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Jones KM, Krein SL, Mantey J, Harrod M, Mody L. Characterizing infection prevention programs and urinary tract infection prevention practices in nursing homes: A mixed-methods study. Infect Control Hosp Epidemiol 2024; 45:40-47. [PMID: 37589094 PMCID: PMC10782201 DOI: 10.1017/ice.2023.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE US policies require robust nursing home (NH) infection prevention and control (IPC) programs to ensure safe care. We assessed IPC resources and practices related to catheter and non-catheter-associated urinary tract infection (CAUTI and UTI) prevention among NHs. METHODS We conducted a mixed-methods study from April 2018 through November 2019. Quantitative surveys assessed NH IPC program resources, practices, and communication during resident transfer. Semistructured qualitative interviews focused on IPC programs, CAUTI and UTI prevention practices, and resident transfer processes. Using a matrix as an analytic tool, findings from the quantitative survey data were combined with the qualitative data in the form of a joint display. RESULTS Representatives from 51 NHs completed surveys; interviews were conducted with 13 participants from 7 NHs. Infection preventionists (IPs) had limited experience and/or additional roles, and in 36.7% of NHs, IPs had no specific IPC training. IP turnover was often mentioned during interviews. Most facilities were aware of their CAUTI and UTI rates and reported using prevention practices, such as hydration (85.7%) or nurse-initiated catheter discontinuation (65.3%). Qualitative interviewees confirmed use of these practices and expressed additional concerns about overuse of urine testing and antibiotics. Although transfer sheets were used by 84% to communicate about infections, the information received was described as suboptimal. CONCLUSIONS NHs identified IP challenges related to turnover, limited education, and serving multiple roles. However, most NHs reported awareness of their CAUTI and UTI rates as well as their use of prevention practices. Importantly, we identified opportunities to enhance communication between NHs and hospitals to improve resident care and safety.
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Affiliation(s)
- Karen M. Jones
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sarah L. Krein
- Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julia Mantey
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Molly Harrod
- Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Geriatrics Research Education and Clinical Center (GRECC), Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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Winqvist I, Näppä U, Rönning H, Häggström M. Reducing risks in complex care transitions in rural areas: a grounded theory. Int J Qual Stud Health Well-being 2023; 18:2185964. [PMID: 36866630 PMCID: PMC9987724 DOI: 10.1080/17482631.2023.2185964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
PURPOSE Although previous research indicates that care transitions differ between rural and urban areas, the knowledge of challenges related to care transitions in rural areas appears limited. This study aimed to provide a deeper understanding of what registered nurses' perceive as the main concerns in care transitions from hospital care to home healthcare in rural areas, and how they handle these during the care transition process. METHODS A Constructivist Grounded Theory method based on individual interviews with 21 registered nurses. RESULTS The main concern in the transition process was "Care coordination in a complex context". The complexity stemmed from several environmental and organizational factors, creating a messy and fragmented context for registered nurses to navigate. The core category "Actively communicating to reduce patient safety risks" was explained by the three categories- "Collaborating on expected care needs", "Anticipating obstacles" and "Timing the departure". CONCLUSIONS The study shows a very complex and stressed process that includes several organizations and actors. Reducing risks during the transition process can be facilitated by clear guidelines, tools for communication across organizations and sufficient staffing.
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Affiliation(s)
- Idun Winqvist
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
| | - Ulla Näppä
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
| | - Helén Rönning
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
| | - Marie Häggström
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
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Thevathasan T, Paul J, Gaul AL, Degbeon S, Füreder L, Dischl D, Knie W, Girke G, Wurster T, Landmesser U, Skurk C. Mortality and healthcare resource utilisation after cardiac arrest in the United States - A 10-year nationwide analysis prior to the COVID-19 pandemic. Resuscitation 2023; 193:109946. [PMID: 37634860 DOI: 10.1016/j.resuscitation.2023.109946] [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: 05/26/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
AIM Understanding the public health burden of cardiac arrest (CA) is important to inform healthcare policies, particularly during healthcare crises such as the COVID-19 pandemic. This study aimed to analyse outcomes of in-hospital mortality and healthcare resource utilisation in adult patients with CA in the United States over the last decade prior to the COVID-19 pandemic. METHODS The United States (US) National Inpatient Sample was utilised to identify hospitalised adult patients with CA between 2010 and 2019. Logistic and Poisson regression models were used to analyse outcomes by adjusting for 47 confounders. RESULTS 248,754 adult patients with CA (without "Do Not Resuscitate"-orders) were included in this study, out of which 57.5% were male. In-hospital mortality was high with 51.2% but improved significantly from 58.3% in 2010 to 46.4% in 2019 (P < 0.001). Particularly, elderly patients, non-white patients and patients requiring complex therapy had a higher mortality rate. Although the average hospital LOS decreased by 11%, hospital expenses have increased by 13% between 2010 and 2019 (each P < 0.001), presumably due to more frequent use of mechanical circulatory support (MCS, e.g. ECMO from 2.6% to 8.7% or Impella® micro-axial flow pump from 1.8% to 14.2%). Strong disparities existed among patient age groups and ethnicities across the US. Of note, the number of young adults with CA and opioid-induced CA has almost doubled within the study period. CONCLUSION Over the last ten years prior to the COVID-19 pandemic, CA-related survival has incrementally improved with shorter hospitalisations and increased medical expenses, while strong disparities existed among different age groups and ethnicities. National standards for CA surveillance should be considered to identify trends and differences in CA treatment to allow for standardised medical care.
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Affiliation(s)
- Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany; Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Julia Paul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Anna L Gaul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Sêhnou Degbeon
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Lisa Füreder
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Dominic Dischl
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wulf Knie
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Georg Girke
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Thomas Wurster
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany.
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Kuye IO, Dalal S, Eid S, Gundareddy V. Hospitalists Improving Transitions of Care Through Virtual Collaborative Rounding with Skilled Nursing Facilities-the HiToC SNF Study. J Gen Intern Med 2023; 38:3628-3632. [PMID: 37783978 PMCID: PMC10713912 DOI: 10.1007/s11606-023-08345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/20/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Over one in five Medicare patients discharged to skilled nursing facilities (SNFs) are re-hospitalized within 30 days of discharge. Poor communication between the hospital and SNF upon hospital discharge is frequently cited as the most common cause of readmission. AIM The goal of this program was to assess the ability of a weekly post-discharge hospitalist led virtual rounding program to augment the written discharge summary sent to SNFs. SETTING Two academic hospitals and six SNFs in Baltimore, MD. PARTICIPANTS Hospitalists and medical directors or directors of nursing from the partner SNF. PROGRAM DESCRIPTION During weekly encounters, the hospitalist and SNF providers discussed the clinical status, discharge medications, treatment plan, and follow-up care of all discharged patients. The intervention took place from July 2021 to December 2021. PROGRAM EVALUATION During the study, 544 patients were discussed in a post-discharge virtual encounter. After the discussions, hospitalists identified clinically significant errors in 124 discharge summaries. A survey of participating hospitalists and SNF medical and nursing leadership indicated the intervention was thought to improve care transitions. DISCUSSION Our innovation was successful in identifying errors in discharge summaries and was thought to improve the transition of care by participating SNF and hospitalist providers.
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Affiliation(s)
- Ifedayo O Kuye
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sonia Dalal
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaker Eid
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Venkat Gundareddy
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Baluyot A, McNeill C, Wiers S. Improving Communication From Hospital to Skilled Nursing Facility Through Standardized Hand-Off: A Quality Improvement Project. PATIENT SAFETY 2022. [DOI: 10.33940/med/2022.12.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Inadequate hand-off communication from hospital to skilled nursing facility (SNF) hinders SNF nurses’ ability to prepare for specific patient needs, including prescriptions for critical medications, such as controlled medications and intravenous (IV) antibiotics, resulting in delayed medication administration. This project aims to improve hand-off communication from hospital to SNF by utilizing a standardized hand-off tool. This project was conducted in an inpatient, 50-bed, post-hospital skilled nursing care unit of a local SNF. The participants included all 32 staff nurses employed by the SNF.
Methods: Lewin’s change management theory (CMT) guided this quality improvement (QI) project. Baseline assessment included a one-month chart review of 76 patient charts that was conducted to assess the disparities related to ineffective hand-off and medication delays in the SNF before intervention. The wait time for the availability of prescriptions for controlled medications and IV antibiotics, and delays in medication administration were assessed.
Intervention: Multiple randomly selected hospital-to-SNF hand-offs were observed. Semistructured interviews with all staff nurses were conducted using open-ended questions about hand-off structure and process matters. Data gathered from observation and interviews were used to create the standardized hand-off tool used in this project. In-service training on hand-off tool utilization for SNF nurses was conducted. Champions for each shift were cultivated to assist with project implementation.
Results: After six weeks of implementation, a chart review of 101 patient charts was conducted to evaluate the effects of the hand-off tool on the wait time on the availability of prescriptions for controlled medications and IV antibiotics, and medication administration. The wait time of prescriptions availability during the hospital-to-SNF transition was decreased by 79% for controlled medications, with an associated 52.9% reduction in late administration, and decreased by 94% for IV antibiotics, with a 77.8% reduction in late administration.
Conclusion: The use of standardized hand-off resulted in improved communication during the hospital-to-SNF hand-off and significantly decreased the wait time for the availability of prescriptions for controlled medications and IV antibiotics. Integrating standardized hand-off into the SNF policies can help sustain improved communication, medication management, and patient transition from hospital to SNF.
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UWO x PCC Group C, Strickland C, Chi N, Ditz L, Gomez L, Wagner B, Wang S, Lizotte D. Factors Influencing Admission Decisions in Skilled Nursing Facilities: A Retrospective Quantitative Study (Preprint). J Med Internet Res 2022; 25:e43518. [PMID: 37195755 DOI: 10.2196/43518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Occupancy rates within skilled nursing facilities (SNFs) in the United States have reached a record low. Understanding drivers of occupancy, including admission decisions, is critical for assessing the recovery of the long-term care sector as a whole. We provide the first comprehensive analysis of financial, clinical, and operational factors that impact whether a patient referral to an SNF is accepted or denied, using a large health informatics database. OBJECTIVE Our key objectives were to describe the distribution of referrals sent to SNFs in terms of key referral- and facility-level features; analyze key financial, clinical, and operational variables and their relationship to admission decisions; and identify the key potential reasons behind referral decisions in the context of learning health systems. METHODS We extracted and cleaned referral data from 627 SNFs from January 2020 to March 2022, including information on SNF daily operations (occupancy and nursing hours), referral-level factors (insurance type and primary diagnosis), and facility-level factors (overall 5-star rating and urban versus rural status). We computed descriptive statistics and applied regression modeling to identify and describe the relationships between these factors and referral decisions, considering them individually and controlling for other factors to understand their impact on the decision-making process. RESULTS When analyzing daily operation values, no significant relationship between SNF occupancy or nursing hours and referral acceptance was observed (P>.05). By analyzing referral-level factors, we found that the primary diagnosis category and insurance type of the patient were significantly related to referral acceptance (P<.05). Referrals with primary diagnoses within the category "Diseases of the Musculoskeletal System" are least often denied whereas those with diagnoses within the "Mental Illness" category are most often denied (compared with other diagnosis categories). Furthermore, private insurance holders are least often denied whereas "medicaid" holders are most often denied (compared with other insurance types). When analyzing facility-level factors, we found that the overall 5-star rating and urban versus rural status of an SNF are significantly related to referral acceptance (P<.05). We found a positive but nonmonotonic relationship between the 5-star rating and referral acceptance rates, with the highest acceptance rates found among 5-star facilities. In addition, we found that SNFs in urban areas have lower acceptance rates than their rural counterparts. CONCLUSIONS While many factors may influence a referral acceptance, care challenges associated with individual diagnoses and financial challenges associated with different remuneration types were found to be the strongest drivers. Understanding these drivers is essential in being more intentional in the process of accepting or denying referrals. We have interpreted our results using an adaptive leadership framework and suggested how SNFs can be more purposeful with their decisions while striving to achieve appropriate occupancy levels in ways that meet their goals and patients' needs.
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Casanova NL, LeClair AM, Xiao V, Mullikin KR, Lemon SC, Freund KM, Haas JS, Freedman RA, Battaglia TA. Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology. Cancer 2022; 128 Suppl 13:2649-2658. [PMID: 35699611 PMCID: PMC9201987 DOI: 10.1002/cncr.33944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Implementing city-wide patient navigation processes that support patients across the continuum of cancer care is impeded by a lack of standardized tools to integrate workflows and reduce gaps in care. The authors present an actionable workflow process mapping protocol for navigation process planning and improvement based on methods developed for the Translating Research Into Practice study. METHODS Key stakeholders at each study site were identified through existing community partnerships, and data on each site's navigation processes were collected using mixed methods through a series of team meetings. The authors used Health Quality Ontario's Quality Improvement Guide, service design principles, and key stakeholder input to map the collected data onto a template structured according to the case-management model. RESULTS Data collection and process mapping exercises resulted in a 10-step protocol that includes: 1) workflow mapping procedures to guide data collection on the series of activities performed by health care personnel that comprise a patient's navigation experience, 2) a site survey to assess program characteristics, 3) a semistructured interview guide to assess care coordination workflows, 4) a site-level swim lane workflow process mapping template, and 5) a regional high-level process mapping template to aggregate data from multiple site-level process maps. CONCLUSIONS This iterative, participatory approach to data collection and process mapping can be used by improvement teams to streamline care coordination, ultimately improving the design and delivery of an evidence-based navigation model that spans multiple treatment modalities and multiple health systems in a metropolitan area. This protocol is presented as an actionable toolkit so the work may be replicated to support other quality-improvement initiatives and efforts to design truly patient-centered breast cancer treatment experiences. LAY SUMMARY Evidence-based patient navigation in breast cancer care requires the integration of services through each phase of cancer treatment. The Translating Research Into Practice study aims to implement patient navigation for patients with breast cancer who are at risk for delays and are seeking care across 6 health systems in Boston, Massachusetts. The authors designed a 10-step protocol outlining procedures and tools that support a systematic assessment for health systems that want to implement breast cancer patient navigation services for patients who are at risk for treatment delays.
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Affiliation(s)
- Nicole L Casanova
- University of Washington School of Public Health, 1959 NE Pacific St., Seattle, WA, United States of America
| | - Amy M LeClair
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center,800 Washington Street., Boston, MA, United States of America
| | - Victoria Xiao
- Boston Medical Center, 801 Massachusetts Ave., Boston, MA, United States of America
| | - Katelyn R Mullikin
- Boston Medical Center, 801 Massachusetts Ave., Boston, MA, United States of America
| | - Stephenie C Lemon
- University of Massachusetts Medical School, 368 Plantation St., Worcester MA, United States of America
| | - Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center,800 Washington Street., Boston, MA, United States of America
| | - Jennifer S Haas
- Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, United States of America
| | - Rachel A Freedman
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, United States of America
| | - Tracy A Battaglia
- Boston Medical Center, 801 Massachusetts Ave., Boston, MA, United States of America,Boston University School of Medicine, 801 Massachusetts Ave., Boston, MA, United States of America
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30-Day Readmission Reduction in a Skilled Facility Population Through Pharmacist-Driven Medication Reconciliation. J Healthc Qual 2022; 44:152-160. [PMID: 35506711 DOI: 10.1097/jhq.0000000000000313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transitions of care can be difficult to manage and if not performed properly, can lead to increased readmissions and poor outcomes. Transitions are more complex when patients are discharged to skilled nursing facilities. PURPOSE We assessed the impact of pharmacist-led initiatives, including medication reconciliation, on readmission rates between an academic medical center and a local skilled nursing facility (SNF). METHODS We conducted a two-phase quality improvement project focusing on pharmacist-led medication reconciliation at different points in the transition process. All-cause 30-day readmission rates, medication reconciliation completion rates, and total pharmacist interventions were compared between the 2 groups. RESULTS The combined intervention and baseline cohorts resulted in a 29.8% relative reduction (14.5% vs. 20.6%) in readmission rates. Medication reconciliation was completed on 93.8% of SNF admitted patients in the first phase and 97.7% of patients in the second phase. Pharmacist interventions per reconciliation were 2.39 in the first phase compared with 1.82 in the second phase. CONCLUSION Pharmacist-led medication reconciliation can contribute to reduction of hospital readmissions from SNFs and is an essential part of the SNF transition process.
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Written discharge communication of diagnostic and decision-making information for persons living with dementia during hospital to skilled nursing facility transitions. Geriatr Nurs 2022; 45:215-222. [PMID: 35569425 PMCID: PMC9327092 DOI: 10.1016/j.gerinurse.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/26/2023]
Abstract
Hospital-to-skilled nursing facility (SNF) transitions constitute a vulnerable point in care for people with dementia and often precede important care decisions. These decisions necessitate accurate diagnostic/decision-making information, including dementia diagnosis, power of attorney for health care (POAHC), and code status; however, inter-setting communication during hospital-to-SNF transitions is suboptimal. This retrospective cohort study examined omissions of diagnostic/decision-making information in written discharge communication during hospital-to-SNF transitions. Omission rates were 22% for dementia diagnosis, 82% and 88% for POAHC and POAHC activation respectively, and 70% for code status. Findings highlight the need to clarify and intervene upon causes of hospital-to-SNF communication gaps.
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de Boer B, Caljouw M, Landeweer E, Perry M, Stoop A, Groen W, Schols J, Verbeek H. The Need to Consider Relocations WITHIN Long-Term Care. J Am Med Dir Assoc 2021; 23:318-320. [PMID: 34932987 DOI: 10.1016/j.jamda.2021.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Bram de Boer
- The Living Lab in Aging and Long-Term Care, Maastricht University, Maastricht, the Netherlands
| | - Monique Caljouw
- The University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Elleke Landeweer
- The University Network of Elderly Care-UMCG, University of Groningen, Groningen, the Netherlands
| | - Marieke Perry
- The University Knowledge Network for Older People-Nijmegen, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Annerieke Stoop
- The Academic Collaborative Centre Older Adults-Tranzo, Tilburg University, Tilburg, the Netherlands
| | - Wim Groen
- The University Network for Organizations of Elderly Care-Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jos Schols
- The Living Lab in Aging and Long-Term Care, Maastricht University, Maastricht, the Netherlands
| | - Hilde Verbeek
- The Living Lab in Aging and Long-Term Care, Maastricht University, Maastricht, the Netherlands
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Camicia ME, Ann Laslo M, Lutz BJ. Implementing a Caregiver Assessment and Tailored Plan: An Emerging Case Management Competency. Prof Case Manag 2021; 26:205-213. [PMID: 34021107 DOI: 10.1097/ncm.0000000000000513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michelle E Camicia
- Michelle E. Camicia, PhD, RN, CRRN, CCM, NEA-BC, FARN, FAHA, FAAN , is the Director of Operations for Kaiser Foundation Rehabilitation Center. She is an international leader in rehabilitation and nursing, with expertise in care transitions for individuals with chronic and disabling conditions. Dr. Camicia received her PhD from the Betty Irene Moore School of Nursing at the University of California Davis. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers
- Mary Ann Laslo, MSN, RN, CRRN, CCM, CNL, has expertise in care transitions for individuals with chronic and disabling conditions. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers. She is a Clinical Practice Consultant at the Kaiser Foundation Rehabilitation Center in Vallejo, California. She has extensive experience in rehabilitation nursing, case management, and quality, including extensive managerial, organizational, and education/program development capabilities in acute and postacute rehabilitation
- Barbara J. Lutz, PhD, RN, CRRN, PHNA-BC, FAHA, FAAN, is the McNeill Distinguished Professor at the University of North Carolina-Wilmington School of Nursing. Her research focuses on understanding the needs and experiences of patients with chronic disabling illnesses and their family caregivers as they move through the continuum of care, from acute care to home
| | - Mary Ann Laslo
- Michelle E. Camicia, PhD, RN, CRRN, CCM, NEA-BC, FARN, FAHA, FAAN , is the Director of Operations for Kaiser Foundation Rehabilitation Center. She is an international leader in rehabilitation and nursing, with expertise in care transitions for individuals with chronic and disabling conditions. Dr. Camicia received her PhD from the Betty Irene Moore School of Nursing at the University of California Davis. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers
- Mary Ann Laslo, MSN, RN, CRRN, CCM, CNL, has expertise in care transitions for individuals with chronic and disabling conditions. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers. She is a Clinical Practice Consultant at the Kaiser Foundation Rehabilitation Center in Vallejo, California. She has extensive experience in rehabilitation nursing, case management, and quality, including extensive managerial, organizational, and education/program development capabilities in acute and postacute rehabilitation
- Barbara J. Lutz, PhD, RN, CRRN, PHNA-BC, FAHA, FAAN, is the McNeill Distinguished Professor at the University of North Carolina-Wilmington School of Nursing. Her research focuses on understanding the needs and experiences of patients with chronic disabling illnesses and their family caregivers as they move through the continuum of care, from acute care to home
| | - Barbara J Lutz
- Michelle E. Camicia, PhD, RN, CRRN, CCM, NEA-BC, FARN, FAHA, FAAN , is the Director of Operations for Kaiser Foundation Rehabilitation Center. She is an international leader in rehabilitation and nursing, with expertise in care transitions for individuals with chronic and disabling conditions. Dr. Camicia received her PhD from the Betty Irene Moore School of Nursing at the University of California Davis. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers
- Mary Ann Laslo, MSN, RN, CRRN, CCM, CNL, has expertise in care transitions for individuals with chronic and disabling conditions. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers. She is a Clinical Practice Consultant at the Kaiser Foundation Rehabilitation Center in Vallejo, California. She has extensive experience in rehabilitation nursing, case management, and quality, including extensive managerial, organizational, and education/program development capabilities in acute and postacute rehabilitation
- Barbara J. Lutz, PhD, RN, CRRN, PHNA-BC, FAHA, FAAN, is the McNeill Distinguished Professor at the University of North Carolina-Wilmington School of Nursing. Her research focuses on understanding the needs and experiences of patients with chronic disabling illnesses and their family caregivers as they move through the continuum of care, from acute care to home
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Takahashi PY, Chandra A, McCoy RG, Borkenhagen LS, Larson ME, Thorsteinsdottir B, Hickman JA, Swanson KM, Hanson GJ, Naessens JM. Outcomes of a Nursing Home-to-Community Care Transition Program. J Am Med Dir Assoc 2021; 22:2440-2446.e2. [PMID: 33984293 DOI: 10.1016/j.jamda.2021.04.010] [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: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Most transitional care initiatives to reduce rehospitalization have focused on the transition that occurs between a patient's hospital discharge and return home. However, many patients are discharged from a skilled nursing facility (SNF) to their homes. The goal was to evaluate the effectiveness of the Mayo Clinic Care Transitions (MCCT) program (hereafter called program) among patients discharged from SNFs to their homes. DESIGN Propensity-matched control-intervention trial. INTERVENTION Patients in the intervention group received care management following nursing stay (a home visit and nursing phone calls). SETTING AND PARTICIPANTS Patients enrolled after discharge from an SNF to home were matched to patients who did not receive intervention because of refusal, program capacity, or distance. Patients were aged ≥60 years, at high risk for hospitalization, and discharged from an SNF. METHODS Program enrollees were matched through propensity score to nonenrollees on the basis of age, sex, comorbid health burden, and mortality risk score. Conditional logistic regression analysis examined 30-day hospitalization and emergency department (ED) use; Cox proportional hazards analyses examined 180-day hospital stay and ED use. RESULTS Each group comprised 160 patients [mean (standard deviation) age, 85.4 (7.4) years]. Thirty-day hospitalization and ED rates were 4.4% and 10.0% in the program group and 3.8% and 10.0% in the group with usual care (P = .76 for hospitalization; P > .99 for ED). At 180 days, hospitalization and ED rates were 30.6% and 46.3% for program patients compared with 11.3% and 25.0% in the comparison group (P < .001). CONCLUSIONS AND IMPLICATIONS We found no evidence of reduced hospitalization or ED visits by program patients vs the comparison group. Such findings are crucial because they illustrate how aggressive stabilization care within the SNF may mitigate the program role. Furthermore, we found higher ED and hospitalization rates at 180 days in program patients than the comparison group.
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Affiliation(s)
- Paul Y Takahashi
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA.
| | - Anupam Chandra
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA
| | - Rozalina G McCoy
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Lynn S Borkenhagen
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mary E Larson
- Employee and Community Health, Mayo Clinic, Rochester, MN, USA
| | | | - Joel A Hickman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kristi M Swanson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Gregory J Hanson
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA; Division of Community Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - James M Naessens
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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Muhlestein WE, Monsour MA, Friedman GN, Zinzuwadia A, Zachariah MA, Coumans JV, Carter BS, Chambless LB. Predicting Discharge Disposition Following Meningioma Resection Using a Multi-Institutional Natural Language Processing Model. Neurosurgery 2021; 88:838-845. [PMID: 33483747 DOI: 10.1093/neuros/nyaa585] [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: 03/03/2020] [Accepted: 10/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Machine learning (ML)-based predictive models are increasingly common in neurosurgery, but typically require large databases of discrete variables for training. Natural language processing (NLP) can extract meaningful data from unstructured text. OBJECTIVE To present an NLP model that predicts nonhome discharge and a point-of-care implementation. METHODS We retrospectively collected age, preoperative notes, and radiology reports from 595 adults who underwent meningioma resection in an academic center from 1995 to 2015. A total of 32 algorithms were trained with the data; the 3 best performing algorithms were combined to form an ensemble. Predictive ability, assessed by area under the receiver operating characteristic curve (AUC) and calibration, was compared to a previously published model utilizing 52 neurosurgeon-selected variables. We then built a multi-institutional model by incorporating notes from 693 patients at another center into algorithm training. Permutation importance was used to analyze the relative importance of each input to model performance. Word clouds and non-negative matrix factorization were used to analyze predictive features of text. RESULTS The single-institution NLP model predicted nonhome discharge with AUC of 0.80 (95% CI = 0.74-0.86) on internal and 0.76 on holdout validation compared to AUC of 0.77 (95% CI = 0.73-0.81) and 0.74 for the 52-variable ensemble. The multi-institutional model performed similarly well with AUC = 0.78 (95% CI = 0.74-0.81) on internal and 0.76 on holdout validation. Preoperative notes most influenced predictions. The model is available at http://nlp-home.insds.org. CONCLUSION ML and NLP are underutilized in neurosurgery. Here, we construct a multi-institutional NLP model that predicts nonhome discharge.
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Affiliation(s)
- Whitney E Muhlestein
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Gabriel N Friedman
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Marcus A Zachariah
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jean-Valery Coumans
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bob S Carter
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Antonacci G, Lennox L, Barlow J, Evans L, Reed J. Process mapping in healthcare: a systematic review. BMC Health Serv Res 2021; 21:342. [PMID: 33853610 PMCID: PMC8048073 DOI: 10.1186/s12913-021-06254-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/08/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. METHODS We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC-Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. RESULTS The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. CONCLUSION The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. TRIAL REGISTRATION Prospero ID: CRD42017082140.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
| | - James Barlow
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Liz Evans
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
| | - Julie Reed
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
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Keeney T. Physical Therapy in the COVID-19 Pandemic: Forging a Paradigm Shift for Rehabilitation in Acute Care. Phys Ther 2020; 100:1265-1267. [PMID: 32453426 PMCID: PMC7313845 DOI: 10.1093/ptj/pzaa097] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Tamra Keeney
- Brown University School of Public Health, Center for Gerontology and Health Care Research, Box G-S121–4, Providence, RI 02912; Massachusetts General Hospital, Department of Physical Therapy Services, 15 Parkman Street, Boston, MA 02114,Address all correspondence to Dr Keeney at:
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