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Allenspach P, Srinivasan M. Oral health status of institutionalized older adults receiving domiciliary dental care: A cross-sectional retrospective study. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38745373 DOI: 10.1111/scd.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
AIM This study aimed to evaluate the oral health of care-dependent institutionalized older adults receiving domiciliary dental care. METHODS AND RESULTS Dental health records of institutionalized adults receiving regular domiciliary dental care were examined (observation period: 5 years). Relevant demographic and oral health information were extracted. Statistical analyses included descriptive and non-parametric tests (α = .05). Records of 398 nursing home residents (mean-age: 84.9 ± 6.4 years) were included. Average time spent by the residents in the institution was 2.8 ± 1.5 years. The mean number of teeth present and the overall DMF-T score was 14.7 ± 9.1 and 27.4 ± 6.2, respectively. The DMF-T score increased until the 3-year recall, with a significant increase in the number of decayed teeth (2-year: p = .013; 3-year: p = .010). An improvement in the residents' periodontal health was seen during the observation period but was not statistically significant. CONCLUSION The findings of this cross-sectional study confirmed that regular domiciliary dental care provision to institutionalized older adults helps maintain gingival and periodontal health. However, the incidence of dental caries might still be a problem that needs to be addressed with effective measures that improve the daily oral care provision to these older adults.
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Affiliation(s)
- Philipp Allenspach
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Murali Srinivasan
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
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Dai Y, Johnson CE, Ding J, Chen Y, Connolly A, Wang L, Daveson BA. Cross-cultural adaptation and psychometric validation of point-of-care outcome assessment tools in Chinese palliative care clinical practice. BMC Palliat Care 2024; 23:89. [PMID: 38566178 PMCID: PMC10988912 DOI: 10.1186/s12904-024-01395-6] [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: 10/19/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND A standardized national approach to routinely assessing palliative care patients helps improve patient outcomes. However, a quality improvement program-based on person centered outcomes within palliative care is lacking in Mainland China. The well-established Australian Palliative Care Outcome Collaboration (PCOC) national model improves palliative care quality. This study aimed to culturally adapt and validate three measures that form part of the PCOC program for palliative care clinical practice in China: The PCOC Symptom Assessment Scale (PCOC SAS), Palliative Care Problem Severity Scale (PCPSS), Palliative Care Phase. METHODS A study was conducted on cross-cultural adaptation and validation of PCOC SAS, PCPSS and Palliative Care Phase, involving translation methods, cognitive interviewing, and psychometric testing through paired assessments. RESULTS Cross-cultural adaptation highlighted the need to strengthen the link between the patient's care plan and the outcome measures to improve outcomes, and the concept of distress in PCOC SAS. Analysis of 368 paired assessments (n = 135 inpatients, 22 clinicians) demonstrated that the PCOC SAS and PCPSS had good and acceptable coherence (Cronbach's a = 0.85, 0.75 respectively). Palliative Care Phase detected patients' urgent needs. PCOC SAS and PCPSS showed fair discriminant and concurrent validity. Inter-rater reliability was fair for Palliative Care Phase (k = 0.31) and PCPSS (k = 0.23-0.30), except for PCPSS-pain, which was moderate (k = 0.53). CONCLUSIONS The Chinese version of PCOC SAS, PCPSS, and Palliative Care Phase can be used to assess outcomes as part of routine clinical practice in Mainland China. Comprehensive clinical education regarding the assessment tools is necessary to help improve the inter-rater reliability.
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Affiliation(s)
- Yunyun Dai
- Faculty of Science, Medicine and Health, University of Wollongong, 239 Squires Way, Wollongong, 2522, New South Wales, Australia.
- School of Nursing, Guilin Medical University, Guilin, Guangxi, China.
| | - Claire E Johnson
- Palliative Aged Care Outcomes Program, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yongyi Chen
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Alanna Connolly
- Palliative Aged Care Outcomes Program, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Palliative Care Outcomes Collaboration, Faculty of Science, Medicine and Health, University of Wollongong, Sydney, New South Wales, Australia
| | - Lianjun Wang
- School of Nursing, Guilin Medical University, Guilin, Guangxi, China
| | - Barbara A Daveson
- Palliative Care Outcomes Collaboration, Faculty of Science, Medicine and Health, University of Wollongong, Sydney, New South Wales, Australia
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Gussin GM, Singh RD, Gohil SK, Saavedra R, Tjoa TT, Nguyen KP, Pedroza R, Hsi JB, O'Brien K, Berman C, Park J, Hsi EA, Ghasemian K, Osalvo A, Chun S, Fonda E, Huang SS. Impact of universal chlorhexidine bathing with or without COVID-19 intensive training on staff and resident COVID-19 case rates in nursing homes. Infect Control Hosp Epidemiol 2024:1-4. [PMID: 38440877 DOI: 10.1017/ice.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
We evaluated whether universal chlorhexidine bathing (decolonization) with or without COVID-19 intensive training impacted COVID-19 rates in 63 nursing homes (NHs) during the 2020-2021 Fall/Winter surge. Decolonization was associated with a 43% lesser rise in staff case-rates (P < .001) and a 52% lesser rise in resident case-rates (P < .001) versus control.
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Affiliation(s)
- Gabrielle M Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Raveena D Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Shruti K Gohil
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Raheeb Saavedra
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Thomas T Tjoa
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Kristine P Nguyen
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Robert Pedroza
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Joshua B Hsi
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Kevin O'Brien
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Chase Berman
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jessica Park
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Emily A Hsi
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Kimia Ghasemian
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Avy Osalvo
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Stephanie Chun
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | | | - Susan S Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
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Rao-Newton A, Gallagher E, Mickelsen J, Sanchez C, Forby F, Andrews K, Hosie A, Sheehan C, DeNatale M, Agar M. Timely Assessment of Breathing-Related Distress in Community Palliative Care: A Multidisciplinary Collaborative Quality Improvement Project. J Palliat Med 2024; 27:324-334. [PMID: 37962858 DOI: 10.1089/jpm.2022.0576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Background: Breathlessness is a common symptom for palliative patients that can cause distress and decrease function and quality of life. Palliative care services in Australia aim to routinely assess patients for breathing-related distress, but timely reassessment is not always achieved. Objective: To improve the timeliness of breathlessness reassessment in a home-based community palliative care service in New South Wales for people with moderate-to-severe breathing-related distress. Breathing-related distress was defined as a Symptom Assessment Score for "breathing problems" of four or more. Methods: This collaborative quality improvement (QI) project between SPHERE Palliative Care CAG, Stanford University mentors, and a Sydney metropolitan specialist palliative care service included a: (1) retrospective chart audit; (2) cause and effect analyses using a fishbone diagram; (3) development and implementation of key drivers and interventions; and (4) a pre-and-post evaluation of the timeliness of reassessment of breathing-related distress and changes in Symptom Assessment Scale scores for "breathing problems." Results: Key interventions included multidisciplinary education sessions to facilitate buy-in, with nurses as case managers responsible for breathlessness reassessment and documentation of scores, access and training in electronic palliative care data entry software, fortnightly monitoring and reporting of breathing-related distress scores, and development of an educational flowchart. The proportion of patients reassessed within seven days of an initial nursing assessment of moderate-to-severe breathing-related distress increased from 34% at baseline to 92% at six months. Conclusion: A local QI project increased the proportion of patients with a timely reassessment of their breathing-related distress in a community palliative care service.
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Affiliation(s)
- Angela Rao-Newton
- School of Nursing, College of Health and Medicine, University of Tasmania, Lilyfield, New South Wales, Australia
- Improving Palliative Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Elaine Gallagher
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | - Jake Mickelsen
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Carmen Sanchez
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | - Felicity Forby
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | - Kate Andrews
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | - Annmarie Hosie
- Improving Palliative Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- University of Notre Dame, Sydney, New South Wales, Australia
- St Vincent's Health Network Sydney, New South Wales, Australia
| | - Caitlin Sheehan
- Improving Palliative Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | | | - Meera Agar
- Improving Palliative Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Egbujie BA, Turcotte LA, Heckman GA, Morris JN, Hirdes JP. Functional Decline in Long-Term Care Homes in the First Wave of the COVID-19 Pandemic: A Population-based Longitudinal Study in Five Canadian Provinces. J Am Med Dir Assoc 2024; 25:282-289. [PMID: 37839468 DOI: 10.1016/j.jamda.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We aimed to examine whether functional decline accelerated during the first wave of the COVID-19 pandemic (March to June 2020) for persons in long-term care facilities (LTCs) in Canada compared with the pre-pandemic period. DESIGN We conducted a population-based longitudinal study of persons receiving care in LTC homes in 5 Canadian provinces before and during the COVID-19 pandemic. SETTING AND PARTICIPANTS Residents in 1326 LTC homes within the Canadian provinces of Alberta, British Columbia, Manitoba, Newfoundland & Labrador, and Ontario between January 31, 2019, and June 30, 2020, with activities of daily living Hierarchy scale less than 6 and so, who still have potential for decline (6 being the worst of the 0-6 scale). METHODS We fit a generalized estimating equation model with adjustment for repeated measures to obtain the adjusted odds of functional decline between COVID period exposed and unexposed pre-pandemic residents. RESULTS LTC residents experienced slightly higher rates of functional decline during the first wave of the COVD-19 pandemic compared with the pre-pandemic period (23.3% vs 22.3%; P < .0001). The adjusted odds of functional decline were slightly greater during the pandemic (odds ratio [OR], 1.17; 95% CI, 1.15-1.20). Likewise, residents receiving care in large homes (OR, 1.20; 95% CI, 1.17-1.24) and urban-located LTC homes (OR, 1.20; 95% CI, 1.17-1.23), were more likely to experience functional decline during the COVID-19 pandemic. The odds of functional decline were also only significantly higher during the pandemic for LTC home residents in British Columbia (OR, 1.17; 95% CI, 1.11-1.23) and Ontario (OR, 1.25; 95% CI, 1.21-1.29). CONCLUSIONS AND IMPLICATIONS This study provides evidence that the odds of experiencing functional decline were somewhat greater during the first wave of the COVID-19 pandemic. It highlights the need to maintain physical activity and improve nutrition among older adults during periods of stress. The information would be helpful to health administrators and decision-makers seeking to understand how the COVID-19 pandemic and associated public health measures affected LTC residents' health outcomes.
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Affiliation(s)
- Bonaventure A Egbujie
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Luke A Turcotte
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John N Morris
- Hebrew SeniorLife, Institute for Aging Research, Boston, MA, USA
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Roydhouse J, Connolly A, Daveson B, de Graaff B, Blanchard M, Currow DC. Palliative care symptoms and problems in a culturally and linguistically diverse population: large retrospective cohort study. BMJ Support Palliat Care 2024; 13:e1228-e1237. [PMID: 36720586 DOI: 10.1136/spcare-2022-004111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Migrant Australians with cancer have higher unmet needs and poorer health-related quality of life. Less is known about their palliative care experience. We aimed to assess comparative symptom distress and problem severity for culturally and linguistically diverse Australians with cancer in palliative care. METHODS This was a retrospective, consecutive cohort study using data from the Palliative Care Outcomes Collaboration, which routinely collects standardised symptom assessments nationally at point-of-care. Adults with a cancer diagnosis who died 01/01/2016-31/12/2019 were included. The presence/absence of patient-reported symptom distress and clinician-rated problem severity were compared between people who preferred English and people who preferred another language using logistic regression models. We also compared people who preferred English and the four most common non-English languages in the dataset: Chinese, Greek, Italian and Slavic. RESULTS A total of 53 964 people with cancer died within the study period, allowing analysis of 104 064 assessments. People preferring non-English languages were less likely to report symptoms (pain: OR=0.89 (0.84 to 0.94); all other symptoms except fatigue OR<1 and CIs did not contain 1). Except for family/carer problems (OR=1.24 (1.12 to 1.31)), linguistically diverse people were less likely to report problems. Variation was seen between non-English language groups. CONCLUSIONS We did not find evidence of comparatively worse symptom distress or problem severity for nearly all scores for culturally and linguistically diverse Australians. Better symptom management or differential reporting may explain this. It is important to examine this further, including assessing differences within cultural and linguistic groups to ensure the delivery of high-quality palliative care.
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Affiliation(s)
- Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Alanna Connolly
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara Daveson
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Megan Blanchard
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Rajlic G, Sorensen JM, Mithani A. Exploring Post-COVID-19 Functional Outcomes in Residents in Long-Term Care Homes in British Columbia, Canada. Gerontol Geriatr Med 2024; 10:23337214241245551. [PMID: 38779377 PMCID: PMC11110507 DOI: 10.1177/23337214241245551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/04/2024] [Accepted: 03/20/2024] [Indexed: 05/25/2024] Open
Abstract
Research on functional outcomes in long-term care (LTC) home residents after COVID-19 infection is limited. In the current study, we examined outcomes in 1,310 LTC residents with a positive COVID-19 test in the period from March 2020 to April 2022 ("COVID" group). We also reviewed outcomes in residents in the same LTC homes without a history of COVID-19 during the same period ("No-COVID" group, n = 2,301). In a retrospective longitudinal design, we explored activities of daily living (ADLs), cognitive function, and clinical care needs over time. Change was assessed from the last assessment before contracting COVID-19 to three assessments subsequent to COVID-19, over on average seven months after infection. We found deterioration over time in ADLs and cognitive performance in both groups. The change in ADLs and clinical care needs was slightly greater in the COVID than the No-COVID group from baseline to the first follow-up assessment; in subsequent assessments, the change was similar in both groups. Overall, we observed similar functional outcomes among surviving residents in the two groups, with initially greater deterioration in ADLs and clinical care needs in residents with a history of COVID-19 followed by a trajectory resembling the one in the No-COVID residents.
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Wong AK, Wang D, Marco D, Le B, Philip J. Prevalence, Severity, and Predictors of Insomnia in Advanced Colorectal Cancer. J Pain Symptom Manage 2023; 66:e335-e342. [PMID: 37295563 DOI: 10.1016/j.jpainsymman.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
CONTEXT Insomnia is an under-recognized and undertreated symptom in palliative care and advanced cancer cohorts. Insomnia in an advanced colorectal cancer cohort is yet to be investigated despite colorectal cancer being the third commonest cancer worldwide and one with a high symptom burden. OBJECTIVES To examine the prevalence of insomnia and its associations in a large advanced colorectal cancer cohort. METHODS A consecutive cohort study of 18,302 patients with colorectal cancer seen by palliative care services across various settings (inpatient, outpatient, and ambulatory) was conducted from an Australia-wide database (2013-2019). The Symptom Assessment Score (SAS) was used to assess the severity of insomnia. Clinically significant insomnia was defined as SAS score ≥3/10, and used to compare associations with other symptoms and functional scores from validated questionnaires. RESULTS The prevalence of any insomnia was 50.5%, and clinically significant insomnia 35.6%, particularly affecting people who were younger (<45-years-old), more mobile (AKPS score ≥70), or physically capable (RUG-ADL score ≤5). Outpatients and patients living at home had higher prevalence of insomnia. Nausea, anorexia and psychological distress were the commonest concurrent symptoms in patients with clinically significant insomnia. CONCLUSIONS To our knowledge, this study was the first to investigate the prevalence and associations of insomnia in an advanced colorectal cancer cohort. Our findings demonstrate several groups at greater risk of suffering from insomnia (younger, greater physical capacity, living at home, and those with greater psychological distress). This may guide earlier recognition and management of insomnia to improve overall quality of life in this population.
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Affiliation(s)
- Aaron K Wong
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia.
| | - Dorothy Wang
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Marco
- Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia; Centre for Palliative Care, St Vincent's Hospital Melbourne (D.M.), Fitzroy, Victoria, Australia
| | - Brian Le
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jennifer Philip
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia; Palliative Care Service (J.P.), St Vincent's Hospital, Fitzroy, Victoria, Australia
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Liu H, Cook A, Ding J, Lu H, Jiao J, Bai W, Johnson CE. Palliative care needs and specialist services post stroke: national population-based study. BMJ Support Palliat Care 2023:spcare-2023-004280. [PMID: 37500566 DOI: 10.1136/spcare-2023-004280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES (1) To compare palliative care needs of patients admitted primarily with stroke and (2) to determine how the care needs of these patients affect their use of different types of specialist palliative care services. METHODS Observational study based on point-of-care data from the Australian Palliative Care Outcomes Collaboration. Multivariate logistic regression models were used to explore the association between patients' palliative care needs and use of community versus inpatient specialist palliative care services. RESULTS The majority of patients who had a stroke in this study population had mild or no symptom distress, but experienced a high degree of functional impairment and needed substantial help with basic tasks of daily living. A lower Australia-modified Karnofsky Performance Status score (OR=1.82, 95% CI 1.06 to 3.13) and occurrence of an 'unstable' palliative care phase (OR=28.34, 95% CI 9.03 to 88.94) were associated with use of inpatient versus community palliative care, but otherwise, no clear association was observed between the majority of symptoms and use of different care services. CONCLUSIONS Many people with stroke could potentially have been cared for and could have experienced the terminal phases of their condition in a community setting if more community support services were available for their families.
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Affiliation(s)
- Huiqin Liu
- Health Management Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Angus Cook
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Yale School of Internal Medicine, New Haven, Connecticut, USA
| | - Hongwei Lu
- Health Management Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingjing Jiao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Wenhui Bai
- Department of Nursing, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Claire E Johnson
- AHSRI, University of Wollongong Faculty of Business, Wollongong, New South Wales, Australia
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Chang PJ, Lin CF, Juang YH, Chiu JY, Lee LC, Lin SY, Huang YH. Death place and palliative outcome indicators in patients under palliative home care service: an observational study. BMC Palliat Care 2023; 22:44. [PMID: 37072784 PMCID: PMC10114304 DOI: 10.1186/s12904-023-01167-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/04/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Dying at home accompanied by loved-ones is regarded favorably and brings good luck in Taiwan. This study aimed to examine the relevant factors affecting whether an individual dies at home or not in a group of terminal patients receiving palliative home care service. METHODS The patients who were admitted to a palliative home care service at a hospital-affiliated home health care agency were consecutively enrolled between March 1, 2021 and March 31, 2022. During the period of care, the instruments of the palliative care outcomes collaboration was used to assess patients in each home visit twice a week, including symptom assessment scale, palliative care problem severity score, Australia-modified Karnofsky performance status, resource utilization groups-activities of daily living, and palliative care phase. RESULTS There were 56 participants (53.6% female) with a median age of 73.0 years (interquartile range (IQR) 61.3-80.3 y/o), of whom 51 (91.1%) patients were diagnosed with cancer and 49 (96.1%) had metastasis. The number of home visits was 3.5 (IQR 2.0-5.0) and the average number of days under palliative home care service was 31 (IQR 16.3-51.5) before their death. After the end of the study, there was a significant deterioration of sleeping, appetite, and breathing problems in the home-death group, and appetite problems in the non-home death patients. However, physician-reported psychological/spiritual problems improved in the home-death group, and pain improved in the non-home death patients. Physical performance deteriorated in both groups, and more resource utilization of palliative care was needed. The 44 patients who died at home had greater cancer disease severity, fewer admissions, and the proportion of families desiring a home death for the patient was higher. CONCLUSIONS Although the differences in palliative outcome indicators were minor between patients who died at home and those who died in the hospital, understanding the determinants and change of indicators after palliative care service at different death places may be helpful for improving the quality of end-of-life care.
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Affiliation(s)
- Pei-Jung Chang
- Home Health Care Agency, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Department of Nursing, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Cheng-Fu Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Division of Occupational Medicine, Department of Emergency, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Research Center for Geriatrics and Gerontology, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan
| | - Ya-Huei Juang
- Home Health Care Agency, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Department of Nursing, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Jui-Yu Chiu
- Home Health Care Agency, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Department of Nursing, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan.
- Research Center for Geriatrics and Gerontology, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan.
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 40705, Taiwan.
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan.
| | - Yu-Hui Huang
- Home Health Care Agency, Taichung Veterans General Hospital, Taichung, 40705, Taiwan.
- Department of Nursing, Taichung Veterans General Hospital, Taichung, 40705, Taiwan.
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Lee J, Currow D, Lovell M, Phillips JL, McLachlan A, Ritchie M, Brown L, Fazekas B, Aggarwal R, Seah D, Sheehan C, Chye R, Noble B, McCaffrey N, Aggarwal G, George R, Kow M, Ayoub C, Linton A, Sanderson C, Mittal D, Rao A, Prael G, Urban K, Vandersman P, Agar M. Lidocaine for Neuropathic Cancer Pain (LiCPain): study protocol for a mixed-methods pilot study. BMJ Open 2023; 13:e066125. [PMID: 36810169 PMCID: PMC9945039 DOI: 10.1136/bmjopen-2022-066125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Many patients experience unrelieved neuropathic cancer-related pain. Most current analgesic therapies have psychoactive side effects, lack efficacy data for this indication and have potential medication-related harms. The local anaesthetic lidocaine (lignocaine) has the potential to help manage neuropathic cancer-related pain when administered as an extended, continuous subcutaneous infusion. Data support lidocaine as a promising, safe agent in this setting, warranting further evaluation in robust, randomised controlled trials. This protocol describes the design of a pilot study to evaluate this intervention and explains the pharmacokinetic, efficacy and adverse effects evidence informing the design. METHODS AND ANALYSIS A mixed-methods pilot study will determine the feasibility of an international first, definitive phase III trial to evaluate the efficacy and safety of an extended continuous subcutaneous infusion of lidocaine for neuropathic cancer-related pain. This study will comprise: a phase II double-blind randomised controlled parallel-group pilot of subcutaneous infusion of lidocaine hydrochloride 10% w/v (3000 mg/30 mL) or placebo (sodium chloride 0.9%) over 72 hours for neuropathic cancer-related pain, a pharmacokinetic substudy and a qualitative substudy of patients' and carers' experiences. The pilot study will provide important safety data and help inform the methodology of a definitive trial, including testing proposed recruitment strategy, randomisation, outcome measures and patients' acceptability of the methodology, as well as providing a signal of whether this area should be further investigated. ETHICS AND DISSEMINATION Participant safety is paramount and standardised assessments for adverse effects are built into the trial protocol. Findings will be published in a peer-reviewed journal and presented at conferences. This study will be considered suitable to progress to a phase III study if there is a completion rate where the CI includes 80% and excludes 60%. The protocol and Patient Information and Consent Form have been approved by Sydney Local Health District (Concord) Human Research Ethics Committee 2019/ETH07984 and University of Technology Sydney ETH17-1820. TRIAL REGISTRATION NUMBER ANZCTR ACTRN12617000747325.
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Affiliation(s)
- Jessica Lee
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - David Currow
- University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Melanie Lovell
- Greenwich Palliative and Supportive Care Services, HammondCare, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Andrew McLachlan
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Megan Ritchie
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Linda Brown
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Belinda Fazekas
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Rajesh Aggarwal
- Palliative Care, Bankstown Hospital, Bankstown, New South Wales, Australia
| | - Davinia Seah
- Palliative Care, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Caitlin Sheehan
- Palliative Care, Calvary Health Care, Kogarah, New South Wales, Australia
| | - Richard Chye
- Palliative Care, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Beverly Noble
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Nikki McCaffrey
- Deakin Health Economics, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
| | - Ghauri Aggarwal
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Rachel George
- Pharmacy, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Marian Kow
- Pharmacy, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Chadi Ayoub
- Cardiology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Anthony Linton
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Dipti Mittal
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Angela Rao
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Palliative Care, Calvary Health Care, Kogarah, New South Wales, Australia
| | - Grace Prael
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Katalin Urban
- Palliative Care, Northern New South Wales Local Health Network, Lismore, New South Wales, Australia
| | - Priyanka Vandersman
- Research Centre for Palliative Care Death & Dying, Flinders University, Adelaide, South Australia, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Palliative Care, Sydney South West Area Health Service, Liverpool, New South Wales, Australia
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12
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The Implementation of Integrated Health Information Systems - Research Studies from 7 Countries Involving the InterRAI Assessment System. Int J Integr Care 2023; 23:8. [PMID: 36819613 PMCID: PMC9936911 DOI: 10.5334/ijic.6968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction In the past years, governments from several countries have shown interest in implementing integrated health information systems. The interRAI Suite of instruments fits this concept, as it is a set of standardised, evidence-based assessments, which have been validated for different care settings. The system allows the electronic transfer of information across care settings, enabling integration of care and providing support for care planning and quality monitoring. The main purpose of this research is to describe the recent implementation process of the interRAI instruments in seven countries: Belgium, Switzerland, France, Ireland, Iceland, Finland and New Zealand. Methods The study applied a case study methodology with the focus on the implementation strategies in each country. Principal investigators gathered relevant information from multiple sources and summarised it according to specific aspects of the implementation process, comparing them across countries. The main implementation aspects are described, as well as the main advantages and barriers perceived by the users. Results The seven case studies showed that adequate staffing, appropriate information technology, availability of hardware, professional collaboration and continuous training are perceived as important factors which can contribute to the implementation of the interRAI instruments. In addition, the use of electronic standardised assessment instruments such as the interRAI Suite provided evidence to improve decision-making and quality of care, enabling resource planning and benchmarking. Conclusion In practice, the implementation of health information systems is a process that requires a cultural shift of policymakers and professional caregivers at all levels of health policy and service delivery. Information about the implementation process of the interRAI Suite in different countries can help investigators and policymakers to better plan this implementation. This research sheds light on the advantages and pitfalls of the implementation of the interRAI Suite of instruments and proposes approaches to overcome difficulties.
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Hsiao WH, Wang CL, Lee LC, Chien SP, Hsu CC, Chu WM. Exploring Risk Factors of Unexpected Death, Using Palliative Care Outcomes Collaboration (PCOC) Measures, among Terminal Patients Receiving Palliative Care in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13294. [PMID: 36293875 PMCID: PMC9602686 DOI: 10.3390/ijerph192013294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Palliative care has the ability to relieve both physical discomfort and psychological distress in terminally ill patients. However, unexpected death may still occur in palliative care settings. This study aimed to utilize Palliative Care Outcomes Collaboration (PCOC) data to better determine any associated factors which may surround unexpected death in palliative care settings. Data were extracted from the PCOC database by the palliative care team within Taichung Veterans General Hospital (TCVGH). Data of deceased patients were extracted during the period from January 2021 to December 2021 from multiple palliative care settings. The deaths of patients whose last recorded palliative phase was 1-3 were defined as unexpected. A total of 280 deceased patients were included, with mean age at death being 67.73, 61% being male, and 83.2% cancer patients. We discovered that shortness of breath, as assessed by the Symptom Assessment Scale (SAS), decreased risk of unexpected death (OR: 0.91, 95% CI: 0.84-0.98), while impending death discharge (OR: 3.93, 95% CI: 1.20-12.94) and a higher Australia-modified Karnofsky performance status (AKPS) score (OR: 1.15, 95% CI: 1.10-1.21) were associated with unexpected death. Thus, medical staff must inform the family of patients early on regarding any risk factors surrounding unexpected death to help everyone involved be prepared in advance.
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Affiliation(s)
- Wen-Hsuan Hsiao
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chun-Li Wang
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407, Taiwan
| | - Szu-Pei Chien
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Public Health, China Medical University, Taichung 404, Taiwan
| | - Chin-Chu Hsu
- Department of Nursing, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
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Tang D, Bian J, He M, Yang N, Zhang D. Research on the Current Situation and Countermeasures of Inpatient Cost and Medical Insurance Payment Method for Rehabilitation Services in City. Front Public Health 2022; 10:880951. [PMID: 35844844 PMCID: PMC9280708 DOI: 10.3389/fpubh.2022.880951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to introduce bed-day payment for rehabilitation services in City S, China, and analyze the cost of inpatient rehabilitation services. Key issues were defined and relevant countermeasures were discussed. Methods The data about the rehabilitation cost of 3,828 inpatient patients from June 2018 to December 2019 was used. Descriptive statistics and the Kruskal–Wallis test were employed to describe sample characteristics and clarify the comparity of cost and length of stay (LOS) across different groups. After normalizing the distribution of cost and LOS by Box–Cox transformation, multiple linear regression was used to explore the factors influencing cost and LOS by calculating the variance inflation factor (VIF) to identify multicollinearity. Finally, 20 senior and middle management personnel of the hospitals were interviewed through a semi-structured interview method to further figure out the existing problems and countermeasures. Results (1) During 2015–2019: both discharges and the cost of rehabilitation hospitalization in City S rose rapidly. (2) The highest number of discharges were for circulatory system diseases (57.65%). Endocrine, nutritional, and metabolic diseases were noted to have the longest average length of stay (ALOS) reaching 105.8 days. The shortest ALOS was found to be 24.2 days from the diseases of the musculoskeletal system and connective tissue. Neurological, circulatory, urological, psychiatric, infectious, and parasitic diseases were observed to be generally more costly. (3) The cost of rehabilitation was determined to mainly consist of the rehabilitation fee (23.63%), comprehensive medical service fee (22.61%), and treatment fee (19.03%). (4) Type of disease, age, nature of the hospital, and grade of the hospital have significant influences both on cost and LOS (P < 0.05). The most critical factor affecting the cost was found to be the length of stay (standardized coefficient = 0.777). (5) The key issues of City S's rehabilitative services system were identified to be the incomplete criteria, imperfections in the payment system, and the fragmentation of services. Conclusions Bed-day payment is the main payment method for rehabilitation services, but there is a conflict between rapidly rising costs and increasing demand for rehabilitation. The main factors affecting the cost include the length of stay, type of disease, the grade of the hospital, etc. Lack of criteria, imperfections in the payment system, and the fragmentation of services limit sustainability. The core approach is to establish a three-tier rehabilitative network and innovate the current payment system.
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Affiliation(s)
- Dongfeng Tang
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Jinwei Bian
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Meihui He
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Ning Yang
- School of Economics and Management, University of Science and Technology Beijing, Beijing, China
| | - Dan Zhang
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
- *Correspondence: Dan Zhang
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Lucey M, O'Reilly M, Coffey S, Sheridan J, Moran S, Twomey F, Conroy M, Eager K, Currow D. The association between phase of illness and resource utilisation-a potential model for demonstrating clinical efficiency? Int J Palliat Nurs 2022; 28:254-260. [PMID: 35727831 DOI: 10.12968/ijpn.2022.28.6.254] [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: 11/11/2022]
Abstract
Background: Healthcare efficiency involves demonstrating flexible inter-relationships between resource utilisation and patient need. In palliative care, five phases of patient illness have been identified: stable, unstable, deteriorating, terminal and bereaved. Evaluating the association between phase of illness and nursing activities could demonstrate clinical efficiency. Aim: The aim of this study was to evaluate the association between the phase of illness and the intensity of nursing care in a specialist palliative care unit. Methods: This was a prospective, observational cohort study of consecutive admissions (n=400) to a specialist palliative care unit. Patient phase of illness was documented on admission and daily thereafter. A nursing activity tool was developed, which scored daily nursing interventions (physical, psychological, family care and symptom control). This score was called the nursing total score (NTS) and reflected the intensity of nursing activities. Data were entered into SPSS and descriptive statistics weregenerated. Results: A total of 342 (85%) patients had full data recorded on admission. Stable, unstable, deteriorating and terminal phases were associated with progressively increasing median NTSs on days 1, 2, 3 and 4 (all P<0.01). Phase stabilisation from the unstable to the stable phase during this timeframe resulted in reductions in physical care (p=0.038), symptom management (p=0.007) and near-significant reductions in family support (p=0.06). Conclusion: A significant association was demonstrated between phase of illness and intensity of nursing activities, which were sensitive to phase changes, from unstable to stable. This demonstrates technically efficient resource utilisation and identifies a potential efficiency model for future evaluations of inpatient palliative care.
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Affiliation(s)
- Michael Lucey
- Consultant in Palliative Medicine, Milford Hospice, Ireland
| | | | | | | | - Sue Moran
- Clinical Nurse Manager, Milford Hospice, Ireland
| | - Feargal Twomey
- Consultant in Palliative Medicine, Milford Hospice, Ireland
| | - Marian Conroy
- Consultant in Palliative Medicine, Milford Hospice, Ireland
| | - Kathy Eager
- Professor of Health Services Research; Director of the Australian Health Services Research Institute (AHSRI), University of Wollongong, Australia
| | - David Currow
- Chief Cancer Officer of New South Wales; Chief Executive Officer of the Cancer Institute New South Wales, University of Wollongong, Australia
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16
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Mueller C. Multidimensional Aspects of Nurse Staffing in Nursing Homes. Nurs Clin North Am 2022; 57:179-189. [DOI: 10.1016/j.cnur.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Mulla RT, Turcotte LA, Wellens NI, Angevaare MJ, Weir J, Jantzi M, Hébert PC, Heckman GA, van Hout H, Millar N, Hirdes JP. Prevalence and predictors of influenza vaccination in long-term care homes: a cross-national retrospective observational study. BMJ Open 2022; 12:e057517. [PMID: 35437252 PMCID: PMC9016404 DOI: 10.1136/bmjopen-2021-057517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To compare facility-level influenza vaccination rates in long-term care (LTC) homes from four countries and to identify factors associated with influenza vaccination among residents. DESIGN AND SETTING Retrospective cross-sectional study of individuals residing in LTC homes in New Brunswick (Canada), New Zealand, Switzerland, and the Netherlands between 2017 and 2020. PARTICIPANTS LTC home residents assessed with interRAI assessment system instruments as part of routine practice in New Brunswick (n=7006) and New Zealand (n=34 518), and national pilot studies in Switzerland (n=2760) and the Netherlands (n=1508). End-of-life residents were excluded from all country cohorts. OUTCOMES Influenza vaccination within the past year. RESULTS Influenza vaccination rates among LTC home residents were highest in New Brunswick (84.9%) and lowest in Switzerland (63.5%). For all jurisdictions where facility-level data were available, substantial interfacility variance was observed. There was approximately a fourfold difference in the coefficient of variation for facility-level vaccination rates with the highest in Switzerland at 37.8 and lowest in New Brunswick at 9.7. Resident-level factors associated with vaccine receipt included older age, severe cognitive impairment, medical instability, health conditions affecting a greater number of organ systems and social engagement. Residents who displayed aggressive behaviours and smoke tobacco were less likely to be vaccinated. CONCLUSION There are opportunities to increase influenza vaccine uptake at both overall country and individual facility levels. Enhanced vaccine administration monitoring programmes in LTC homes that leverage interRAI assessment systems should be widely adopted.
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Affiliation(s)
- Reem T Mulla
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Luke Andrew Turcotte
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Nathalie Ih Wellens
- HES-SO La Source Institute and School of Nursing, Lausanne, Switzerland
- Public Health and Social Affairs of the Canton of Vaud, Directorate General of Health, Lausanne, Switzerland
| | - Milou J Angevaare
- Department of Medicine for Older People & Department of General Practice, Amsterdam Public Health research institute, Amsterdam UMC - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Julie Weir
- New Brunswick Association of Nursing Homes, Fredericton, New Brunswick, Canada
| | - Micaela Jantzi
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul C Hébert
- Université de Montréal, Montreal, Québec, Canada
- Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Hein van Hout
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Guthrie DM, Williams N, Beach C, Buzath E, Cohen J, Declercq A, Fisher K, Fries BE, Goodridge D, Hermans K, Hirdes JP, Seow H, Silveira M, Sinnarajah A, Stevens S, Tanuseputro P, Taylor D, Vadeboncoeur C, Martin TLW. A multi-stage process to develop quality indicators for community-based palliative care using interRAI data. PLoS One 2022; 17:e0266569. [PMID: 35390091 PMCID: PMC8989210 DOI: 10.1371/journal.pone.0266569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Individuals receiving palliative care (PC) are generally thought to prefer to receive care and die in their homes, yet little research has assessed the quality of home- and community-based PC. This project developed a set of valid and reliable quality indicators (QIs) that can be generated using data that are already gathered with interRAI assessments—an internationally validated set of tools commonly used in North America for home care clients. The QIs can serve as decision-support measures to assist providers and decision makers in delivering optimal care to individuals and their families.
Methods
The development efforts took part in multiple stages, between 2017–2021, including a workshop with clinicians and decision-makers working in PC, qualitative interviews with individuals receiving PC, families and decision makers and a modified Delphi panel, based on the RAND/ULCA appropriateness method.
Results
Based on the workshop results, and qualitative interviews, a set of 27 candidate QIs were defined. They capture issues such as caregiver burden, pain, breathlessness, falls, constipation, nausea/vomiting and loneliness. These QIs were further evaluated by clinicians/decision makers working in PC, through the modified Delphi panel, and five were removed from further consideration, resulting in 22 QIs.
Conclusions
Through in-depth and multiple-stakeholder consultations we developed a set of QIs generated with data already collected with interRAI assessments. These indicators provide a feasible basis for quality benchmarking and improvement systems for care providers aiming to optimize PC to individuals and their families.
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Affiliation(s)
- Dawn M. Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
- * E-mail:
| | - Nicole Williams
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Cheryl Beach
- Integrated Community Services, Fraser Health, Surrey, British Columbia, Canada
| | - Emma Buzath
- Provincial Palliative and-End-of-Life Care, Seniors Health and Continuing Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anja Declercq
- LUCAS – Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- CESO – Center for Sociological Research, KU Leuven, Leuven, Belgium
| | - Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Brant E. Fries
- Department of Health Management and Policy and Department of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kirsten Hermans
- LUCAS – Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - John P. Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Maria Silveira
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - Susan Stevens
- Nova Scotia Health, Halifax, Halifax, Nova Scotia, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Deanne Taylor
- Research Department, Interior Health Authority, Kelowna, British Columbia, Canada
- Rural Coordination Centre of BC, Penticton, British Columbia, Canada
| | - Christina Vadeboncoeur
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Ottawa, Ontario, Canada
- Roger Neilson House, Ottawa, Ontario, Canada
| | - Tracy Lyn Wityk Martin
- Provincial Palliative and-End-of-Life Care, Seniors Health and Continuing Care, Alberta Health Services, Calgary, Alberta, Canada
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Long KH, Smith C, Petersen R, Emerson J, Ransom J, Mielke MM, Hass S, Leibson C. Medical and nursing home costs: From cognitively unimpaired through dementia. Alzheimers Dement 2022; 18:393-407. [PMID: 34482623 PMCID: PMC8897513 DOI: 10.1002/alz.12400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/02/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Efforts to model the cost-effectiveness of managing/modifying cognitive impairment lack reliable, objective, baseline medical, and nursing-home (NH) costs. METHODS A stratified-random sample of Olmsted County, MN, residents ages 70-89 years (N = 3545), well-characterized as cognitively unimpaired, mild cognitive impairment (MCI), or dementia, were followed forward ≤1 year in provider-linked billing data and the Centers for Medicare & Medicaid Services NH assessments. Direct medical/nursing home/medical + NH costs were estimated. Costs were stratified by vital status and NH-use intensity (NH days/follow-up days [0%, 1% to 24%, 25% to 99%, and 100%]). Between-category mean-annual cost differences were adjusted for patient characteristics and follow-up days. RESULTS Costs/follow-up day distributions differed significantly across cognitive categories. Mean costs/follow-up days were 2.5 to 18 times higher for decedents versus survivors. Among all persons with MCI, <9% with any NH use accounted for 18% of all total annual medical + NH costs. Adjusted-between-category comparisons revealed significantly higher medical and medical + NH costs for MCI versus cognitively unimpaired. DISCUSSION Cost-effectiveness for managing/modifying both MCI and dementia should consider end-of-life costs and NH-use intensity. Results can help inform cost-effectiveness models, predict future-care needs, and aid decision-making by individuals/providers/payers/policymakers.
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Affiliation(s)
- Kirsten Hall Long
- K Long Health Economics Consulting, LLC, 855 Village Center Dr. #111, St. Paul, MN, 55127 USA
| | - Carin Smith
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905 USA
| | - Ronald Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905 USA,Department of Neurology, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905 USA
| | - Jane Emerson
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905 USA
| | - Jeanine Ransom
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905 USA
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905 USA,Department of Neurology, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905 USA
| | - Steven Hass
- Department of Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Cynthia Leibson
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905 USA,Corresponding author: Cynthia Leibson, PhD, Department of Quantitative Health Sciences, Mayo Clinic, 200 1 Street SW, Rochester, MN, 55905 USA; ; phone: 1-612-968-9397; fax: 1-507-284-1516
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20
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Seow H, Barbera LC, McGrail K, Burge F, Guthrie DM, Lawson B, Chan KKW, Peacock SJ, Sutradhar R. Effect of Early Palliative Care on End-of-Life Health Care Costs: A Population-Based, Propensity Score-Matched Cohort Study. JCO Oncol Pract 2022; 18:e183-e192. [PMID: 34388021 PMCID: PMC8758090 DOI: 10.1200/op.21.00299] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE This study aimed to investigate the impact of early versus not-early palliative care among cancer decedents on end-of-life health care costs. METHODS Using linked administrative databases, we created a retrospective cohort of cancer decedents between 2004 and 2014 in Ontario, Canada. We identified those who received early palliative care (palliative care service used in the hospital or community 12 to 6 months before death [exposure]). We used propensity score matching to identify a control group of not-early palliative care, hard matched on age, sex, cancer type, and stage at diagnosis. We examined differences in average health system costs (including hospital, emergency department, physician, and home care costs) between groups in the last month of life. RESULTS We identified 144,306 cancer decedents, of which 37% received early palliative care. After matching, we created 36,238 pairs of decedents who received early and not-early (control) palliative care; there were balanced distributions of age, sex, cancer type (24% lung cancer), and stage (25% stage III and IV). Overall, 56.3% of early group versus 66.7% of control group used inpatient care in the last month (P < .001). Considering inpatient hospital costs in the last month of life, the early group used an average (±standard deviation) of $7,105 (±$10,710) versus the control group of $9,370 (±$13,685; P < .001). Overall average costs (±standard deviation) in the last month of life for patients in the early versus control group was $12,753 (±$10,868) versus $14,147 (±$14,288; P < .001). CONCLUSION Receiving early palliative care reduced average health system costs in the last month of life, especially via avoided hospitalizations.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada,Hsien Seow, PhD, Department of Oncology, McMaster University, 699 Concession St, 4th Fl, Rm 4-229, Hamilton, ON L8V 5C2, Canada; e-mail:
| | - Lisa C. Barbera
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Kimberlyn McGrail
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Fred Burge
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Dawn M. Guthrie
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | | | | | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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21
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Hirdes JP, Morris JN, Perlman CM, Saari M, Betini GS, Franco-Martin MA, van Hout H, Stewart SL, Ferris J. Mood Disturbances Across the Continuum of Care Based on Self-Report and Clinician Rated Measures in the interRAI Suite of Assessment Instruments. Front Psychiatry 2022; 13:787463. [PMID: 35586405 PMCID: PMC9108209 DOI: 10.3389/fpsyt.2022.787463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/25/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mood disturbance is a pervasive problem affecting persons of all ages in the general population and the subset of those receiving services from different health care providers. interRAI assessment instruments comprise an integrated health information system providing a common approach to comprehensive assessment of the strengths, preferences and needs of persons with complex needs across the continuum of care. OBJECTIVE Our objective was to create new mood scales for use with the full suite of interRAI assessments including a composite version with both clinician-rated and self-reported items as well as a self-report only version. METHODS We completed a cross-sectional analysis of 511,641 interRAI assessments of Canadian adults aged 18+ in community mental health, home care, community support services, nursing homes, palliative care, acute hospital, and general population surveys to develop, test, and refine new measures of mood disturbance that combined clinician and self-rated items. We examined validity and internal consistency across diverse care settings and populations. RESULTS The composite scale combining both clinician and self-report ratings and the self-report only variant showed different distributions across populations and settings with most severe signs of disturbed mood in community mental health settings and lowest severity in the general population prior to the COVID-19 pandemic. The self-report and composite measures were strongly correlated with each other but differed most in populations with high rates of missing values for self-report due to cognitive impairment (e.g., nursing homes). Evidence of reliability was strong across care settings, as was convergent validity with respect to depression/mood disorder diagnoses, sleep disturbance, and self-harm indicators. In a general population survey, the correlation of the self-reported mood scale with Kessler-10 was 0.73. CONCLUSIONS The new interRAI mood scales provide reliable and valid mental health measures that can be applied across diverse populations and care settings. Incorporating a person-centered approach to assessment, the composite scale considers the person's perspective and clinician views to provide a sensitive and robust measure that considers mood disturbances related to dysphoria, anxiety, and anhedonia.
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Affiliation(s)
- John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Margaret Saari
- SE Research Centre, SE Health and Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gustavo S Betini
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Hein van Hout
- Department of General Practice and Medicine for Older Persons, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shannon L Stewart
- Faculty of Education, Western University (Canada), London, ON, Canada
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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22
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Potter AJ, Bowblis JR. Nursing home care under Medicaid managed long-term services and supports. Health Serv Res 2021; 56:1179-1189. [PMID: 34263450 DOI: 10.1111/1475-6773.13701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To measure the impact of Medicaid managed long-term services and supports (MLTSS) on nursing home (NH) quality and rebalancing. DATA SOURCES/STUDY SETTING This study analyzes secondary data from annual NH recertification surveys and the minimum dataset (MDS) in three states that implemented MLTSS: Massachusetts (2001-2007), Kansas and Ohio (2011-2017). STUDY DESIGN We utilized a difference-in-difference approach comparing NHs in border counties of states that implemented MLTSS with a control group of NHs in neighboring border counties in states that did not implement MLTSS. Sensitivity analyses included a triple-difference model (stratified by Medicaid payer mix) and a within-state comparison. We examined changes in six NH-level outcomes (percentage of low-care NH residents, facility occupancy, and four NH quality measures) after MLTSS implementation. DATA COLLECTION/EXTRACTION METHODS For each state, all freestanding NHs in border counties were included, as were NHs in neighboring counties located in other states. Information on low-care residents was aggregated to the NH level from MDS data, then combined with Online Survey Certification and Reporting (OSCAR) and Certification and Survey Provider Enhanced Reporting (CASPER) data. PRINCIPAL FINDINGS MLTSS had no statistically significant effects on NH quality outcomes in Massachusetts or Kansas. In Ohio, MLTSS led to an increase of 0.21 nursing hours per resident day [95% CI: 0.03, 0.40], and a decrease of 1.47 deficiencies [95% CI: -2.52, -0.42] and 9.38 deficiency points [95% CI: -18.53, -0.24] per certification survey. After MLTSS, occupancy decreased by 1.52 percentage points [95% CI: -2.92, -0.12] in Massachusetts, but increased by 3.17 percentage points [95% CI: 0.36, 5.99] in Ohio. We found no effect on low-care residents in any state. Findings were moderately sensitive to the choice of comparator group. CONCLUSION The study provides little evidence that MLTSS reduces quality of care, occupancy, or the percentage of low-care residents in NHs.
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Affiliation(s)
- Andrew J Potter
- Department of Political Science & Criminal Justice, California State University, Chico, California, USA
| | - John R Bowblis
- Department of Economics, Miami University, Oxford, Ohio, USA
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23
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Gresham M, Morris T, Min Chao S, Lorang C, Cunningham C. Specialist residential dementia care for people with severe and persistent behaviours: A ten-year retrospective review. Australas J Ageing 2021; 40:309-316. [PMID: 34043267 DOI: 10.1111/ajag.12964] [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: 10/13/2020] [Revised: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022]
Abstract
Very severe behavioural and psychological symptoms of dementia (BPSD) have low prevalence but disproportionately poor outcomes for persons with dementia, others and systems of care, including inappropriate use of medication, tenuous accommodation, poor quality of life and increased costs. The Australian Government has established new Special Dementia Care Programmes (SDCPs) to provide interim care for up to 12 months for those with severe and persistent BPSD unsuitable for mainstream aged care. This 10-year retrospective review describes environmental design, governance, clinical processes, characteristics and outcomes for 80 residents of a similar-aged care mental health partnership SDCP. A key finding was that average length of stay was slightly over 12 months. All surviving residents except one were able to be transferred to mainstream aged care services. Doses of regular and PRN antipsychotic and anxiolytic medications were significantly reduced. SDCPs may have the potential to improve care and outcomes for this group of vulnerable older people.
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Affiliation(s)
- Meredith Gresham
- The Dementia Centre, HammondCare, Sydney, NSW, Australia.,Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, Sydney, NSW, Australia
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24
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Risk adjustment for benchmarking nursing home infection surveillance data: A narrative review. Am J Infect Control 2021; 49:366-374. [PMID: 32791257 DOI: 10.1016/j.ajic.2020.08.006] [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: 05/08/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022]
Abstract
Until recently, there was no national surveillance system for monitoring infection occurrence in long-term care facilities (LTCF) in the United States. As a result, there are no national benchmarks for LTCF infection rates that can be utilized for quality improvement at the facility level. One of the major challenges in the reporting of health care-related infection data is accounting for nonmodifiable facility and patient characteristics that influence benchmarks for infection. The objectives of this paper are to review: (a) published infection rates in LTCF in the United States to assess the level of variability; (b) studies describing facility- and resident-level risk factors for infection that can be used in risk adjustment models; (c) published attempts to risk-adjust LTCF infection rates; and (d) efforts to develop models specifically for risk adjustment of infection rates in LTCF for benchmarking. It is anticipated that this review will stimulate further study of methods to risk-adjust LTCF infection rates for benchmarking that will facilitate research and public reporting.
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25
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A 'case-mix' approach to understand adherence trajectories for a falls prevention exercise intervention: A longitudinal cohort study. Maturitas 2021; 147:1-6. [PMID: 33832641 DOI: 10.1016/j.maturitas.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We identified adherence-based case-mixes from participants' longitudinal adherence to falls prevention exercise interventions over 12 months. Second, we identified modifiable baseline predictors (cognition, mobility and functional status) based on participants' case-mix adherence trajectories. STUDY DESIGN AND OUTCOME MEASURES This study was a 12-month longitudinal secondary analysis of data from 172 participants who received the Otago Exercise Program (OEP) in a randomized controlled trial. Adherence to the OEP was ascertained monthly via self-report. Case-mixes, groups of individuals who followed similar adherence trajectories, were visually defined using 12-month longitudinal trajectories; we used latent class growth modeling. Baseline predictors of adherence were examined for the following categories: 1) cognition, 2) mobility and 3) functional status. RESULTS Four distinct case-mixes were identified. The "non-adherent" case-mix (18 %) was distinguished by a non-adherent and decreasing adherence trajectory over time. The "low adherence" case-mix (45 %) did not have complete adherence or consistent adherence over the 12-month follow-up. The "moderate adherence" case-mix (27 %) was characterized by a stable (i.e., non-variable) adherence trajectory with a slightly increasing pattern at midpoint. The "high adherence" case-mix (10 %) demonstrated consistent and high adherence over the 12-month follow-up. For individuals with "moderate adherence", the Digit Symbol Substitution Test (DSST) significantly predicted adherence (relative risk ratio (RRR) = 1.12 (0.95 CI: 1.0-1.26); p = 0.049). For individuals with "high adherence", the Digits Forward minus Digits Backward (RRR = 0.43 (0.95 CI: 0.23-0.79); p = 0.002) and Instrumental Activities of Daily Living (RRR = 0.36 (0.95 CI: 0.16-0.81); p = 0.01) significantly predicted adherence. CONCLUSIONS Cognitive profile and activities of daily living at baseline may predict the longitudinal pattern of adherence.
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26
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Brühl A, Sappok-Laue H, Lau S, Christ-Kobiela P, Müller J, Sesterhenn-Ochtendung B, Stürmer-Korff R, Stelzig A, Lobb M, Bleidt W. Indicating Care Process Quality: A Multidimensional Scaling Analysis. J Nurs Meas 2021; 30:364-387. [PMID: 33431558 DOI: 10.1891/jnm-d-20-00096] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Resident assessments are analyzed by multidimensional scaling. METHODS We analyzed observer-based real care and support time in four facilities with 209 residents during two working days; resident, organizational data and pairs of residents were assessed by registered and assistant nurses regarding the dissimilarity of resident pairs. Registered- and assistant nurses dissimilarity assessments are compared to criteriabased nursing management assessment. RESULTS The fits of management criteria matrices as external restrictions are higher in registered nurses' than in assistant nurses' assessments. These differences disappear with low staffing. CONCLUSION The influence of qualification levels on assessment is affected by staffing. Low complexity of Assistant Nurses assessments is connected to higher nursing care and support time in groups of demanding residents.
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Affiliation(s)
- Albert Brühl
- Vallendar University of Philosophy and Theology (PTHV), Vallendar, Germany
| | | | - Steffi Lau
- Vocational school Koblenz, Koblenz, Germany
| | | | - Joachim Müller
- Technical college Kobern-Gondorf, Kobern-Gondorf, Germany
| | | | | | | | - Michael Lobb
- Bethesda Foundation-St. Martin, Boppard, Germany
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27
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Stewart SL, Celebre A, Head MJ, James ML, Martin L, Fries BE. A Case-Mix System for Children and Youth With Developmental Disabilities. Health Serv Insights 2020; 13:1178632920977899. [PMID: 33414639 PMCID: PMC7750751 DOI: 10.1177/1178632920977899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022] Open
Abstract
Limited funding across health and social service programs presents a challenge
regarding how to best match resources to the needs of the population. There is
increasing consensus that differences in individual characteristics and care
needs should be reflected in variations in service costs, which has led to the
development of case-mix systems. The present study sought to develop a new
approach to allocate resources among children and youth with intellectual and
developmental disabilities (IDD) as part of a system-wide Medicaid payment
reform initiative in Arkansas. To develop the system, assessment data collected
using the interRAI Child and Youth Mental Health-Developmental Disability
instrument was matched to paid service claims. The sample consisted of 346
children and youth with developmental disabilities in the home setting. Using
automatic interactions detection, individuals were sorted into unique,
clinically relevant groups (ie, based on similar resource use) and a
standardized relative measure of the cost of services provided to each group was
calculated. The resulting case-mix system has 8 distinct, final groups and
explains 30% of the variance in per diem costs. Our analyses indicate that this
case-mix classification system could provide the foundation for a future
prospective payment system that is centered around stability and equitability in
the allocation of limited resources within this vulnerable population.
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Affiliation(s)
| | - Angela Celebre
- Faculty of Education, Western University, London, ON, Canada
| | | | - Mary L James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Brant E Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
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28
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de Korte MH, Verhoeven GS, Elissen AMJ, Metzelthin SF, Ruwaard D, Mikkers MC. Using machine learning to assess the predictive potential of standardized nursing data for home healthcare case-mix classification. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1121-1129. [PMID: 32601992 PMCID: PMC7561562 DOI: 10.1007/s10198-020-01213-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Netherlands is currently investigating the feasibility of moving from fee-for-service to prospective payments for home healthcare, which would require a suitable case-mix system. In 2017, health insurers mandated a preliminary case-mix system as a first step towards generating information on client differences in relation to care use. Home healthcare providers have also increasingly adopted standardized nursing terminology (SNT) as part of their electronic health records (EHRs), providing novel data for predictive modelling. OBJECTIVE To explore the predictive potential of SNT data for improvement of the existing preliminary Dutch case-mix classification for home healthcare utilization. METHODS We extracted client-level data from the EHRs of a large home healthcare provider, including data from the existing Dutch case-mix system, SNT data (specifically, NANDA-I) and the hours of home healthcare provided. We evaluated the predictive accuracy of the case-mix system and the SNT data separately, and combined, using the machine learning algorithm Random Forest. RESULTS The case-mix system had a predictive performance of 22.4% cross-validated R-squared and 6.2% cross-validated Cumming's Prediction Measure (CPM). Adding SNT data led to a substantial relative improvement in predicting home healthcare hours, yielding 32.1% R-squared and 15.4% CPM. DISCUSSION The existing preliminary Dutch case-mix system distinguishes client needs to some degree, but not sufficiently. The results indicate that routinely collected SNT data contain sufficient additional predictive value to warrant further research for use in case-mix system design.
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Affiliation(s)
- Maud H. de Korte
- Dutch Healthcare Authority (NZa), Utrecht, The Netherlands
- Department of Economics, Tilburg University, Tilburg, The Netherlands
| | - Gertjan S. Verhoeven
- Dutch Healthcare Authority (NZa), Utrecht, The Netherlands
- Department of Economics, Tilburg University, Tilburg, The Netherlands
| | - Arianne M. J. Elissen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Silke F. Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Misja C. Mikkers
- Dutch Healthcare Authority (NZa), Utrecht, The Netherlands
- Department of Economics, Tilburg University, Tilburg, The Netherlands
- Tilburg Law and Economics Center (TILEC), Tilburg University, Tilburg, The Netherlands
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29
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Ding J, Johnson CE, Qin X, Ho SCH, Cook A. Palliative care needs and utilisation of different specialist services in the last days of life for people with lung cancer. Eur J Cancer Care (Engl) 2020; 30:e13331. [PMID: 33111485 DOI: 10.1111/ecc.13331] [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: 04/09/2020] [Revised: 05/13/2020] [Accepted: 08/07/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To (a) compare palliative care needs of lung cancer patients on their final admission to community-based and inpatient palliative care services; and (b) explore whether and how these care needs affect their utilisation of different palliative care services in the last days of life. METHODS Descriptive study involving 17,816 lung cancer patients who received the last episode of palliative care from specialist services and died between 1 January 2013 and 31 December 2018. RESULTS Both groups of patients admitted to community-based and inpatient palliative care services generally experienced relatively low levels of symptom distress, but high levels of functional impairment and dependency. "Unstable" versus "stable" palliative care phase (Odds ratio = 11.66; 95% Confidence Interval: 9.55-14.24), poorer functional outcomes and severe levels of distress from many symptoms predicted greater likelihood of use of inpatient versus community-based palliative care. CONCLUSIONS Most inpatient palliative care admissions are not associated with high levels of symptom severity. To extend the period of home care and rate of home death for people with lung cancer, additional investment is required to improve their access to sufficiently skilled palliative care staff, multi-disciplinary teams and 24-hour home support in community settings.
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Affiliation(s)
- Jinfeng Ding
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Claire E Johnson
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia.,Eastern Health, Supportive and Palliative Care, Wantirna, VIC, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Xiwen Qin
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | | | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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30
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Palliative care needs and utilization of specialist services for people imminently dying with dementia: A national population-based study. Int J Nurs Stud 2020; 109:103655. [DOI: 10.1016/j.ijnurstu.2020.103655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 02/05/2023]
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31
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Morgan DD, Brown A, Cerdor PA, Currow DC. Does Resource Utilization Group-Activities of Daily Living Help Us Better Interpret Australian Karnofsky-Modified Performance Scale? J Palliat Med 2020; 23:1153-1154. [DOI: 10.1089/jpm.2020.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Deidre D. Morgan
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
- Formerly Occupational Therapy Department, Peninsula Health, Frankston, Australia
| | - Annabel Brown
- Peninsula Home Hospice Service, Mornington, Australia
| | - Pauline A. Cerdor
- Formerly Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - David C. Currow
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
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32
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Harrington C, Dellefield ME, Halifax E, Fleming ML, Bakerjian D. Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health Serv Insights 2020; 13:1178632920934785. [PMID: 32655278 PMCID: PMC7328494 DOI: 10.1177/1178632920934785] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022] Open
Abstract
US nursing homes are required to have sufficient nursing staff with the
appropriate competencies to assure resident safety and attain or maintain the
highest practicable level of physical, mental, and psychosocial well-being of
each resident. Minimum nurse staffing levels have been identified in research
studies and recommended by experts. Beyond the minimum levels, nursing homes
must take into account the resident acuity to assure they have adequate staffing
levels to meet the needs of residents. This paper presents a guide for
determining whether a nursing home has adequate and appropriate nurse staffing.
We propose five basic steps to: (1) determine the collective resident acuity and
care needs, (2) determine the actual nurse staffing levels, (3) identify
appropriate nurse staffing levels to meet residents care needs, (4) examine
evidence regarding the adequacy of staffing, and (5) identify gaps between the
actual staffing and the appropriate nursing staffing levels based on resident
acuity. Data sources and specific methodologies are analyzed, compared, and
recommended. The goal is to assist nursing home nurses and administrators to
ensure adequate nursing home staffing levels that protect resident health,
safety, and well-being.
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Affiliation(s)
- Charlene Harrington
- Department of Social & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mary Ellen Dellefield
- Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Elizabeth Halifax
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Mary Louise Fleming
- Healthcare Administration and Interprofessional Leadership Program, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Debra Bakerjian
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA
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de Almeida Mello J, Cès S, Vanneste D, Van Durme T, Van Audenhove C, Macq J, Fries B, Declercq A. Comparing the case-mix of frail older people at home and of those being admitted into residential care: a longitudinal study. BMC Geriatr 2020; 20:195. [PMID: 32503445 PMCID: PMC7275336 DOI: 10.1186/s12877-020-01593-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background In order to optimize interventions and services in the community, it is important to identify the profile of persons who are able to stay at home and of those who are being admitted into residential care. Understanding their needs and their use of resources is essential. The main objective of the study is to identify persons who are likely to enter residential care based upon their needs and resource utilization, so that care providers can plan interventions effectively and optimize services and resources to meet the persons’ needs. Methods This is a longitudinal quasi-experimental study. The data consists of primary data from the community setting collected every six months during the period of 2010–2016. Interventions had the goal of keeping older people longer at home. Participants were at least 65 years old and were living in the community. The interRAI Resource Utilization Group system (RUG-III) was used to calculate the case-mix indexes (CMI) of all participants. Comparisons were made between the case-mix of those who were still living at home and those who were admitted into residential care at follow-up. Results A total of 10,289 older persons participated in the study (81.2 ± 7.1 yrs., 69.1% female). From this population, 853 participants (8.3%) were admitted into residential care. The CMI of the persons receiving night care at home were the highest (1.6 at baseline and 1.7 at the entry point of residential care), followed by persons receiving occupational therapy (1.5 at baseline and 1.6 at the entry point of residential care) and persons enrolled in case management interventions with rehabilitation (1.4 at baseline and 1.6 at the entry point of residential care). The CMIs at follow-up were significantly higher than at baseline and the linear regression model showed that admission to residential care was a significant factor in the model. Conclusions The study showed that the RUG-III system offers possibilities for identifying persons at risk of institutionalization. Interventions designed to avoid early nursing home admission can make use of the RUG-III system to optimize care planning and the allocation of services and resources. Based on the RUG-III case-mix, resources can be allocated to keep older persons at home longer, bearing in mind the complexity of care and the availability of services in the community.
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Affiliation(s)
| | - Sophie Cès
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Dirk Vanneste
- LUCAS, Center for Care Research and Consultancy, KULeuven, Leuven, Belgium
| | - Thérèse Van Durme
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | | | - Jean Macq
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Brant Fries
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Anja Declercq
- LUCAS, Center for Care Research and Consultancy, KULeuven, Leuven, Belgium.,CeSO: Centre for Sociological Researc, KULeuven, Leuven, Belgium
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Ding J, Johnson CE, Lee YCO, Gazey A, Cook A. Characteristics of People with Dementia vs Other Conditions on Admission to Inpatient Palliative Care. J Am Geriatr Soc 2020; 68:1825-1833. [PMID: 32329901 DOI: 10.1111/jgs.16458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Our aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care-related problems to patients with other chronic diseases. DESIGN Descriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018). SETTING A total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration. PARTICIPANTS A total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862). MEASUREMENTS This study reported the data collected at the time of admission to inpatient palliative care services including patients' self-rated levels of distress from seven common physical symptoms, clinician-rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases. RESULTS At the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from .15 to .80; P < .05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P < .001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P < .001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND. CONCLUSION The unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis. J Am Geriatr Soc 68:1825-1833, 2020.
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Affiliation(s)
- Jinfeng Ding
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Claire E Johnson
- Monash Nursing and Midwifery, Monash University, Clayton, Australia.,Supportive and Palliative Care, Eastern Health, Victoria, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Australia
| | | | - Angela Gazey
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
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Woods JA, Johnson CE, Allingham SF, Ngo HT, Katzenellenbogen JM, Thompson SC. Collaborative data familiarisation and quality assessment: Reflections from use of a national dataset to investigate palliative care for Indigenous Australians. Health Inf Manag 2020; 50:64-75. [PMID: 32216561 DOI: 10.1177/1833358320908957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Data quality is fundamental to the integrity of quantitative research. The role of external researchers in data quality assessment (DQA) remains ill-defined in the context of secondary use for research of large, centrally curated health datasets. In order to investigate equity of palliative care provided to Indigenous Australian patients, researchers accessed a now-historical version of a national palliative care dataset developed primarily for the purpose of continuous quality improvement. OBJECTIVES (i) To apply a generic DQA framework to the dataset and (ii) to report the process and results of this assessment and examine the consequences for conducting the research. METHOD The data were systematically examined for completeness, consistency and credibility. Data quality issues relevant to the Indigenous identifier and framing of research questions were of particular interest. RESULTS The dataset comprised 477,518 records of 144,951 patients (Indigenous N = 1515; missing Indigenous identifier N = 4998) collected from participating specialist palliative care services during a period (1 January 2010-30 June 2015) in which data-checking systems underwent substantial upgrades. Progressive improvement in completeness of data over the study period was evident. The data were error-free with respect to many credibility and consistency checks, with anomalies detected reported to data managers. As the proportion of missing values remained substantial for some clinical care variables, multiple imputation procedures were used in subsequent analyses. CONCLUSION AND IMPLICATIONS In secondary use of large curated datasets, DQA by external researchers may both influence proposed analytical methods and contribute to improvement of data curation processes through feedback to data managers.
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Affiliation(s)
- John A Woods
- 2720The University of Western Australia, Australia
| | - Claire E Johnson
- 2720The University of Western Australia, Australia.,2541Monash University, Australia.,Eastern Health, Victoria, Australia
| | | | - Hanh T Ngo
- 2720The University of Western Australia, Australia
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Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J, Hirdes A, Hoffman R, James ML, Martin L, Perlman CM, Rabinowitz T, Stewart SL, Van Audenhove C. The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care. Front Psychiatry 2020; 10:926. [PMID: 32076412 PMCID: PMC6978285 DOI: 10.3389/fpsyt.2019.00926] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.
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Affiliation(s)
- John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Coline van Everdingen
- Psychiatry and Neuropsychology Department, Maastricht University, Maastricht, Netherlands
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Brant E. Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Jyrki Heikkilä
- Division of Psychiatry, Turku University Hospital, Turku, Finland
| | - Alice Hirdes
- Graduate Program in Health Promotion, Human Development and Society, Lutheran University of Brazil, Canoas, Brazil
| | - Ron Hoffman
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
| | - Mary L. James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Lynn Martin
- Department of Health Sciences for Lynn Martin, Lakehead University, Thunder Bay, ON, Canada
| | - Christopher M. Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Shannon L. Stewart
- Faculty of Education, Althouse College, Western University, London, ON, Canada
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy & Academic Center for General Practice in the Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
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A systematic review of case-mix models for home health care payment: Making sense of variation. Health Policy 2020; 124:121-132. [PMID: 31928858 DOI: 10.1016/j.healthpol.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/03/2019] [Accepted: 12/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Case-mix based payment of health care services offers potential to contain expenditure growth and simultaneously support needs-based care provision. However, limited evidence exists on its application in home health care (HHC). Therefore, this study aimed to synthesize available international literature on existing case-mix models for HHC payment. METHODS We performed a systematic review of scientific literature, supplemented with grey literature. We searched for literature using six scientific databases, reference lists, expert consultation, and targeted websites. Data on study design, case-mix model attributes, and conclusions were extracted narratively. RESULTS Of 3303 references found, 22 scientific studies and 27 grey documents met eligibility criteria. Eight case-mix models for HHC were identified, from the US, Canada, New Zealand, Australia, and Germany. Three countries have implemented a case-mix model as part of a HHC payment system. Different combinations of in total 127 unique case-mix predictors are included across models to predict HHC use. Case-mix models also differ in targeted services, operationalization, and outcome measures and predictive power. CONCLUSIONS Case-mix based payment is not yet widely used within HHC. Multiple varieties were found between HHC case-mix models, and no one best form of a model seems to exist. Even though varieties are partly inevitable due to country-specific contexts, developing a shared vision in case-mix model attributes would be key to achieving efficient, needs-based HHC.
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Looney F, Cobbe S, Ryan A, Barriscale I, McMahon A, Real S. The Search for a Functional Outcome Measure for Physical Therapy in Specialist Palliative Care: An Ongoing Journey. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bae SH, Lee S, Kim H. Extent of and factors associated with pain among older residents in nursing homes in South Korea: A nationwide survey study. Geriatr Gerontol Int 2019; 20:118-124. [PMID: 31828946 PMCID: PMC7027823 DOI: 10.1111/ggi.13834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/07/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
AIM Pain can have a critical negative impact on the quality of life of institutionalized older people. This study aimed to examine the characteristics of pain and associated factors among older people at nursing homes in Korea. METHODS A nationwide survey was carried out on the functional status of 1444 older residents at 91 nursing homes using the interRAI Long-Term Care Facilities instrument. The frequency, intensity, severity and consistency of pain were assessed, and data on potential attributes at the resident and facility levels were collected. Multivariate and multilevel regression analysis models were developed. RESULTS More than one-third (36.7%) of older residents had pain. Pain prevalence differed by several sociodemographic and clinical factors, including sex, depressive symptoms, cognition, or whether or not the resident was a Medical Aid beneficiary. Pain prevalence also varied according to nursing home size and location. In the multivariate, multilevel regression analyses, both having severe pain and having consistent pain were positively associated with depressive symptoms, and the pain experience was significantly lower among older residents in nursing homes that met the nursing staffing standard. CONCLUSIONS This is the most comprehensive study on pain assessment in long-term care facilities in Korea using a representative sample so far. Pain is prevalent among nursing home residents in Korea. Besides individual factors, facility characteristics - in particular, meeting the staffing standard - were important to pain control, which implies there is room for improving pain assessment and management through advancing quality of care policies. Geriatr Gerontol Int 2020; 20: 118-124.
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Affiliation(s)
- Sung-Heui Bae
- Ewha Womans University, College of Nursing, Seoul, Korea
| | - Seyune Lee
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Hongsoo Kim
- Graduate School of Public Health Deptartment of Public Health Sciences, Seoul National University; Institute of Health and Environment, Institute of Aging, Seoul, Korea
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Guthrie DM, Harman LE, Barbera L, Burge F, Lawson B, McGrail K, Sutradhar R, Seow H. Quality Indicator Rates for Seriously Ill Home Care Clients: Analysis of Resident Assessment Instrument for Home Care Data in Six Canadian Provinces. J Palliat Med 2019; 22:1346-1356. [DOI: 10.1089/jpm.2019.0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dawn M. Guthrie
- Department of Kinesiology and Physical Education and Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa E. Harman
- Department of Kinesiology and Physical Education and Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Ford JH, Vranas L, Coughlin D, Selle KM, Nordman-Oliveira S, Ryther B, Ewers T, Griffin VL, Eslinger A, Boero J, Hardgrove P, Crnich CJ. Effect of a Standard vs Enhanced Implementation Strategy to Improve Antibiotic Prescribing in Nursing Homes: A Trial Protocol of the Improving Management of Urinary Tract Infections in Nursing Institutions Through Facilitated Implementation (IMUNIFI) Study. JAMA Netw Open 2019; 2:e199526. [PMID: 31509204 PMCID: PMC6739723 DOI: 10.1001/jamanetworkopen.2019.9526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Suspicion of urinary tract infection (UTI) is the major driver of overuse and misuse of antibiotics in nursing homes (NHs). Effects of interventions to improve the recognition and management of UTI in NHs have been mixed, potentially owing to differences in how interventions were implemented in different studies. An improved understanding of how implementation approach influences intervention adoption is needed to achieve wider dissemination of antibiotic stewardship interventions in NHs. OBJECTIVE To compare the effects of 2 implementation strategies on the adoption and effects of a quality improvement toolkit to enhance recognition and management of UTIs in NHs. DESIGN, SETTING, AND PARTICIPANTS This cluster-randomized hybrid type 2 effectiveness-implementation clinical trial will be performed over a 6-month baseline (January to June 2019) and 12-month postimplementation period (July 2019 to June 2020). A minimum of 20 Wisconsin NHs with 50 or more beds will be recruited and randomized in block sizes of 2 stratified by rurality (rural vs urban). All residents who are tested and/or treated for UTI in study NHs will be included in the analysis. All study NHs will implement a quality improvement toolkit focused on enhancing the recognition and management of UTIs. Facilities will be randomized to either a usual or enhanced implementation approach based on external facilitation (coaching), collaborative peer learning, and peer comparison feedback. Enhanced implementation is hypothesized to be associated with improvements in adoption of the quality improvement toolkit and clinical outcomes. Primary outcomes of the study will include number of (1) urine cultures per 1000 resident days and (2) antibiotic prescriptions for treatment of suspected UTI per 1000 resident-days. Secondary outcomes of the study will include appropriateness of UTI treatments, treatment length, use of fluoroquinolones, and resident transfers and mortality. A mixed-methods evaluation approach will be used to assess extent and determinants of adoption of the UTI quality improvement toolkit in study NHs. DISCUSSION Knowledge gained during this study could help inform future efforts to implement antibiotic stewardship and quality improvement interventions in NHs. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03520010.
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Affiliation(s)
- James H. Ford
- School of Pharmacy, University of Wisconsin, Madison
| | - Lillian Vranas
- School of Medicine and Public Health, University of Wisconsin, Madison
| | - DaRae Coughlin
- Center for Health Systems Research and Analysis, University of Wisconsin, Madison
| | - Kathi M. Selle
- School of Medicine and Public Health, University of Wisconsin, Madison
| | | | - Brenda Ryther
- Center for Health Systems Research and Analysis, University of Wisconsin, Madison
| | - Tola Ewers
- School of Medicine and Public Health, University of Wisconsin, Madison
| | - Victoria L. Griffin
- Wisconsin Department of Health Services, Division of Quality Assurance, Bureau of Education Services & Technology, Madison
| | | | - Joe Boero
- Wisconsin Healthcare-Associated Infections in Long-Term Care Coalition, Madison
| | | | - Christopher J. Crnich
- School of Medicine and Public Health, University of Wisconsin, Madison
- William S. Middleton Veterans Administration Hospital, Madison, Wisconsin
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Tran N, Poss JW, Perlman C, Hirdes JP. Case-Mix Classification for Mental Health Care in Community Settings: A Scoping Review. Health Serv Insights 2019; 12:1178632919862248. [PMID: 31427856 PMCID: PMC6683314 DOI: 10.1177/1178632919862248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
As mental health care transitions from facility-based care to community-based services, methods to classify patients in terms of their expected health care resource use are an essential tool to balance the health care needs and equitable allocation of health care resources. This study performed a scoping review to summarize the nature, extent, and range of research on case-mix classifications used to predict mental health care resource use in community settings. This study identified 17 eligible studies with 32 case-mix classification systems published since the 1980s. Most of these studies came from the USA Veterans Affairs and Medicare systems, and the most recent studies came from Australia. There were a wide variety of choices of input variables and measures of resource use. However, much of the variance in observed resource use was not accounted for by these case-mix systems. The research activity specific to case-mix classification for community mental health care was modest. More consideration should be given to the appropriateness of the input variables, resource use measure, and evaluation of predictive performance. Future research should take advantage of testing case-mix systems developed in other settings for community mental health care settings, if possible.
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Affiliation(s)
- Nam Tran
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Jeffrey W Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Christopher Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Fries BE, James ML, Martin L, Head MJ, Park PS. A Case-Mix System for Adults with Developmental Disabilities. Health Serv Insights 2019; 12:1178632919856011. [PMID: 31263374 PMCID: PMC6593926 DOI: 10.1177/1178632919856011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 11/17/2022] Open
Abstract
Effective management of publicly funded services matches the provision of needed services with cost-efficient payment methods. Payment systems that recognize differences in care needs (eg, case-mix systems) allow for greater proportions of available funds to be directed to providers supporting individuals with more needs. We describe a new way to allocate funds spent on adults with intellectual disabilities (ID) as part of a system-wide Medicaid payment reform initiative in Arkansas. Analyses were based on population-level data for persons living at home, collected using the interRAI ID assessment system, which were linked to paid service claims. We used automatic interactions detection to sort individuals into unique groups and provide a standardized relative measure of the cost of the services provided to each group. The final case-mix system has 33 distinct final groups and explains 26% of the variance in costs, which is similar to other systems in health and social services sectors. The results indicate that this system could be the foundation for a future case-mix approach to reimbursement and stand the test of “fairness” when examined by stakeholders, including parents, advocates, providers, and political entities.
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Affiliation(s)
- Brant E Fries
- Geriatrics Center, University of Michigan, Ann Arbor, MI, USA
| | - Mary L James
- Geriatrics Center, University of Michigan, Ann Arbor, MI, USA
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | | | - Pil S Park
- Geriatrics Center, University of Michigan, Ann Arbor, MI, USA
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Indigenous compared with non-Indigenous Australian patients at entry to specialist palliative care: Cross-sectional findings from a multi-jurisdictional dataset. PLoS One 2019; 14:e0215403. [PMID: 31048843 PMCID: PMC6497232 DOI: 10.1371/journal.pone.0215403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022] Open
Abstract
Background There are few quantitative studies on palliative care provision to Indigenous Australians, a population known to experience distinctive barriers to quality healthcare and to have poorer health outcomes than other Australians. Objectives To investigate equity of specialist palliative care service provision through characterising and comparing Indigenous and non-Indigenous patients at entry to care. Methods Using data (01/01/2010–30/06/2015) from all services participating in the multi-jurisdictional Palliative Care Outcomes Collaboration, Indigenous and non-Indigenous patients entering palliative care were compared on proportions vis-à-vis those expected from national statutory datasets, demographic characteristics, and entry-to-care status across fourteen ‘problem’ domains (e.g., pain, functional impairment) after matching by age, sex, and specific diagnosis. Results Of 140,267 patients, 1,465 (1.0%, much lower than expected from statutory data) were Indigenous, 133,987 (95.5%) non-Indigenous, and 4,905 (3.5%) had a missing identifier. The proportion of patients with a missing identifier diminished markedly over the study period, without a corresponding increase in the proportion identified as Indigenous. Indigenous compared with non-Indigenous patients were younger (mean 62.8 versus 73.0 years, p<0.001), a higher proportion were female (51.5% versus 46.3%; p<0.001) or resided outside major cities (44.2% versus 21.5%, p<0.001). Across all domains, Indigenous compared with matched non-Indigenous patients had lower or equal risk of status requiring prompt intervention. Conclusions Indigenous patients (especially those residing outside major cities) are substantially under-represented in care by services participating in the nationwide specialist palliative care Collaboration, likely reflecting widespread access barriers. However, the similarity of status indicators among Indigenous and non-Indigenous patients at entry to care suggests that Indigenous patients who are able to access these services do not disproportionately experience clinically important impediments to care initiation.
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Do-Not-Resuscitate and Do-Not-Hospitalize Orders in Nursing Homes: Who Gets Them and Do They Make a Difference? J Am Med Dir Assoc 2019; 20:1169-1174.e1. [PMID: 30975587 DOI: 10.1016/j.jamda.2019.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe the rate of do-not-resuscitate (DNR) and do-not-hospitalize (DNH) orders among residents newly admitted into long-term care homes. We also assessed the association between DNR and DNH orders with hospital admissions, deaths in hospital, and survival. DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Admissions in all 640 publicly funded long-term care homes in Ontario, Canada, between January 1, 2010 and March 1, 2012 (n = 49,390). MEASURES We examined if a DNR and/or DNH was recorded on resident's admission assessment. All residents were followed until death, discharge, or end of study to ascertain rates of several outcomes, including death and hospitalization, controlling for resident characteristics. RESULTS Upon admission, 60.7% of residents were recorded to have a DNR and 14.8% a DNH order. Those who were older, female, widowed, lived in rural facilities, lived in higher income neighborhoods prior to entry, had higher health instability or cognitive impairment, and spoke English or French were more likely to receive a DNR or DNH. Survival time was only slightly shorter for those with a DNR and DNH with a mean of 145 and 133 days, respectively, vs 160 and 153 days for those without a DNR and DNH. After controlling for age, sex, rurality, neighborhood income, marital status, health instability, cognitive performance score, and multimorbidity, DNR and DNH were associated with an odds ratio of 0.57 [95% confidence interval (CI) 0.53-0.62] and 0.41 (95% CI 0.37-0.46) for dying in hospital, respectively. Those with a DNR and DNH, after adjustment, had an incidence rate ratio of 0.87 (95% CI 0.83-0.90) and 0.70 (95% CI 0.67-0.73), respectively, days spent in hospital. CONCLUSIONS AND IMPLICATIONS This study outlines identifiable factors influencing whether residents have a DNR and/or DNH order upon admission. Both orders led to lower rates, but not absolute avoidance, of hospitalizations near and at death.
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Stewart SL, Poss JW, Thornley E, Hirdes JP. Resource Intensity for Children and Youth: The Development of an Algorithm to Identify High Service Users in Children's Mental Health. Health Serv Insights 2019; 12:1178632919827930. [PMID: 30828248 PMCID: PMC6390227 DOI: 10.1177/1178632919827930] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022] Open
Abstract
Children’s mental health care plays a vital role in many social, health care, and
education systems, but there is evidence that appropriate targeting strategies
are needed to allocate limited mental health care resources effectively. The aim
of this study was to develop and validate a methodology for identifying children
who require access to more intense facility-based or community resources.
Ontario data based on the interRAI Child and Youth Mental Health instruments
were analysed to identify predictors of service complexity in children’s mental
health. The Resource Intensity for Children and Youth (RIChY) algorithm was a
good predictor of service complexity in the derivation sample. The algorithm was
validated with additional data from 61 agencies. The RIChY algorithm provides a
psychometrically sound decision-support tool that may be used to inform the
choices related to allocation of children’s mental health resources and
prioritisation of clients needing community- and facility-based resources.
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Affiliation(s)
| | - Jeff W Poss
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
| | | | - John P Hirdes
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
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Turcotte LA, Poss J, Fries B, Hirdes JP. An Overview of International Staff Time Measurement Validation Studies of the RUG-III Case-mix System. Health Serv Insights 2019; 12:1178632919827926. [PMID: 30828247 PMCID: PMC6390217 DOI: 10.1177/1178632919827926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/13/2019] [Indexed: 11/17/2022] Open
Abstract
The RUG-III case-mix system is a method of grouping patients in long-term and post-acute care settings. RUG-III groups patients by relative per diem resource consumption and may be used as the basis for prospective payment systems to ensure that facility reimbursement is commensurate with patient acuity. Since RUG-III's development in 1994, more than a dozen international staff time measurement studies have been published to evaluate the utility of the case-mix system in a variety of diverse health care environments around the world. This overview of the literature summarizes the results of these RUG-III validation studies and compares the performance of the algorithm across countries, patient populations, and health care environments. Limitations of the RUG-III validation literature are discussed for the benefit of health system administrators who are considering implementing RUG-III and next-generation resource utilization group case-mix systems.
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Affiliation(s)
- Luke A Turcotte
- School of Public Health and Health
Systems, University of Waterloo, Waterloo, ON, Canada
| | - Jeff Poss
- School of Public Health and Health
Systems, University of Waterloo, Waterloo, ON, Canada
| | - Brant Fries
- Geriatrics Center, Department of
Internal Medicine and School of Public Health, University of Michigan, Ann Arbor,
MI, USA
| | - John P Hirdes
- School of Public Health and Health
Systems, University of Waterloo, Waterloo, ON, Canada
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Hosie A, Phillips J, Lam L, Kochovska S, Noble B, Brassil M, Kurrle SE, Cumming A, Caplan GA, Chye R, Le B, Ely EW, Lawlor PG, Bush SH, Davis JM, Lovell M, Brown L, Fazekas B, Cheah SL, Edwards L, Agar M. Multicomponent non-pharmacological intervention to prevent delirium for hospitalised people with advanced cancer: study protocol for a phase II cluster randomised controlled trial. BMJ Open 2019; 9:e026177. [PMID: 30696686 PMCID: PMC6352777 DOI: 10.1136/bmjopen-2018-026177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Delirium is a significant medical complication for hospitalised patients. Up to one-third of delirium episodes are preventable in older inpatients through non-pharmacological strategies that support essential human needs, such as physical and cognitive activity, sleep, hydration, vision and hearing. We hypothesised that a multicomponent intervention similarly may decrease delirium incidence, and/or its duration and severity, in inpatients with advanced cancer. Prior to a phase III trial, we aimed to determine if a multicomponent non-pharmacological delirium prevention intervention is feasible and acceptable for this specific inpatient group. METHODS AND ANALYSIS The study is a phase II cluster randomised wait-listed controlled trial involving inpatients with advanced cancer at four Australian palliative care inpatient units. Intervention sites will introduce delirium screening, diagnostic assessment and a multicomponent delirium prevention intervention with six domains of care: preserving natural sleep; maintaining optimal vision and hearing; optimising hydration; promoting communication, orientation and cognition; optimising mobility; and promoting family partnership. Interdisciplinary teams will tailor intervention delivery to each site and to patient need. Control sites will first introduce only delirium screening and diagnosis, later implementing the intervention, modified according to initial results. The primary outcome is adherence to the intervention during the first seven days of admission, measured for 40 consecutively admitted eligible patients. Secondary outcomes relate to fidelity and feasibility, acceptability and sustainability of the study intervention, processes and measures in this patient population, using quantitative and qualitative measures. Delirium incidence and severity will be measured to inform power calculations for a future phase III trial. ETHICS AND DISSEMINATION Ethical approval was obtained for all four sites. Trial results, qualitative substudy findings and implementation of the intervention will be submitted for publication in peer-reviewed journals, and reported at conferences, to study sites and key peak bodies. TRIAL REGISTRATION NUMBER ACTRN12617001070325; Pre-results.
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Affiliation(s)
- Annmarie Hosie
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Phillips
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lawrence Lam
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Slavica Kochovska
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Beverly Noble
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Meg Brassil
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Susan E Kurrle
- Hornsby Ku-ring-gai Health Service, Northern Clinical School, University of Sydney, Hornsby, New South Wales, Australia
| | - Anne Cumming
- Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia
| | - Gideon A Caplan
- Geriatric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Randwick, New South Wales, Australia
| | - Richard Chye
- Sacred Heart Health Service, St. Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Brian Le
- Palliative and Supportive Services, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center at Vanderbilt University, and the Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville TN USA, Nashville, Tennessee, USA
| | - Peter G Lawlor
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jan Maree Davis
- Palliative Care, Calvary Health Care Kogarah, Sydney, New South Wales, Australia
| | - Melanie Lovell
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
- Hornsby Ku-ring-gai Health Service, Northern Clinical School, University of Sydney, Hornsby, New South Wales, Australia
- HammondCare, Greenwich Hospital, Greenwich, New South Wales, Australia
| | - Linda Brown
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Belinda Fazekas
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Seong Leang Cheah
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Layla Edwards
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Meera Agar
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
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Potential quality indicators for seriously ill home care clients: a cross-sectional analysis using Resident Assessment Instrument for Home Care (RAI-HC) data for Ontario. BMC Palliat Care 2019; 18:3. [PMID: 30626374 PMCID: PMC6325754 DOI: 10.1186/s12904-018-0389-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Currently, there are no formalized measures for the quality of home based palliative care in Ontario. This study developed a set of potential quality indicators for seriously ill home care clients using a standardized assessment. Methods Secondary analysis of Resident Assessment Instrument for Home Care data for Ontario completed between 2006 and 2013 was used to develop quality indicators (QIs) thought to be relevant to the needs of older (65+) seriously ill clients. QIs were developed through a review of the literature and consultation with subject matter experts in palliative care. Serious illness was defined as a prognosis of less than 6 months to live or the presence of severe health instability. The rates of the QIs were stratified across Ontario’s geographic regions, and across four common life-limiting illnesses to observe variation. Results Within the sample, 14,312 clients were considered to be seriously ill and were more likely to experience negative health outcomes such as cognitive performance (OR = 2.77; 95% CI: 2.66–2.89) and pain (OR = 1.59; 95% CI: 1.53–1.64). Twenty subject matter experts were consulted and a list of seven QIs was developed. Indicators with the highest overall rates were prevalence of falls (50%) prevalence of daily pain (47%), and prevalence of caregiver distress (42%). The range in QI rates was largest across regions for prevalence of caregiver distress (21.5%), the prevalence of falls (16.6%), and the prevalence of social isolation (13.7%). Those with some form of dementia were most likely to have a caregiver that was distressed (52.6%) or to experience a fall (53.3%). Conclusion Home care clients in Ontario who are seriously ill are experiencing high rates of negative health outcomes, many of which are amenable to change. The RAI-HC can be a useful tool in identifying these clients in order to better understand their needs and abilities. These results contribute significantly to the process of creating and validating a standardized set of QIs that can be generated by organizations using the RAI-HC as part of normal clinical practice.
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Mills WL, Ying J, Kunik ME. Identifying potential long-stay residents in veterans health administration nursing homes. Geriatr Nurs 2019; 40:51-55. [DOI: 10.1016/j.gerinurse.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
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