1
|
Ryskina KL, Liang J, Ritter AZ, Spetz J, Barnes H. State scope of practice restrictions and nurse practitioner practice in nursing homes: 2012-2019. Health Aff Sch 2024; 2:qxae018. [PMID: 38426081 PMCID: PMC10901290 DOI: 10.1093/haschl/qxae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/26/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, and health care workforce characteristics; state fixed effects; and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least 1 NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.
Collapse
Affiliation(s)
- Kira L Ryskina
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Junning Liang
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ashley Z Ritter
- NewCourtland, Philadelphia, PA 19119, United States
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Joanne Spetz
- School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158, United States
| | - Hilary Barnes
- Widener University School of Nursing, Chester, PA 19013, United States
| |
Collapse
|
2
|
Golos AM, Buttenheim AM, Ritter AZ, Bair EF, Chapman GB. Effects Of An Employee COVID-19 Vaccination Mandate At A Long-Term Care Network. Health Aff (Millwood) 2023; 42:1140-1146. [PMID: 37549332 DOI: 10.1377/hlthaff.2022.01596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
We assessed COVID-19 vaccination and employment status among employees of a long-term care network that announced an employee vaccination mandate on July 29, 2021. The day before the announcement, 1,208 employees were unvaccinated; of these workers, 56.2 percent subsequently were vaccinated, whereas 20.9 percent (3.7 percent of active employees) were terminated because of noncompliance with the mandate.
Collapse
Affiliation(s)
- Aleksandra M Golos
- Aleksandra M. Golos , University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Gretchen B Chapman
- Gretchen B. Chapman, Carnegie Mellon University, Pittsburgh, Pennsylvania
| |
Collapse
|
3
|
Ritter AZ, Kosar CM, White EM, Feifer RA, Blackman C, Mor V. Incidence and Outcomes of SARS-CoV-2 in Post-Acute Skilled Nursing Facility Care. J Am Med Dir Assoc 2022; 23:1269-1273. [PMID: 35718000 PMCID: PMC9124921 DOI: 10.1016/j.jamda.2022.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine the risk of contracting SARS-CoV-2 during a post-acute skilled nursing facility (SNF) stay and the associated risk of death. DESIGN Cohort study using Minimum Data Set and electronic health record data from a large multistate long-term care provider. Primary outcomes included testing positive for SARS-CoV-2 during the post-acute SNF stay, and death among those who tested positive. SETTING AND PARTICIPANTS The sample included all new admissions to the provider's 286 SNFs between January 1 and December 31, 2020. Patients known to be infected with SARS-CoV-2 at the time of admission were excluded. METHODS SARS-CoV-2 infection and mortality rates were measured in time intervals by month of admission. A parametric survival model with SNF random effects was used to measure the association of patient demographic factors, clinical characteristics, and month of admission, with testing positive for SARS-CoV-2. RESULTS The sample included 45,094 post-acute SNF admissions. Overall, 5.7% of patients tested positive for SARS-CoV-2 within 100 days of admission, with 1.0% testing positive within 1-14 days, 1.4% within 15-30 days, and 3.4% within 31-100 days. Of all newly admitted patients, 0.8% contracted SARS-CoV-2 and died, whereas 6.7% died without known infection. Infection rates and subsequent risk of death were highest for patients admitted during the first and third US pandemic waves. Patients with greater cognitive and functional impairment had a 1.45 to 1.92 times higher risk of contracting SARS-CoV-2 than patients with less impairment. CONCLUSIONS AND IMPLICATIONS The absolute risk of SARS-CoV-2 infection and death during a post-acute SNF admission was 0.8%. Those who did contract SARS-CoV-2 during their SNF stay had nearly double the rate of death as those who were not infected. Findings from this study provide context for people requiring post-acute care, and their support systems, in navigating decisions around SNF admission during the SARS-CoV-2 pandemic.
Collapse
Affiliation(s)
- Ashley Z Ritter
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Cyrus M Kosar
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Elizabeth M White
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | | | | | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
4
|
Ritter AZ, Freed S, Coe NB. Younger Individuals Increase Their Use of Nursing Homes Following ACA Medicaid Expansion. J Am Med Dir Assoc 2022; 23:852-857.e5. [PMID: 34555342 PMCID: PMC11027188 DOI: 10.1016/j.jamda.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study examines the effect of Medicaid eligibility expansion under the Affordable Care Act (ACA) on the utilization of nursing home services by younger individuals and those covered by Medicaid. DESIGN Compared the age of nursing home residents, proportion of individuals covered by Medicaid, annual nursing home admissions in those younger than 65, and nursing home length of stay in states that expanded Medicaid eligibility through the ACA to states that did not. We used data from LTCFocus (nursing home level), the Minimum Data Set (individual level), and Medicaid expansion status from the Kaiser Family Foundation. SETTING AND PARTICIPANTS The study included 15,005,888 nursing home admissions, 2,446,950 of which were residents younger than 65, across 14,132 nursing homes between 2009 and 2016. METHODS A time-varying difference-in-difference model including state and year fixed effects with effect modification by pre-2014 nursing home occupancy. RESULTS Facilities in expansion states with a pre-ACA occupancy rate of more than 70% increased the fraction of residents younger than 65 by 2.74% to 6.32%, compared with similar facilities in nonexpansion states. Medicaid admissions varied, with an increase in year 2 after expansion compared with nonexpansion states. Among residents entering from an acute care hospital, the proportion younger than 65 increased in facilities with pre-2014 occupancy rates of more than 70%, compared with similar facilities in nonexpansion states, an increase of up to 6.51%. Median nursing home length of stay for individuals younger than 65 decreased relative to nonexpansion states across all occupancy categories, ranging from 1.68 to 6.06 days after Medicaid expansion. CONCLUSIONS AND IMPLICATIONS Medicaid expansion increased access to nursing home post-acute care for individuals younger than 65. It remains unclear if the benefit of post-acute care is the same among this group, or if the needs of younger individuals can be adequately met in this setting.
Collapse
Affiliation(s)
- Ashley Z Ritter
- National Clinician Scholar Program, University of Pennsylvania, Philadelphia, PA, USA; Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA.
| | - Salama Freed
- Duke Margolis Center for Health Policy, Washington, DC, USA; National Pharmaceutical Council, Washington, DC, USA
| | - Norma B Coe
- University of Pennsylvania Department of Medical Ethics and Health Policy, Philadelphia, PA, USA
| |
Collapse
|
5
|
Albrecht SS, Aronowitz SV, Buttenheim AM, Coles S, Dowd JB, Hale L, Kumar A, Leininger L, Ritter AZ, Simanek AM, Whelan CB, Jones M. Lessons Learned From Dear Pandemic, a Social Media-Based Science Communication Project Targeting the COVID-19 Infodemic. Public Health Rep 2022; 137:449-456. [PMID: 35238241 PMCID: PMC9066238 DOI: 10.1177/00333549221076544] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The World Health Organization has identified excessive COVID-19 pandemic-related information as a public health crisis, calling it an "infodemic." Social media allows misinformation to spread quickly and outcompete scientifically grounded information delivered via other methods. Dear Pandemic is an innovative, multidisciplinary, social media-based science communication project whose mission is to educate and empower individuals to successfully navigate the overwhelming amount of information circulating during the pandemic. This mission has 2 primary objectives: (1) to disseminate trustworthy, comprehensive, and timely scientific content about the pandemic to lay audiences via social media and (2) to promote media literacy and information-hygiene practices, equipping readers to better manage the COVID-19 infodemic within their own networks. The volunteer team of scientists publishes 8-16 posts per week on pandemic-relevant topics. Nearly 2 years after it launched in March 2020, the project has a combined monthly reach of more than 4 million unique views across 4 social media channels, an email newsletter, and a website. We describe the project's guiding principles, lessons learned, challenges, and opportunities. Dear Pandemic has emerged as an example of a promising new paradigm for public health communication and intervention. The contributors deliver content in ways that are personal, practical, actionable, responsive, and native to social media platforms. The project's guiding principles are a model for public health communication targeting future infodemics and can bridge the chasm between the scientific community and the practical daily decision-making needs of the general public.
Collapse
Affiliation(s)
- Sandra S. Albrecht
- Department of Epidemiology, Mailman
School of Public Health at Columbia University, New York, NY, USA,Sandra S. Albrecht, PhD, MPH, Columbia
University Mailman School of Public Health, Department of Epidemiology, 722 West
168th St, New York, NY 10032, USA.
| | - Shoshana V. Aronowitz
- Department of Family and Community
Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Alison M. Buttenheim
- Department of Family and Community
Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Sarah Coles
- Department of Family, Community and
Preventive Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, AZ,
USA
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic
Science, University of Oxford, Oxford, United Kingdom
| | - Lauren Hale
- Department of Family, Population, and
Preventive Medicine, Program in Public Health, Stony Brook University, Stony Brook,
NY, USA
| | - Aparna Kumar
- Thomas Jefferson University College of
Nursing, Philadelphia, PA, USA
| | | | - Ashley Z. Ritter
- National Clinician Scholar Program,
University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda M. Simanek
- Joseph J. Zilber School of Public
Health, University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | | | - Malia Jones
- Applied Population Laboratory,
University of Wisconsin–Madison, Madison, WI, USA
| |
Collapse
|
6
|
Burke RE, Xu Y, Ritter AZ. Use of Post-Acute Care by Medicare Beneficiaries With a Diagnosis of Dementia. J Am Med Dir Assoc 2021; 23:877-879.e3. [PMID: 34644532 DOI: 10.1016/j.jamda.2021.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Hospitalized patients with dementia transitioning to post-acute care may be particularly vulnerable to changes in post-acute care utilization driven by payment reforms; however, use of post-acute care in this population is incompletely understood. We sought to describe post-acute care utilization in skilled nursing facilities (SNFs) and from home health (HH) agencies among Medicare beneficiaries with a diagnosis of dementia. DESIGN Retrospective, observational study using 100% sample of Medicare beneficiaries from 2013 to 2016. SETTING AND PARTICIPANTS We identified hospitalizations and diagnoses using Medicare Provider Analysis and Review (MedPAR), SNF stays using the Minimum Data Set, HH episodes using the Outcome and Assessment Information Set, and dementia diagnoses using the Medicare Beneficiary Summary File Chronic Conditions segment. METHODS We calculated overall utilization and trends in post-acute care use over time, stratified by dementia diagnosis, type of post-acute care (SNF vs HH), and payer (fee-for-service vs Medicare Advantage). RESULTS Of the 9,762,208 Medicare fee-for-service beneficiaries who received post-acute care from 2013 to 2016, 3,155,560 (32.3%) carried a diagnosis of dementia. Rates of post-acute care use were similar over time. More beneficiaries with a diagnosis of dementia received post-acute care (44.2% vs 27.7%) and proportionally more SNF care (71.7% vs 49.6%). Overall use and trends were similar in the Medicare Advantage population. CONCLUSIONS AND IMPLICATIONS One-third of all fee-for-service Medicare beneficiaries receiving post-acute care have a diagnosis of dementia, and more than 7 in 10 receive this care in an SNF. These findings serve as a foundation for needed evaluations of how best to meet the post-hospital needs of older adults with dementia.
Collapse
Affiliation(s)
- Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA; Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Yao Xu
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Z Ritter
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
7
|
Burke R, Xu Y, Ritter AZ, Werner RM. Outcomes of
Post‐Acute
Care in Home Health Versus a Skilled Nursing Facility in Medicare Beneficiaries with Dementia. Health Serv Res 2021. [DOI: 10.1111/1475-6773.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Robert Burke
- Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
- University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
| | - Yao Xu
- University of Pennsylvania Perelman School of Medicine PHILADELPHIA Pennsylvania USA
| | - Ashley Z. Ritter
- Corporal Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Rachel M. Werner
- University of Pennsylvania Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Philadelphia Pennsylvania USA
| |
Collapse
|
8
|
Ritter AZ, Kelly J, Kent RM, Howard P, Theil R, Cavanaugh P, Hollingsworth J, Duffey JS, Schuler M, Naylor MD. Implementation of a Coronavirus Disease 2019 Vaccination Condition of Employment in a Community Nursing Home. J Am Med Dir Assoc 2021; 22:1998-2002. [PMID: 34418376 PMCID: PMC8346362 DOI: 10.1016/j.jamda.2021.07.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
The rate of coronavirus disease 2019 (COVID-19) vaccination uptake by US nursing home staff remains low despite the increased risks of viral transmission and related morbidity and mortality in this setting. This study describes vaccine uptake activities including a COVID-19 vaccination condition of employment (COE) policy in one community nursing home. This case study summarizes the timeline of vaccination uptake activities, staff vaccination rates over time, and stakeholder perspectives around the implementation of a COVID-19 vaccination COE. Organizational data were used to calculate vaccination rates from January 1, 2021 until May 1, 2021 among all nursing home staff. Interviews were held with the executive leadership team, human resources leadership, and nursing home staff to understand the process of implementation. During a 4-month period, nursing home leaders provided 8 written handouts about COVID-19 to all staff, hosted 5 on-site vaccination clinics in partnership with area pharmacies, conducted 2 virtual presentations for staff in addition to individual outreach and internal communications. Fewer than one-half of the staff were vaccinated prior to the decision to pursue a vaccine COE on February 9, 2021. The decision to pursue a COVID-19 vaccination COE was supported by executive leadership and nursing home staff to protect the health and safety of each other and their residents. By May 1, 2021 a total of 221 of the 246 (89.8%) nursing home staff members received a COVID-19 vaccination. The facility reached 100% compliance with the vaccination COE policy with 18 people who chose to resign and 7 people who were exempt or on a leave of absence. In combination with frequent, personalized outreach, a COVID-19 vaccination COE resulted in high staff vaccination rates and minimal staff turnover. This case study provides a detailed summary of vaccination uptake activities within an organizational context to inform efforts at other healthcare facilities.
Collapse
Affiliation(s)
- Ashley Z Ritter
- NewCourtland, Philadelphia, PA, USA; NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | | | | | | | | | | | | | | | | | - Mary D Naylor
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| |
Collapse
|
9
|
Burke RE, Xu Y, Ritter AZ, Werner RM. Postacute care outcomes in home health or skilled nursing facilities in patients with a diagnosis of dementia. Health Serv Res 2021; 57:497-504. [PMID: 34389982 DOI: 10.1111/1475-6773.13855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the outcomes of postacute care between home health (HH) and skilled nursing facilities (SNFs) following hospitalization among Medicare beneficiaries with a diagnosis of dementia. DATA SOURCES 100% MedPAR data, Minimum Data Set, and Outcome and Assessment Information Set assessment data from January 1, 2015 to December 31, 2016. STUDY DESIGN Retrospective cohort analysis using an instrumental variable design to compare outcomes (30-day readmission and mortality, 100-day mortality) of HH versus SNF following acute hospitalization. We used the differential distance between patients' home and the closest HH agency and SNF to instrument for nonrandom allocation of patients. DATA COLLECTION/EXTRACTION METHODS We identified hospital discharges followed by SNF and HH stays for Medicare fee-for-service beneficiaries with dementia. We excluded beneficiaries younger than age 65, admitted to the hospital from a nursing home, or enrolled in hospice. We identified dementia using validated diagnostic codes with a 3-year look-back. PRINCIPAL FINDINGS Our sample included 977,946 beneficiaries with a diagnosis of dementia; 297,732 (30.4%) received HH, while 680,214 (69.6%) went to SNF. Overall, 16.8% were readmitted to the hospital and 6.1% died within 30 days, while 15.4% died within 100 days of hospital discharge. In the instrumental variable analysis, there were no differences in any outcome between the two postacute care settings. CONCLUSIONS Medicare beneficiaries with a diagnosis of dementia receiving postacute care in HH or SNF experienced similar rates of readmission and mortality across settings. This finding raises important questions about current postacute care referral patterns, given 7 in 10 patients with a diagnosis of dementia in our sample were discharged to SNF.
Collapse
Affiliation(s)
- Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Yao Xu
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Z Ritter
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel M Werner
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
10
|
Burke RE, Xu Y, Ritter AZ. Outcomes of post-acute care in skilled nursing facilities in Medicare beneficiaries with and without a diagnosis of dementia. J Am Geriatr Soc 2021; 69:2899-2907. [PMID: 34173231 DOI: 10.1111/jgs.17321] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND More than 600,000 Medicare beneficiaries with a diagnosis of dementia are discharged to skilled nursing facilities (SNFs) after hospitalization annually. However, it is unclear how their risks and benefits of a SNF stay compare to beneficiaries without a diagnosis of dementia. DESIGN Retrospective analysis comparing SNF outcomes for Medicare beneficiaries with and without a diagnosis of dementia. SETTING One hundred percent sample of Medicare beneficiaries from 2015 to 2016. PARTICIPANTS Dementia was identified using validated diagnosis codes. In beneficiaries who had an acute hospitalization followed by SNF stay, we used propensity score matching to balance demographics, comorbidities, characteristics of the index hospital stay, prior hospital and SNF utilization, and cognitive status on SNF admission. MEASUREMENTS Outcomes included unplanned hospital readmission, community discharge rate, and mortality during the SNF stay. Multivariate models were adjusted for hospital and SNF characteristics. RESULTS Our sample included 2,418,853 Medicare beneficiaries discharged from hospital to SNF; 830,524 (34.3%) carried a diagnosis of dementia. Overall, 14.7% of the sample had a hospital readmission, 5.0% died, and 61.5% were successfully discharged to the community. In the propensity-matched cohort, beneficiaries with a diagnosis of dementia had a lower odds ratio of mortality (OR 0.87; 95% confidence interval [CI] 0.86-0.89), similar odds of hospital readmission (OR 0.99; 95% CI 0.98-1.00), and reduced odds of discharge to the community (OR 0.92; 95% CI 0.91-0.93). However, these findings varied by the severity of cognitive impairment on SNF admission: in beneficiaries with no impairment, those with a diagnosis of dementia had higher odds of adverse outcomes. In beneficiaries with severe impairment, beneficiaries with a diagnosis of dementia had lower odds of adverse outcomes. CONCLUSIONS Cognitive dysfunction on SNF admission is a stronger predictor of outcomes than a diagnosis of dementia, suggesting the need to individualize decisions about the benefits and risks of SNF care in populations with cognitive impairment.
Collapse
Affiliation(s)
- Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yao Xu
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashley Z Ritter
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
11
|
Ritter AZ, Aronowitz S, Leininger L, Jones M, Dowd JB, Albrecht S, Buttenheim AM, Simanek AM, Hale L, Kumar A. Dear Pandemic: Nurses as key partners in fighting the COVID-19 infodemic. Public Health Nurs 2021; 38:603-609. [PMID: 33876450 PMCID: PMC8251166 DOI: 10.1111/phn.12903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022]
Abstract
The COVID‐19 pandemic and subsequent proliferation of misinformation have created parallel public health crises. Social media offers a novel platform to amplify evidence‐based communication to broader audiences. This paper describes the application of science communication engagement on social media platforms by an interdisciplinary team of female scientists in a campaign called Dear Pandemic. Nurses are trusted professionals trained in therapeutic communication and are central to this effort. The Dear Pandemic campaign now has more than 97,000 followers with international and multilingual impact. Public health strategies to combat misinformation and guide individual behavior via social media show promise, and require further investment to support this novel dissemination of science communication.
Collapse
Affiliation(s)
- Ashley Z Ritter
- National Clinician Scholar Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Shoshana Aronowitz
- National Clinician Scholar Program, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Malia Jones
- Applied Population Laboratory, University of Wisconsin-Madison, Madison, WI, USA
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
| | - Sandra Albrecht
- Department of Epidemiology, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Amanda M Simanek
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Lauren Hale
- Program in Public Health Department of Family, Population, and Preventative Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Aparna Kumar
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
12
|
Naylor MD, Morgan B, Ritter AZ. Stemming the Rising Toll of People Living with Complex Care Needs. JAMA Health Forum 2020; 1:e200282. [PMID: 36218608 PMCID: PMC9999413 DOI: 10.1001/jamahealthforum.2020.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mary D Naylor
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia
| | - Brianna Morgan
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia
| | - Ashley Z Ritter
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia.,National Clinician Scholars Program, University of Pennsylvania, Philadelphia
| |
Collapse
|
13
|
Carpenter JG, Lam K, Ritter AZ, Ersek M. A Systematic Review of Nursing Home Palliative Care Interventions: Characteristics and Outcomes. J Am Med Dir Assoc 2020; 21:583-596.e2. [PMID: 31924556 DOI: 10.1016/j.jamda.2019.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/11/2019] [Accepted: 11/20/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal. OBJECTIVE To examine the characteristics and effectiveness of nursing home interventions that incorporated multiple palliative care domains (eg, physical aspects of care-symptom management, and ethical aspects-advance care planning). DESIGN Systematic review. METHODS We searched MEDLINE via PubMed, Embase, CINAHL, and Cochrane Library's CENTRAL from inception through January 2019. We included all randomized and nonrandomized trials that compared palliative care to usual care and an active comparator. We assessed the type of intervention, outcomes, and the risk of bias. RESULTS We screened 1167 records for eligibility and included 13 articles. Most interventions focused on staff education and training strategies and on implementing a palliative care team. Many interventions integrated advance care planning initiatives into the intervention. We found that palliative care interventions in nursing homes may enhance palliative care practices, including processes to assess and manage pain and symptoms. However, inconsistent outcomes and high or unclear risk of bias among most studies requires results to be interpreted with caution. CONCLUSIONS AND IMPLICATIONS Heterogeneity in methodology, findings, and study bias within the existing literature revealed limited evidence for nursing home palliative care interventions. Findings from a small group of diverse clinical trials suggest that interventions enhanced nursing home palliative care and improved symptom assessment and management processes.
Collapse
Affiliation(s)
- Joan G Carpenter
- University of Pennsylvania School of Nursing, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.
| | - Karissa Lam
- University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Ashley Z Ritter
- University of Pennsylvania National Clinician Scholars Program, Philadelphia, PA
| | - Mary Ersek
- University of Pennsylvania School of Nursing, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
14
|
Lo Y, Lynch SF, Urbanowicz RJ, Olson RS, Ritter AZ, Whitehouse CR, O'Connor M, Keim SK, McDonald M, Moore JH, Bowles KH. Using Machine Learning on Home Health Care Assessments to Predict Fall Risk. Stud Health Technol Inform 2019; 264:684-688. [PMID: 31438011 DOI: 10.3233/shti190310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Falls are the leading cause of injuries among older adults, particularly in the more vulnerable home health care (HHC) population. Existing standardized fall risk assessments often require supplemental data collection and tend to have low specificity. We applied a random forest algorithm on readily available HHC data from the mandated Outcomes and Assessment Information Set (OASIS) with over 100 items from 59,006 HHC patients to identify factors that predict and quantify fall risks. Our ultimate goal is to build clinical decision support for fall prevention. Our model achieves higher precision and balanced accuracy than the commonly used multifactorial Missouri Alliance for Home Care fall risk assessment. This is the first known attempt to determine fall risk factors from the extensive OASIS data from a large sample. Our quantitative prediction of fall risks can aid clinical discussions of risk factors and prevention strategies for lowering fall incidence.
Collapse
Affiliation(s)
- Yancy Lo
- Clinical Research Informatics Core, Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Selah F Lynch
- Clinical Research Informatics Core, Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan J Urbanowicz
- Clinical Research Informatics Core, Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Randal S Olson
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Z Ritter
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina R Whitehouse
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.,Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Melissa O'Connor
- Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Susan K Keim
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Margaret McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service New York, New York, NY, USA
| | - Jason H Moore
- Clinical Research Informatics Core, Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn H Bowles
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.,Center for Home Care Policy & Research, Visiting Nurse Service New York, New York, NY, USA
| |
Collapse
|
15
|
Ritter AZ, Bowles KH, O'Sullivan AL, Carthon MB, Fairman JA. A Policy Analysis of Legally Required Supervision of Nurse Practitioners and Other Health Professionals. Nurs Outlook 2018; 66:551-559. [DOI: 10.1016/j.outlook.2018.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 05/10/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
|
16
|
Sefcik JS, Ritter AZ, Flores EJ, Nock RH, Chase JAD, Bradway C, Potashnik S, Bowles KH. Why older adults may decline offers of post-acute care services: A qualitative descriptive study. Geriatr Nurs 2017; 38:238-243. [PMID: 27964972 PMCID: PMC5466841 DOI: 10.1016/j.gerinurse.2016.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/23/2022]
Abstract
The most common post-acute care (PAC) services available to patients after hospital discharge include home care, skilled nursing facilities, nursing homes, inpatient rehabilitation, and hospice. Patients who need PAC and receive services have better outcomes, however almost one-third of those offered services decline. Little research exists on PAC decision-making and why patients may decline services. This qualitative descriptive study explored the responses of thirty older adults to the question: "Can you, from the patient point of view, tell me why someone would not want post hospital care?" Three themes emerged. Participants may decline due to 1) previous negative experiences with PAC, or 2) a preference to be home. Some participants stated, "I'd be there" and would not decline services. Participants also discussed 3) why other patients might decline PAC which included patients' past experiences, lack of understanding/preconceived ideas, and preferences. Clinical implications include assessing patients' knowledge and experience before providing recommendations.
Collapse
Affiliation(s)
- Justine S. Sefcik
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19103
| | - Ashley Z. Ritter
- Robert Wood Johnson Future of Nursing Scholar, University of Pennsylvania School of Nursing,
| | - Emilia J. Flores
- Hillman Nursing in Innovation Scholar, Jonas Nurse Scholar, Ruth L. Kirschstein NRSA T32 (T32NR009356) Predoctoral Fellow, University of Pennsylvania School of Nursing,
| | - Rebecca H. Nock
- Ruth L. Kirschstein NRSA T32 (T32NR009356) Predoctoral Fellow, University of Pennsylvania School of Nursing,
| | - Jo-Ana D. Chase
- University of Missouri Sinclair School of Nursing, S343 Sinclair School of Nursing, Columbia, MO 65211, Postdoctoral Fellow T32NR009356, University of Pennsylvania School of Nursing,
| | | | | | | |
Collapse
|