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Edelstein J, Li CY, Meythaler J, Weaver JA, Graham JE. Inpatient Rehabilitation Facility Ownership Type Yields Mixed Performances on Quality Measures. Arch Phys Med Rehabil 2024; 105:443-451. [PMID: 37907161 PMCID: PMC11006015 DOI: 10.1016/j.apmr.2023.10.010] [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: 03/10/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To evaluate the effects of inpatient rehabilitation facility (IRF) ownership type on IRF-Quality Reporting Program (IRF-QRP) measures. DESIGN Cross-sectional, observational design. SETTING We used 2 Centers for Medicare and Medicare publicly-available, facility-level data sources: (1) IRF compare files and (2) IRF rate setting files - final rule. Data from 2021 were included. PARTICIPANTS The study sample included 1092 IRFs (N=1092). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We estimated the effects of IRF ownership type, defined as for-profit and nonprofit, on 15 IRF-QRP measures using general linear models. Models were adjusted for the following facility-level characteristics: (1) Centers for Medicare and Medicaid census divisions; (2) number of discharges; (3) teaching status; (4) freestanding vs hospital unit; and (5) estimated average weight per discharge. RESULTS Ownership type was significantly associated with 9 out of the fifteen IRF-QRP measures. Nonprofit IRFs performed better with having lower readmissions rates within stay and 30-day post discharge. For-profit IRFs performed better for all the functional measures and with higher rates of returning to home and the community. Lastly, for-profit IRFs spent more per Medicare beneficiary. CONCLUSIONS Ideally, IRF performance would not vary based on ownership type. However, we found that ownership type is associated with IRF-QRP performance scores. We suggest that future studies investigate how ownership type affects patient-level outcomes and the longitudinal effect of ownership type on IRF-QRP measures.
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Affiliation(s)
- Jessica Edelstein
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO.
| | - Chih-Ying Li
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX
| | - Jay Meythaler
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | - Jennifer A Weaver
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO
| | - James E Graham
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO
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Hoben M, Dymchuk E, Doupe MB, Keefe J, Aubrecht K, Kelly C, Stajduhar K, Banerjee S, O'Rourke HM, Chamberlain S, Beeber A, Salma J, Jarrett P, Arya A, Corbett K, Devkota R, Ristau M, Shrestha S, Estabrooks CA. Counting what counts: assessing quality of life and its social determinants among nursing home residents with dementia. BMC Geriatr 2024; 24:177. [PMID: 38383339 PMCID: PMC10880372 DOI: 10.1186/s12877-024-04710-1] [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: 09/28/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants. Therefore, we lack robust, quantitative studies evaluating the association of multiple intersecting social determinants with NH residents' QoL. The goal of this study is to address this critical knowledge gap. METHODS We will recruit a random sample of 80 NHs from 5 Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario). We will stratify facilities by urban/rural location, for-profit/not-for-profit ownership, and size (above/below median number of beds among urban versus rural facilities in each province). In video-based structured interviews with care staff, we will complete QoL assessments for each of ~ 4,320 residents, using the DEMQOL-CH, a validated, feasible tool for this purpose. We will also assess resident's social determinants of QoL, using items from validated Canadian population surveys. Health and quality of care data will come from routinely collected Resident Assessment Instrument - Minimum Data Set 2.0 records. Knowledge users (health system decision makers, Alzheimer Societies, NH managers, care staff, people with dementia and their family/friend caregivers) have been involved in the design of this study, and we will partner with them throughout the study. We will share and discuss study findings with knowledge users in web-based summits with embedded focus groups. This will provide much needed data on knowledge users' interpretations, usefulness and intended use of data on NH residents' QoL and its health and social determinants. DISCUSSION This large-scale, robust, quantitative study will address a major knowledge gap by assessing QoL and multiple intersecting social determinants of QoL among NH residents with dementia. We will also generate evidence on clusters of intersecting social determinants of QoL. This study will be a prerequisite for future studies to investigate in depth the mechanisms leading to QoL inequities in LTC, longitudinal studies to identify trajectories in QoL, and robust intervention studies aiming to reduce these inequities.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Room 301E Stong College, 4700 Keele StreetON, Toronto, M3J 1P3, Canada.
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Emily Dymchuk
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Malcolm B Doupe
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Canada
| | - Katie Aubrecht
- Department of Sociology, Faculty of Arts, St. Francis Xavier University, Antigonish, NS, Canada
| | - Christine Kelly
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kelli Stajduhar
- School of Nursing, Faculty of Human & Social Development, University of Victoria, Victoria, BC, Canada
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Hannah M O'Rourke
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Jordana Salma
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Pamela Jarrett
- Faculty of Medicine, Dalhousie University, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Amit Arya
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON, Canada
- Specialist Palliative Care in Long-Term Care Outreach Team, Kensington Gardens Long-Term Care, Kensington Health, Toronto, ON, Canada
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Devkota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Melissa Ristau
- Dr. Gerald Zetter Care Centre, The Good Samaritan Society, Edmonton, AB, Canada
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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Crea-Arsenio M, Baumann A, Antonipillai V, Akhtar-Danesh N. Factors associated with pressure ulcer and dehydration in long-term care settings in Ontario, Canada. PLoS One 2024; 19:e0297588. [PMID: 38295099 PMCID: PMC10830047 DOI: 10.1371/journal.pone.0297588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Pressure ulcers and dehydration are common conditions among residents of long-term care facilities that result in negative health effects. They have been associated with signs of neglect and increased 30-day mortality among LTC residents. However, they are both preventable and with proper care can be effectively managed and treated. We conducted a retrospective cohort study to examine factors associated with pressure ulcers and dehydration among long-term care residents in the province of Ontario, Canada. Results indicated that close to one-fifth of residents were dehydrated (17.3%) or had a pressure ulcer (18.9%) during the study period. Advanced age was significantly associated with the presence of pressure ulcers and dehydration for both men and women. However, men were more likely to present with a pressure ulcer while women were more likely to exhibit symptoms of dehydration. Study findings also demonstrate the presence of both conditions being higher in municipal and not-for-profit homes compared to for-profit homes. The significant differences observed in relation to home ownership which require further investigation to identify the most relevant factors in explaining these differences. Overall, pressure ulcers and dehydration are preventable conditions that warrant attention from policymakers to ensure quality of care and resident safety are prioritized.
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Affiliation(s)
| | - Andrea Baumann
- Global Health, McMaster University, Hamilton, Ontario, Canada
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | - Noori Akhtar-Danesh
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Havaei F, Kobekyaa F, Ma A, MacPhee M, Zhang W, Kaulius M, Ahmadi B, Boamah S, Easterbrook A, Salmon A. A Mixed Methods Study to Implement the Synergy Tool and Evaluate Its Impact on Long-Term Care Residents. Healthcare (Basel) 2023; 11:2187. [PMID: 37570427 PMCID: PMC10418466 DOI: 10.3390/healthcare11152187] [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: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND There are ongoing workforce challenges with the delivery of long-term care (LTC), such as staffing decisions based on arbitrary standards. The Synergy tool, a resident-centered approach to staffing, provides objective, real-time acuity and dependency scores (Synergy scores) for residents. The purpose of this study was to implement and evaluate the impact of the Synergy tool on LTC delivery. METHODS A longitudinal mixed methods study took place within two publicly funded LTC homes in British Columbia, Canada. Quantitative data included weekly Synergy scores for residents (24 weeks), monthly aggregated resident falls data (18 months) and a six-month economic evaluation. Qualitative data were gathered from family caregivers and thematically analyzed. RESULTS Quantitative findings from Synergy scores revealed considerable variability for resident acuity/dependency needs within and across units; and falls decreased during implementation. The six-month economic evaluation demonstrated some cost savings by comparing Synergy tool training and implementation costs with savings from resident fall rate reductions. Qualitative analyses yielded three positive impact themes (improved care delivery, better communication, and improved resident-family-staff relationships), and two negative structural themes (language barrier and staff shortages). CONCLUSIONS The Synergy tool provides useful data for enhancing a 'fit' between resident needs and available staff.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Francis Kobekyaa
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Andy Ma
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Wei Zhang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
| | - Megan Kaulius
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Bahar Ahmadi
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Sheila Boamah
- School of Nursing, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Amy Salmon
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Cox MB, McGregor MJ, Poss J, Harrington C. The association of facility ownership with COVID-19 outbreaks in long-term care homes in British Columbia, Canada: a retrospective cohort study. CMAJ Open 2023; 11:E267-E273. [PMID: 36944427 PMCID: PMC10035665 DOI: 10.9778/cmajo.20220022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Long-term care (LTC) in Canada is delivered by a mix of government-, for-profit- and nonprofit-owned facilities that receive public funding to provide care, and were sites of major outbreaks during the early stages of the COVID-19 pandemic. We sought to assess whether facility ownership was associated with COVID-19 outbreaks among LTC facilities in British Columbia, Canada. METHODS We conducted a retrospective observational study in which we linked LTC facility data, collected annually by the Office of the Seniors Advocate BC, with public health data on outbreaks. A facility outbreak was recorded when 1 or more residents tested positive for SARS-CoV-2 between Mar. 1, 2020, and Jan. 31, 2021. We used the Cox proportional hazards method to calculate the adjusted hazard ratio (HR) of the association between risk of COVID-19 outbreak and facility ownership, controlling for community incidence of COVID-19 and other facility characteristics. RESULTS Overall, 94 outbreaks involved residents in 80 of 293 facilities. Compared with health authority-owned facilities, for-profit and nonprofit facilities had higher risks of COVID-19 outbreaks (adjusted HR 1.99, 95% confidence interval [CI] 1.12-3.52 and adjusted HR 1.84, 95% CI 1.00-3.36, respectively). The model adjusted for community incidence of infection (adjusted HR 1.12, 95% CI 1.07-1.17), total nursing hours per resident-day (adjusted HR 0.84, 95% CI 0.33-2.14), facility age (adjusted HR 1.01, 95% CI 1.00-1.02), number of facility beds (adjusted HR 1.20, 95% CI 1.12-1.30) and facilities with beds in shared rooms (adjusted HR 1.16, 95% CI 0.73-1.85). INTERPRETATION Findings suggest that ownership of LTC facilities by health authorities in BC offered some protection against COVID-19 outbreaks. Further study is needed to unpack the underlying pathways behind this observed association.
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Affiliation(s)
- Michelle B Cox
- Department of Family Practice (Cox, McGregor), Faculty of Medicine, University of British Columbia; Centre for Clinical Epidemiology and Evaluation (McGregor), Vancouver Coastal Health Research Institute, Vancouver, BC; School of Public Health Sciences (Poss), University of Waterloo, Waterloo, Ont.; Department of Social and Behavioral Sciences (Harrington), University of California - San Francisco, San Francisco, Calif
| | - Margaret J McGregor
- Department of Family Practice (Cox, McGregor), Faculty of Medicine, University of British Columbia; Centre for Clinical Epidemiology and Evaluation (McGregor), Vancouver Coastal Health Research Institute, Vancouver, BC; School of Public Health Sciences (Poss), University of Waterloo, Waterloo, Ont.; Department of Social and Behavioral Sciences (Harrington), University of California - San Francisco, San Francisco, Calif.
| | - Jeffrey Poss
- Department of Family Practice (Cox, McGregor), Faculty of Medicine, University of British Columbia; Centre for Clinical Epidemiology and Evaluation (McGregor), Vancouver Coastal Health Research Institute, Vancouver, BC; School of Public Health Sciences (Poss), University of Waterloo, Waterloo, Ont.; Department of Social and Behavioral Sciences (Harrington), University of California - San Francisco, San Francisco, Calif
| | - Charlene Harrington
- Department of Family Practice (Cox, McGregor), Faculty of Medicine, University of British Columbia; Centre for Clinical Epidemiology and Evaluation (McGregor), Vancouver Coastal Health Research Institute, Vancouver, BC; School of Public Health Sciences (Poss), University of Waterloo, Waterloo, Ont.; Department of Social and Behavioral Sciences (Harrington), University of California - San Francisco, San Francisco, Calif
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Delivering person-centred palliative care in long-term care settings: is humanism a quality of health-care employees or their organisations? AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Reflecting on sustained calls for patient-centredness and culture change in long-term care, we evaluated the relative importance of personal and organisational predictors of palliative care, hypothesising the former as weaker predictors than the latter. Health-care employees (N = 184) from four Canadian long-term care homes completed a survey of person-centred care, self-efficacy, employee wellbeing and occupational characteristics. Using backward stepwise regression models, we examined the relative contributions of these variables to person-centred palliative care. Specifically, blocks of variables representing personal, organisational and occupational characteristics; palliative care self-efficacy; and employee wellbeing were simultaneously regressed on variables representing aspects of person-centred care. The change in R2 associated with the removal of each block was examined to determine each block's overall contribution to the model. We found that occupational characteristics (involvement in care planning), employee wellbeing (compassion satisfaction) and self-efficacy were reliably associated with person-centred palliative care (p < 0.05). Facility size was not associated, and facility profit status was less consistently associated. Demographic characteristics (gender, work experience, education level) and some aspects of employee wellbeing (burnout, secondary trauma) were also not reliably associated. Overall, these results raise the possibility that humanistic care is less related to intrinsic characteristics of employees, and more related to workplace factors, or to personal qualities that can be cultivated in the workplace, including meaningful role engagement, compassion and self-efficacy.
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