Hospice Medical Directors: A Survey of One State

Challenges to Admitting Residents: Perspectives from Rural Nursing Home Administrators and Staff

Rural residents are older, on average, than urban residents, with more underlying health conditions and higher rates of disability. Rural nursing homes face unique challenges admitting medically-complex patients and meeting their needs throughout their stay. These challenges may be amplified for certain health conditions. Greater geographic distances also strain transitional care coordination practices with health system referral hubs in urban areas. In this study, we assess perceptions of difficulty rural nursing homes encounter in admitting and serving individuals with dementia, obesity, mental and behavioral health conditions, and medically complex conditions. Using a survey of nursing home administrators located in non-metropolitan counties across the U.S. (n = 209), we assessed the self-reported degree of difficulty identified in serving each of the 4 type of conditions, coupled with qualitative analysis of open-ended questions identifying specific challenges. Rural nursing homes have capacity constraints owing to lower population density, limited financial resources, and unique challenges recruiting and retaining workforce to rural areas. Nursing home administrators reported the most challenges to providing high-quality care to residents with mental and behavioral health challenges, followed by obesity. For specific challenges, administrators focused primarily on staffing concerns, as well as space and equipment needs. Rural nursing home administrators identified challenges related to specific conditions and capacity constraints. To ensure appropriate and high-quality nursing home placement for rural residents, and to minimize the disruption of transitions into nursing home settings, more attention is needed on addressing the constraints identified by rural nursing home administrators in this study.

Toward a Practice-Informed Agenda for Hospice Intervention Research: What Are Staff Members' Biggest Challenges?

The translation of evidence-based interventions into routine hospice care is impeded by numerous barriers, including a disconnect between research priorities and clinical care. To inform the development of a more practice-informed agenda for hospice intervention research, our team conducted a qualitative descriptive study, posing the following research questions: 1) How do hospice staff members describe their most significant work-related challenges? and 2) What regulatory changes do hospice staff members report would most improve hospice care? To answer these research questions, we interviewed 22 hospice staff members and then conducted a template analysis of the interview content. In doing so, we identified themes that described challenges in 5 key areas: time, documentation, professional roles, recruitment and retention, and burn-out. In addition, we identified a perceived need among hospice staff members for more regulatory flexibility and clarity. Based on our findings, we conclude that a practice-informed agenda for hospice intervention research includes the development and testing of interventions that increase efficiency, explicitly speak to the humanity of hospice care, and elevate the roles of all members of the interdisciplinary team.

Bridging research and policy to address childhood obesity among border Hispanics: a pilot study

BACKGROUND

Mexican-American children are disproportionately affected by obesity compared to other population groups. Although national guidelines recommend using environmental and policy approaches to address this public health issue, the majority of Mexican-American children do not meet physical activity recommendations.

PURPOSE

To describe a knowledge transfer process involving local decision makers to address childhood obesity and physical activity needs among low-income, Mexican-American children and to examine environmental policy recommendations generated in this process.

METHODS

This pilot study employed a qualitative research design that included the dissemination of primary research data to local decision makers in the Texas-Mexico border region. Stakeholders attending public meetings were briefed about a research project reporting on the physical activity needs of Mexican-American children from impoverished neighborhoods known as colonias. Seventy-four stakeholders responded to an unstructured questionnaire and proposed policy recommendations. Data were collected January-April 2011 and analyzed July-September 2011. Data were analyzed using a content analysis technique.

RESULTS

Four policy themes emerged from the data: (1) establishing sustainable community-based health programs; (2) improving neighborhood infrastructure and safety; (3) increasing access to parks; and (4) supporting community organizations to disseminate health education to parents and children.

CONCLUSIONS

Knowledge transfer processes planned and facilitated by researchers at public meetings with local decision makers are effective methods to influence policy development related to childhood obesity.