Nursing Homes as Data Collection Sites
AHRQ's 2012 Annual Conference Slide Presentation
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Slide 1
Nursing Homes as Data Collection Sites
Nursing homes are complex systems with a unique culture Philip D. Sloane, MD, MPH
University of North Carolina at Chapel Hill
ABT team: Rosanna Bertrand, PhD; Lauren Olsho; Louise Hadden; Alrick Edwards.
UNC team: Sheryl Zimmerman, PhD; Anna Beeber, PhD, GNP, RN; Christine Kistler, MD, MASc; C. Madeline Mitchell, MURP
Funding provided by AHRQ contract # HHSA 290200600001I.
Slide 2
Prior Research Experience
UNC Team (CS-LTC)
Nursing home research:
- Over 25 funded NH studies over 20+ years involving primary data collection.
- 7 NH intervention trials.
Infection research:
- 2 NH infection studies.
ABT Team
Nursing home research:
- Over 20 years of NH QI research.
- Over 30 federally-funded intervention/evaluation studies.
Infection research:
- Antibiogram use in NHs.
- Multiple US and international HIV studies.
Slide 3
Goals and Study Design
Goals:
- Implement & evaluate a multicomponent QI program on optimizing antibiotic prescribing.
- Assess the validity of the Loeb Minimum Criteria.
Design:
- LTC provider group / 2 geographically separate regions
- One region assigned to intervention (6 NHs).
- Other assigned to comparison (6 NHs).
- 9 months chart abstraction (3m baseline, 6m follow-up).
- QI program (months 4–9)
- Provider and NH staff training (Pocket Card/Referral Form).
- Brochure / meetings for residents/families.
- Monthly data reports / meetings with facility QI teams.
Slide 4
Main Results
Image: A line graph compares the percentage change in Abx prescribing for the Invention Group and Comparison Group for all Indicators.
Slide 5
Using NH Records as Data Sources
- Many NHs pre-electronic; some have EHR.
- Physician notes:
- If electronic, access limited.
- If paper, quality often poor.
- Nursing notes:
- Often quite limited; length, quality, and consistency inferior to hospital setting.
- Assessment data consistent, illness data not.
- Our attempt to introduce a standardized reporting tool for infections → limited acceptance.
Slide 6
Collecting Primary Data in NHs
- No major administrative barriers encountered: NH staff cooperative.
- Data collection staff must be clinical (we used RNs), well trained, and supervised.
- Records can be massive; audit time per record was longer than we’d anticipated.
- Lack of systems for acute illness made standardization of data collection difficult.
