experienced TCP as a time of great uncertainty and feared the unknown when discharged from hospital to transition care. They expressed grief at the loss of existing life roles and anxiety about the possibility of being unable to return home. Health professionals need to inform and tailor rehabilitation for older adults to better support this transient time of life.
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Shah SJ, Fang MC, Wannier SR, Steinman MA, Covinsky KE. Association of Social Support With Functional Outcomes in Older Adults Who Live Alone. JAMA Intern Med 2022; 182:26-32. [PMID: 34779818 PMCID: PMC8593829 DOI: 10.1001/jamainternmed.2021.6588] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Older adults who live alone are at risk for poor health outcomes. Whether social support mitigates the risk of living alone, particularly when facing a sudden change in health, has not been adequately reported. OBJECTIVE To assess if identifiable support buffers the vulnerability of a health shock while living alone. DESIGN, SETTING, AND PARTICIPANTS In this longitudinal, prospective, nationally representative cohort study from the Health and Retirement Study (enrollment March 2006 to April 2015), 4772 community-dwelling older adults 65 years or older who lived alone in the community and could complete activities of daily living (ADLs) and instrumental ADLs independently were followed up biennially through April 2018. Statistical analysis was completed from May 2020 to March 2021. EXPOSURES Identifiable support (ie, can the participant identify a relative/friend who could help with personal care if needed), health shock (ie, hospitalization, new diagnosis of cancer, stroke, heart attack), and interaction (multiplicative and additive) between the 2 exposures. MAIN OUTCOMES AND MEASURES The primary outcomes were incident ADL dependency, prolonged nursing home stay (≥30 days), and death. RESULTS Of 4772 older adults (median [IQR] age, 73 [68-81] years; 3398 [71%] women) who lived alone, at baseline, 1813 (38%) could not identify support, and 3013 (63%) experienced a health shock during the study. Support was associated with a lower risk of a prolonged nursing home stay at 2 years (predicted probability, 6.7% vs 5.2%; P = .002). Absent a health shock, support was not associated with a prolonged nursing home stay (predicted probability over 2 years, 1.9% vs 1.4%; P = .21). However, in the presence of a health shock, support was associated with a lower risk of a prolonged nursing home stay (predicted probability over 2 years, 14.2% vs 10.9%; P = .002). Support was not associated with incident ADL dependence or death. CONCLUSIONS AND RELEVANCE In this longitudinal cohort study among older adults who live alone, identifiable support was associated with a lower risk of a prolonged nursing home stay in the setting of a health shock.
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Affiliation(s)
- Sachin J Shah
- Division of Hospital Medicine, University of California, San Francisco
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco
| | - S Rae Wannier
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center.,Associate Editor, JAMA Internal Medicine
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Golla A, Richter C, Mau W, Saal S. [Factors Influencing the Access to and Utilization of Medical Rehabilitation Services Recommended after Care Assessment - Results of Qualitative Interviews with Professionals Involved in the Decision Process]. REHABILITATION 2021; 61:25-33. [PMID: 34407550 DOI: 10.1055/a-1500-6760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE In Germany, persons in need of care can receive a rehabilitation recommendation from the medical service of the health insurance companies. Approximately half of these recommendations lead to applications and every fourth recommendation to actual utilisation of medical rehabilitation. Little is known about the supporting factors for and barriers to this special access to medical rehabilitation for persons in need of care. To explore the influencing factors - both personal and procedural - from the perspectives of involved professionals. METHODS Interviews regarding on the access to medical rehabilitation were conducted with expert raters from the medical service of the German statutory health insurance system and with employees in long-term care and in health insurance. For data analysis systematic text condensation was used. RESULTS Based on 53 interviews with 56 involved professionals, individual- and process-related influencing factors were identified. In addition to sociodemographic, health-related, personal and financial characteristics, rehabilitation-related attitudes and a strong attachment to the home environment seem to be particularly relevant. Furthermore, service-related (e. g. expectations and wishes) and process-related (e. g. care structures) characteristics also seem to have an impact. The importance of social support from relatives was emphasized. CONCLUSIONS The results point to potential supporting factors and barriers in the access to rehabilitation by means of care assessment. They should be considered for possible improvements of the assessment and approval procedures as well as the necessary early and sufficient councelling of the concerned persons and their relatives.
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Affiliation(s)
- André Golla
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
| | - Cynthia Richter
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
| | - Wilfried Mau
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
| | - Susanne Saal
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg
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Smith JM, Lin H, Thomas-Hawkins C, Tsui J, Jarrín OF. Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5623. [PMID: 34070282 PMCID: PMC8197411 DOI: 10.3390/ijerph18115623] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 01/02/2023]
Abstract
Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3-7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25-1.32). Among the patients who received late services (8-14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97-4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.
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Affiliation(s)
- Jamie M. Smith
- College of Nursing, Thomas Jefferson University, Philadelphia, PA 19107, USA;
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07108, USA; (H.L.); (C.T.-H.)
| | - Haiqun Lin
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07108, USA; (H.L.); (C.T.-H.)
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Charlotte Thomas-Hawkins
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07108, USA; (H.L.); (C.T.-H.)
| | - Jennifer Tsui
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA 90033, USA;
| | - Olga F. Jarrín
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07108, USA; (H.L.); (C.T.-H.)
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
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McPhillips MV, Petrovsky DV, Brewster GS, Li J, Gooneratne NS, Hodgson NA, Sefcik JS. Recruiting Persons with Dementia and Caregivers in a Clinical Trial: Dyads Perceptions. West J Nurs Res 2021; 44:557-566. [PMID: 33870784 DOI: 10.1177/01939459211008563] [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: 11/17/2022]
Abstract
Recruitment for dementia research is challenging and costly. Using Ajzen's Theory of Planned Behavior we explored attitudes, perceived norms, and perceived behavioral control of persons living with dementia (PLWD) and their caregivers who participated in one clinical trial to better understand factors that influence dyads' decisions to enroll. We conducted semi-structured telephone interviews with 12 PLWD and 9 caregivers and utilized directed content analysis. Categories connected with positive attitudes about study enrollment were personal desires of wanting to learn and in-person meetings with knowledgeable staff. Additionally, participants said the money always helps in terms of the financial incentive. Participants reported enrolling to support another person (perceived norm). Study requirements were thought to be easy (perceived behavioral control). Participants highlighted the importance of flexible scheduling and study tasks being completed at their home. Findings can inform future recruitment efforts and should be investigated as effective recruitment methods in other clinical trials.
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Affiliation(s)
| | | | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Junxin Li
- School of Nursing, John Hopkins University, Baltimore, MD, USA
| | - Nalaka S Gooneratne
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063196. [PMID: 33808769 PMCID: PMC8003472 DOI: 10.3390/ijerph18063196] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/02/2023]
Abstract
Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at least 12 months and in the United States. The cohort (n = 786,758) was followed for 14 days after their diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014–2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood deprivation, and rural/urban setting. In fully adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8–0.8) and American Indian (OR 0.8, CI 0.8–0.8) patients compared to White patients. Among those discharged to home health care, all non-white racial/ethnic minority patients were less likely to receive services within 14-days. Future efforts to reduce racial/ethnic disparities in post-acute care outcomes among patients with a diabetes-related hospitalization should include policies and practice guidelines that address structural racism and systemic barriers to accessing home health care services.
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Sullivan SS, Mann C, Mullen S, Chang YP. Homecare nurses guide goals for care and care transitions in serious illness: A grounded theory of relationship-based care. J Adv Nurs 2021; 77:1888-1898. [PMID: 33502029 DOI: 10.1111/jan.14739] [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: 06/24/2020] [Revised: 11/17/2020] [Accepted: 12/09/2020] [Indexed: 12/27/2022]
Abstract
AIMS To identify the process that homecare nurses use when recognizing serious illness, engaging patients and families in goals-for-care discussions and guiding transitions to comfort-focused care. DESIGN Constructivist grounded theory. METHODS Semi-structured focus group interviews of 31 homecare Registered Nurses were recorded and transcribed (June-August 2019). Line-by-line coding using the constant comparative method until saturation was achieved and a grounded theory was identified. Credibility, transferability, and confirmability establish study rigor. RESULTS A grounded theory of relationship-based care. Nurses cogitate and act when recognizing serious illness. They have difficult conversations and support care transitions with wisdom and knowing, by identifying changes in illness trajectories and being informed and alert to diminishing quality of life. Nurses are skilled at engaging patients, families, and the team and accommodate care in the home for as long as possible, while manoeuvring through complex systems of care; ultimately relinquishing and guiding care to other providers and settings. However, nurses feel inadequately prepared and frustrated with a fragmented healthcare system and lack of collaboration among the team. CONCLUSION This study identifies a grounded theory to support clinical decision-making and position homecare nurses as leaders in guiding goal care discussions and transitions to comfort-focused care. These findings reinforce the importance of developing health policy that ensures care continuity in serious illness. Further research is needed to improve relationships across care settings and enhance training for the delivery of comfort-focused care in the home as changing needs emerge during serious illness management.
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Affiliation(s)
- Suzanne S Sullivan
- School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Catherine Mann
- School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Samantha Mullen
- School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Yu-Ping Chang
- School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA
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Demiralp B, Speelman JS, Cook CM, Pierotti D, Steele-Adjognon M, Hudak N, Neuman MP, Juliano I, Harder S, Koenig L. Incomplete Home Health Care Referral After Hospitalization Among Medicare Beneficiaries. J Am Med Dir Assoc 2021; 22:1022-1028.e1. [PMID: 33417841 DOI: 10.1016/j.jamda.2020.11.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Patients who are referred to home health care after an acute care hospitalization may not receive home health care, resulting in incomplete home health referrals. This study examines the prevalence of incomplete referrals to home health, defined as not receiving home health care within 7 days after an initial hospital discharge, and investigates the relationship between home health referral completion and patient outcomes. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Medicare beneficiaries who are discharged from short-term acute care hospitals between October 2015 and December 2016 with a discharge status code on the hospital claim indicating home health care. METHODS Patient characteristics and outcomes were compared between Medicare beneficiaries with complete and incomplete home health referrals after hospital discharge. The outcomes included mortality, readmission rate, and total spending over a 1-year episode following hospitalization. These outcomes were risk-adjusted using patient demographic, socioeconomic, clinical characteristic, hospital characteristic, and state fixed effects. RESULTS Approximately 29% of the 724,700 hospitalizations in the analytic dataset had incomplete home health referrals after discharge. The rate of incomplete home health referrals varied among clinical conditions, ranging from 17% among joint/musculoskeletal patients and 38% among digestive/endocrine patients. Risk-adjusted 1-year mortality and readmission rates were 1.4 and 2.4 percentage points lower and total spending was $1053 higher among patients with complete home health referrals as compared with those with incomplete home health referrals after hospital discharge. CONCLUSIONS AND IMPLICATIONS The analysis revealed that almost 1 in 3 patients discharged from a hospital with a discharge status of home health does not receive home health care. In addition, complete home health referrals are associated with lower mortality and readmission rates and higher spending. As home health care utilization increases, policymakers should pay attention to the tradeoff between quality and cost when implementing alternative policies and payment models.
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Affiliation(s)
| | | | | | - Danielle Pierotti
- Visiting Nurse and Hospice for Vermont and New Hampshire, White River Junction, VT, USA
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Wang J, Yu F, Cai X, Caprio TV, Li Y. Functional outcome in home health: Do racial and ethnic minority patients with dementia fare worse? PLoS One 2020; 15:e0233650. [PMID: 32453771 PMCID: PMC7250428 DOI: 10.1371/journal.pone.0233650] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Evaluate the independent and interactive effects of dementia and racial/ethnic minority status on functional outcomes during a home health (HH) admission among Medicare beneficiaries. Methods Secondary analysis of data from the Outcome and Assessment Information Set [OASIS] and billing records in a non-profit HH agency in New York. Participants were adults ≥ 65 years old who received HH in CY 2017 with OASIS records at HH admission and HH discharge. Dementia was identified by diagnosis (ICD-10 codes) and cognitive impairment (OASIS: M1700, M1710, M1740). We used OASIS records to assess race/ethnicity (M0140) and functional status (M1800-M1870 on activities of daily living [ADL]). Functional outcome was measured as change in the composite ADL score from HH admission to HH discharge, where a negative score means improvement and a positive score means decline. Results The sample included 4,783 patients, among whom 93.9% improved in ADLs at HH discharge. In multivariable linear regression that adjusted for HH service use and covariates (R2 = 0.23), being African American (β = 0.21, 95% confidence interval [CI]: 0.06, 0.35, p = 0.005) and having dementia (β = 0.51, 95% CI: 0.41, 0.62, p<0.001) were independently related to less ADL improvement at HH discharge, with significant interaction related to further decrease in ADL improvement. Relative to white patients without dementia, African American patients with dementia (β = 1.08, 95% CI: 0.81, 1.35, p<0.001), Hispanics with dementia (β = 0.92, 95% CI: 0.38, 1.47, p = 0.001) and Asian Americans with dementia (β = 1.47, 95% CI: 0.81, 2.13, p<0.001) showed the least ADL improvement at HH discharge. Conclusion Racial/ethnic minority status and dementia were associated with less ADL improvement in HH with independent and interactive effects. Policies should ensure that these patients have equitable access to appropriate, adequate community-based services to meet their needs in ADLs and disease management for improved outcomes.
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Affiliation(s)
- Jinjiao Wang
- School of Nursing, University of Rochester, Rochester, NY, United States of America
- * E-mail:
| | - Fang Yu
- School of Nursing, University of Minnesota, Minneapolis, MN, United States of America
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States of America
| | - Thomas V. Caprio
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
- University of Rochester Medical Home Care, Rochester, NY, United States of America
- Finger Lakes Geriatric Education Center, Rochester, NY, United States of America
| | - Yue Li
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States of America
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Function and Caregiver Support Associated With Readmissions During Home Health for Individuals With Dementia. Arch Phys Med Rehabil 2020; 101:1009-1016. [PMID: 32035139 DOI: 10.1016/j.apmr.2019.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the association between mobility, self-care, cognition, and caregiver support and 30-day potentially preventable readmissions (PPR) for individuals with dementia. DESIGN This retrospective study derived data from 100% national Centers for Medicare and Medicaid Services data files from July 1, 2013, through June 1, 2015. PARTICIPANTS Criteria from the Home Health Claims-Based Rehospitalization Measure and the Potentially Preventable 30-Day Post Discharge Readmission Measure for the Home Health Quality Reporting Program were used to identify a cohort of 118,171 Medicare beneficiaries. MAIN OUTCOME MEASURE The 30-day PPR rates with associated 95% CIs were calculated for each patient characteristic. Multilevel logistic regression was used to study the relationship between mobility, self-care, caregiver support, and cognition domains and 30-day PPR during home health, adjusting for patient demographics and clinical characteristics. RESULTS The overall rate of 30-day PPR was 7.6%. In the fully adjusted models, patients who were most dependent in mobility (odds ratio [OR], 1.59; 95% CI, 1.47-1.71) and self-care (OR, 1.73; 95% CI, 1.61-1.87) had higher odds for 30-day PPR. Patients with unmet caregiving needs had 1.11 (95% CI, 1.05-1.17) higher odds for 30-day PPR than patients whose caregiving needs were met. Patients with cognitive impairment had 1.23 (95% CI, 1.16-1.30) higher odds of readmission than those with minimal to no cognitive impairment. CONCLUSIONS Decreased independence in mobility and self-care tasks, unmet caregiver needs, and impaired cognitive processing at admission to home health are associated with risk of 30-day PPR during home health for individuals with dementia. Our findings indicate that deficits in mobility and self-care tasks have the greatest effect on the risk for PPR.
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Chase JAD, Russell D, Huang L, Hanlon A, O'Connor M, Bowles KH. Relationships Between Race/Ethnicity and Health Care Utilization Among Older Post-Acute Home Health Care Patients. J Appl Gerontol 2020; 39:201-213. [PMID: 29457521 PMCID: PMC6344331 DOI: 10.1177/0733464818758453] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Few studies have explored racial/ethnic differences in health care outcomes among patients receiving home health care (HHC), despite known differences in other care settings. We conducted a retrospective cohort study examining racial/ethnic disparities in rehospitalization and emergency room (ER) use among post-acute patients served by a large northeastern HHC agency between 2013 and 2014 (N = 22,722). We used multivariable binomial logistic regression to describe the relationship between race/ethnicity and health care utilization outcomes, adjusting for individual-level factors that are conceptually related to health service use. Overall rates of rehospitalization and ER visits were 10% and 13%, respectively. African American and Hispanic patients experienced higher odds of ER visits or rehospitalization during their HHC episode. Racial/ethnic differences in utilization were mediated by enabling factors, such as caregiver availability, and illness-level factors, such as illness severity, functional status, and symptoms. Intervention targets may include early risk assessment, proactive management of clinical conditions, rehabilitative therapy, and caregiver training.
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Affiliation(s)
- Jo-Ana D. Chase
- University of Pennsylvania, 338G School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, Assistant Professor, University of Missouri – Columbia,
| | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 1250 Broadway, 7th Floor, New York, NY 10001,
| | - Liming Huang
- 418 Curie Blvd, Suite 479L, Claire M. Fagin Hall, School of Nursing, University of Pennsylvania,
| | - Alexandra Hanlon
- 418 Curie Blvd, Suite 479L, Claire M. Fagin Hall, School of Nursing, University of Pennsylvania,
| | - Melissa O'Connor
- National Hartford Center for Gerontological Nursing Excellence, Assistant Professor, College of Nursing, Villanova University, Driscoll Hall, Office #316, 800 Lancaster Avenue, Villanova, PA 19085,
| | - Kathryn H. Bowles
- University of Pennsylvania, 418 Curie Boulevard Room 340, Philadelphia, PA 19104; Director of the Center for Home Care Policy and Research, Visiting Nurse Service of New York,
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Jones CD, Jones J, Bowles KH, Flynn L, Masoudi FA, Coleman EA, Levy C, Boxer RS. Quality of Hospital Communication and Patient Preparation for Home Health Care: Results From a Statewide Survey of Home Health Care Nurses and Staff. J Am Med Dir Assoc 2019; 20:487-491. [PMID: 30799224 DOI: 10.1016/j.jamda.2019.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 09/21/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff. DESIGN A web-based 48-question cross-sectional survey of HHC nurses and staff in Colorado to describe the quality of communication after hospital discharge and patient preparedness to receive HHC from the perspective of HHC nurses and staff. Questions were on a Likert scale, with optional free-text questions. SETTING AND PARTICIPANTS Between January and June 2017, we sent a web-based survey to individuals from the 56 HHC agencies in the Home Care Association of Colorado that indicated willingness to participate. RESULTS We received responses from 50 of 122 individuals (41% individual response rate) representing 14 of 56 HHC agencies (25% agency response rate). Half of the respondents were HHC nurses, the remainder were managers, administrators, or quality assurance clinicians. Among respondents, 60% (n = 30) reported receiving insufficient information to guide patient management in HHC and 44% (n = 22) reported encountering problems related to inadequate patient information. Additional tests recommended by hospital clinicians was the communication domain most frequently identified as insufficient (58%). More than half of respondents (52%) indicated that patient preparation to receive HHC was inadequate, with patient expectations frequently including extended-hours caregiving, housekeeping, and transportation, which are beyond the scope of HHC. Respondents with electronic health record (EHR) access for referring providers were less likely to encounter problems related to a lack of information (27% vs 57% without EHR access, P = .04). Respondents with EHR access were also more likely to have sufficient information about medications and contact isolation. CONCLUSIONS/IMPLICATIONS Communication between hospitals and HHC is suboptimal, and patients are often not prepared to receive HHC. Providing EHR access for HHC clinicians is a promising solution to improve the quality of communication.
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Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, PA; Visiting Nurse Service of New York, New York, NY
| | | | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Eric A Coleman
- Division of Health Care Policy and Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cari Levy
- Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO
| | - Rebecca S Boxer
- Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Gadbois EA, Tyler DA, Mor V. Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives. J Am Geriatr Soc 2017; 65:2459-2465. [PMID: 28682444 DOI: 10.1111/jgs.14988] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe individuals' experiences during the hospital discharge planning and skilled nursing facility (SNF) selection process. DESIGN Semistructured interviews focusing on discharge planning and nursing facility selection, including how facilities were chosen, who was involved, and what factors were important in decision-making. SETTING 14 SNFs in five cities across the United States. PARTICIPANTS Newly admitted, previously community-dwelling SNF residents (N = 98) and their family members. MEASUREMENT Semistructured interviews were qualitatively coded to identify underlying themes. RESULTS Most respondents reported receiving only a list of SNF names and addresses from discharge planners and that hospital staff were minimally involved. Proximity to home and prior experience with the facility most often influenced choice of SNF. Most respondents reported being satisfied with their placement, although many stated that they would have been willing to travel further to another SNF were it recommended. Many reported feeling rushed and unprepared, stating that they did not know where or how to get help. CONCLUSION SNF placement is a stressful transition, occurring when people are physically vulnerable and with limited guidance from discharge planners. Therefore, most people select a facility based on its location, perhaps because they are provided with no other information. Given Centers for Medicare and Medicaid Services' proposed changes to the discharge planning process, this research highlights the value of providing people and family caregivers with quality data and assistance in interpreting it.
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Affiliation(s)
- Emily A Gadbois
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Denise A Tyler
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.,RTI International, Waltham, Massachusetts
| | - Vincent Mor
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
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