National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 227 Research Studies DisplayedKistler CE, Wretman Zimmerman, S S
Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline.
The purpose of this study was to examine the concordance between clinicians' diagnosis of suspected urinary tract infection (UTI) with a clinical guideline treated as the gold standard, in order to inform overprescribing and antibiotic stewardship in nursing homes. The authors conducted a cross-sectional web-based survey of a national convenience sample of nursing-home clinicians, including a discrete choice experiment with 19 randomly selected scenarios of nursing-home residents with possible UTIs. Responses were compared to the guideline. The results indicated that nursing-home clinicians tend to over-diagnose UTI. The authors concluded that this necessitates systems-based interventions to augment clinical decisionmaking.
AHRQ-funded; HS024519.
Citation: Kistler CE, Wretman Zimmerman, S S .
Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline.
J Am Geriatr Soc 2022 Apr;70(4):1070-81. doi: 10.1111/jgs.17638..
Keywords: Nursing Homes, Long-Term Care, Urinary Tract Infection (UTI), Guidelines, Diagnostic Safety and Quality, Shared Decision Making
Sun EC, Rishel CA, Jena AB
Association between changes in postoperative opioid utilization and long-term health care spending among surgical patients with chronic opioid utilization.
There is growing interest in identifying and developing interventions aimed at reducing the risk of increased, long-term opioid use among surgical patients. While understanding how these interventions impact health care spending has important policy implications and may facilitate the widespread adoption of these interventions, the extent to which they may impact health care spending among surgical patients who utilize opioids chronically is unknown. This study examined the association between changes in postoperative opioid utilization and long-term health care spending among surgical patients with chronic opioid utilization.
AHRQ-funded; HS026753.
Citation: Sun EC, Rishel CA, Jena AB .
Association between changes in postoperative opioid utilization and long-term health care spending among surgical patients with chronic opioid utilization.
Anesth Analg 2022 Mar;134(3):515-23. doi: 10.1213/ane.0000000000005865..
Keywords: Opioids, Medication, Healthcare Costs, Long-Term Care, Substance Abuse
Alexander GL, Deroche CB, Powell KR
Development and pilot analysis of the nursing home health information technology maturity survey and staging model.
The purpose of this study was the development, psychometric testing, and analysis of a survey instrument and staging model for nursing home health information technology (HIT). The nursing homes (NH) were selected for inclusion in the study based on their HIT scores from a prior study. Researchers recruited 121 NH administrators from January to May 2019 from primarily for-profit, metropolitan nursing homes with medium bed size. The researchers reported that all dimensions and domains were significantly correlated, with the exception of the variables of integration in administrative activities and HIT capabilities. All items loaded intuitively onto four components, explaining 80% of the variance. The researchers concluded that the HIT maturity survey can be used to make reliable assumptions about nursing home health information technology.
AHRQ-funded; HS022497.
Citation: Alexander GL, Deroche CB, Powell KR .
Development and pilot analysis of the nursing home health information technology maturity survey and staging model.
Res Gerontol Nurs 2022 Mar-Apr;15(2):93-99. doi: 10.3928/19404921-20220218-04..
Keywords: Nursing Homes, Long-Term Care, Health Information Technology (HIT)
Cannon JL, Park GW, Anderson B
Hygienic monitoring in long-term care facilities using ATP, crAssphage, and human noroviruses to direct environmental surface cleaning.
Norovirus and C. difficile can be transmitted by contaminated environmental surfaces and are associated with diarrheal illnesses and deaths in long-term care (LTC) facilities. Hygienic monitoring tools such as adenosine triphosphate (ATP) bioluminescence and indicators of fecal contamination can help to identify LTC facility surfaces with cleaning deficiencies. The researchers swabbed and tested high-touch surfaces in 11 LTC facilities for contamination by norovirus, a fecal indicator virus, crAssphage, and ATP. The study found that greater than 90% of surfaces tested positive for crAssphage or failed in their ATP scores. Norovirus contamination was not detected. Handrails, equipment controls, and patient beds were 4 times more likely than other surfaces or locations to have high levels of crAssphage. Patient bed handrails and tables and chairs in patient lounges had high levels of both ATP and crAssphage.
AHRQ-funded; HS025987.
Citation: Cannon JL, Park GW, Anderson B .
Hygienic monitoring in long-term care facilities using ATP, crAssphage, and human noroviruses to direct environmental surface cleaning.
Am J Infect Control 2022 Mar; 50(3):289-94. doi: 10.1016/j.ajic.2021.11.014..
Keywords: Nursing Homes, Long-Term Care, Prevention, Healthcare-Associated Infections (HAIs), Clostridium difficile Infections
Kumar RG, Zhang W, Evans E
Research letter: characterization of older adults hospitalized with traumatic brain injury admitted to long-term acute care hospitals.
The objective of this study was to describe patient, hospital, and geographic characteristics of older adult Medicare beneficiaries who were hospitalized with traumatic brain injury (TBI) then admitted to long-term acute care hospitals. Participants were predominantly White males with an average age of 77.1. Average acute hospital length of stay was 19.4 days. Only 4% of patients were discharged home after a long-term acute care hospital stay; the primary discharge disposition was to skilled nursing facilities. Geographic analyses indicated that Southern and Midwestern states had the greatest number of long-term acute care hospital facilities and highest proportion of admissions. The authors concluded that more research is needed to understand long-term functional outcomes among this population.
AHRQ-funded; HS000011.
Citation: Kumar RG, Zhang W, Evans E .
Research letter: characterization of older adults hospitalized with traumatic brain injury admitted to long-term acute care hospitals.
J Head Trauma Rehabil 2022 Mar-Apr; 37(2):89-95. doi: 10.1097/htr.0000000000000685..
Keywords: Elderly, Brain Injury, Long-Term Care
Konetzka RT, Davila H, Brauner DJ
The quality measures domain in Nursing Home Compare: is high performance meaningful or misleading?
The Federal Centers for Medicare and Medicaid Services publishes a Nursing Home Compare (NHC) web site that provides information to compare nursing homes across the nation. Since NHC began reporting the percent of nursing home residents suffering adverse outcomes, the negative outcomes decreased dramatically. However, the validity of scores has been questioned for nursing homes that score well on facility-reported measures but scored poorly on inspections. The study purpose was to determine whether nursing homes with these “discordant” scores are better than nursing homes that score poorly across all domains. The researchers analyzed national data from 2012- 2016, conducted in-depth interviews and observations of 12 nursing homes in 2017 to 2018, and studied nursing home performance trajectories over time. Both qualitative and quantitative methods were utilized and interpreted together. The study found that facilities identified as discordant took part in more quality improvement (QI) activities than those identified as poor performers, but those QI activities were lower-resource improvements and not of the type and scope that would impact improvements across other quality domains. It was determined that the poor-performing facilities appeared to lack the leadership and staff continuity required for even low-resource improvements. The study concluded that while high performance on quality measures using facility-reported data is mostly meaningful, and the quality measures domain should continue to be utilized in Nursing Home Compare, facilities identified as discordant still have quality defects.
AHRQ-funded; HS024967.
Citation: Konetzka RT, Davila H, Brauner DJ .
The quality measures domain in Nursing Home Compare: is high performance meaningful or misleading?
Gerontologist 2022 Feb 9;62(2):293-303. doi: 10.1093/geront/gnab054..
Keywords: Nursing Homes, Long-Term Care, Provider Performance, Quality Indicators (QIs), Quality Measures, Quality of Care
Katz MJ, Tamma PD, Cosgrove SE
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
The purpose of this study was to determine if AHRQ’s Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use in long-term care (LTC) facilities in the US. Findings showed that participation in the AHRQ safety program was associated with the development of antibiotic stewardship programs (ASPs) that actively engaged clinical staff in the decision-making processes around antibiotic prescriptions in participating LTC facilities. The reduction in days of antibiotic therapy and starts, which was more pronounced in more engaged facilities, indicated that implementation of this multifaceted program may support successful ASPs in LTC settings.
AHRQ-funded; 233201500020I.
Citation: Katz MJ, Tamma PD, Cosgrove SE .
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
JAMA Netw Open 2022 Feb;5(2):e220181. doi: 10.1001/jamanetworkopen.2022.0181..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Long-Term Care, Medication, Implementation, Patient Safety
Zimmerman S, Carder P, Schwartz L
The imperative to reimagine assisted living.
Assisted living (AL) has existed in the United States for decades, evolving in response to older adults' need for supportive care and distaste for nursing homes and older models of congregate care. AL is state-regulated, provides at least 2 meals a day, around-the-clock supervision, and help with personal care, but is not licensed as a nursing home. This article presents the background regarding those tensions, as well as potential solutions that have been borne out, paving the path to a better future of assisted living.
AHRQ-funded; HS026893.
Citation: Zimmerman S, Carder P, Schwartz L .
The imperative to reimagine assisted living.
J Am Med Dir Assoc 2022 Feb;23(2):225-34. doi: 10.1016/j.jamda.2021.12.004..
Keywords: Elderly, Long-Term Care, Healthcare Delivery, Workforce, Quality of Care, Quality of Life, Healthcare Costs
Rosenthal M, Poling J, Wec A
"Medication is just one piece of the whole puzzle": how nursing homes change their use of antipsychotic medications.
This article investigated health professionals’ experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes and its companion coalitions. These programs were introduced in 2012 for the purpose of encouraging reductions in antipsychotic use and increasing use of nonpharmacological treatments for dementia. Interviews were conducted with 40 nursing home physicians and staff in seven states. The authors found that reducing antipsychotics is more time and resource-intensive than relying on medication. However, respondents supported reductions in antipsychotic use. They indicated that with supported staffing, effective communications, and training, they could create or implement individualized treatments.
AHRQ-funded; HS023464.
Citation: Rosenthal M, Poling J, Wec A .
"Medication is just one piece of the whole puzzle": how nursing homes change their use of antipsychotic medications.
J Appl Gerontol 2022 Jan;41(1):62-72. doi: 10.1177/0733464820958919..
Keywords: Elderly, Medication, Nursing Homes, Dementia, Neurological Disorders, Long-Term Care, Shared Decision Making
Yount N, Zebrak KA, Famolaro T
Linking patient safety culture to quality ratings in the nursing home setting.
This study examined the relationship between scores on the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey (NH SOPS) and Centers for Medicare and Medicaid Services Nursing Home Five-Star Quality Ratings. The authors used data on 186 nursing homes to conduct multiple regression analyses predicting the Five-Star Quality Ratings from the NH SOPS survey measures. Five NH SOPS measures were related to the Overall, Health Inspections, and Quality Five-Star Ratings; four NH SOPS measures were related to at least two of the four Five-Star Quality Ratings and three SOPS measures were related to one Five-Star Rating. No NH SOPS measures were significantly associated with the Staffing Five-Star Rating.
AHRQ-funded; 233201500026I.
Citation: Yount N, Zebrak KA, Famolaro T .
Linking patient safety culture to quality ratings in the nursing home setting.
J Appl Gerontol 2022 Jan;41(1):73-81. doi: 10.1177/0733464820969283..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Safety, Nursing Homes, Long-Term Care, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care
Fashaw-Walters SA, McCreedy E, Bynum JPW
Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD.
Investigators examined how race and Alzheimer's and related dementia (ADRD) status influenced the rate of schizophrenia diagnoses among nursing home (NH) residents following the CMS National Partnership to Improve Dementia Care. Using 2011-2015 Minimum Data Set 3.0 assessments, they found that, following the partnership, black NH residents with ADRD were more likely to have a schizophrenia diagnosis documented on their minimum data set assessments, and schizophrenia rates increased for black NH residents with ADRD only.
AHRQ-funded; HS000011.
Citation: Fashaw-Walters SA, McCreedy E, Bynum JPW .
Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD.
J Am Geriatr Soc 2021 Dec;69(12):3623-30. doi: 10.1111/jgs.17464..
Keywords: Elderly, Dementia, Nursing Homes, Racial and Ethnic Minorities, Long-Term Care
Goodwin JS, Agrawal P, Li S
Growth of physicians and nurse practitioners practicing full time in nursing homes.
This retrospective cohort study examined the growth of physicians and nurse practitioners (NPs) and physician assistants (PAs) who work full time in nursing homes, and to assess resident and nursing home characteristics associated with receiving care from full-time providers. Researchers looked at a 20% national sample of Medicare data on long-term care residents in 2008 and 2018 and the physicians, NPs, and PAs who submitted charges for services rendered in nursing homes. Full-time nursing home providers increased from 26% in 2008 to 44.6% in 2017. The largest increase from 2008 to 2017 was in NPs with 1986 total in 2008 increasing 44.6% in 2017. Residents with an NP primary care provider were 23 times more likely to have a full-time provider. Residents who received care from both a physician and an NP or PA increased from 33.5% in 2008 to 62.5% in 2018. There was large variation in the percentage of residents with full-time providers, with 5.72% of residents in the bottom quintile of facilities to 91.4% in the top quintile.
AHRQ-funded; HS020642.
Citation: Goodwin JS, Agrawal P, Li S .
Growth of physicians and nurse practitioners practicing full time in nursing homes.
J Am Med Dir Assoc 2021 Dec;22(12):2534-39.e6. doi: 10.1016/j.jamda.2021.06.019..
Keywords: Nursing Homes, Long-Term Care, Provider: Clinician, Provider: Physician, Provider: Nurse, Workforce
Davila H, Shippee TP, Park YS
Inside the black box of improving on nursing home quality measures.
This qualitative study investigated how nursing homes (NHs) interact with quality measures (QMs) used by Nursing Home Compare (NHC) as part of its 5-star rating system. Semistructured interviews were conducted with 110 NH personnel and 23 NH provider association representatives. Observations of organizational processes in 12 NHs in three states were also done. The authors found that most NHs are working to improve the quality of care they provide, not merely to improve their QM scores. They also found limitations with the QMs, suggesting that the QMs on their own may not accurately reflect the quality of care that NHs provide. The findings suggest several changes to improve NHC.
AHRQ-funded; HS024967.
Citation: Davila H, Shippee TP, Park YS .
Inside the black box of improving on nursing home quality measures.
Med Care Res Rev 2021 Dec;78(6):758-70. doi: 10.1177/1077558720960326..
Keywords: Nursing Homes, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Provider Performance, Long-Term Care
Abrahamson K, Davila H, Kirk L
Can a nursing home psychotropic reduction project be successfully implemented in assisted living?
This study’s objective was to compare implementation of a psychotropic medication reduction project across nursing homes (NH) and assisted living (AL) facilities. Fifteen NHs and 14 AL facilities within a single corporate chain participated. In-person and telephone interviews with 62 staff members from participating NH and AL facilities were conducted to investigate project implementation experience. Implementation at nursing homes made more dramatic changes in residents’ lives and medication use than at assisted living facilities. AL staff identified numerous barriers to implementation.
AHRQ-funded; HS018464.
Citation: Abrahamson K, Davila H, Kirk L .
Can a nursing home psychotropic reduction project be successfully implemented in assisted living?
J Appl Gerontol 2021 Sep;40(9):1071-79. doi: 10.1177/0733464820948328..
Keywords: Elderly, Nursing Homes, Long-Term Care, Medication, Dementia
Shepard V, Chou LN, Kuo YF, et al.
Characteristics associated with feeding tube placement: retrospective cohort study of Texas nursing home residents with advanced dementia.
The purpose of this retrospective cohort study was to investigate resident-level, provider-type, nursing home (NH), and regional factors associated with feeding tube (FT) placement in advanced dementia. The investigators concluded that regional, race, and ethnic variations in prevalence of FT use among NH residents suggested opportunities for clinicians and policy makers to improve the quality of end-of-life care by especially considering other palliative care measures for minorities living in border towns.
AHRQ-funded; HS020642.
Citation: Shepard V, Chou LN, Kuo YF, et al..
Characteristics associated with feeding tube placement: retrospective cohort study of Texas nursing home residents with advanced dementia.
J Am Med Dir Assoc 2021 Jul;22(7):1471-76.e4. doi: 10.1016/j.jamda.2020.10.033..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders
Castle NG
Measuring caregiver retention in nursing homes.
This study examined the retention of nursing home caregivers using a survey of nursing home administrators conducted in 2016 from 2,898 facilities. Survey data was matched with Nursing Home Compare and the Certification and Survey Provider Enhanced Reporting data. Four measures of retention were associated with each of three types for caregivers: nurse aids (NAs), registered nurses (RNs), and licensed practical nurses with six quality indicators. Retention rates at 5 years was shown to be low for all three of these caregiver types. Regression estimates showed some support for the theory that different measures of retention were more/less associated with quality. The 3- and 5-year retention measures had the strongest associations with quality of care.
AHRQ-funded; HS021980.
Citation: Castle NG .
Measuring caregiver retention in nursing homes.
Gerontologist 2021 Jun 2;61(4):e118-e28. doi: 10.1093/geront/gnab012..
Keywords: Nursing Homes, Long-Term Care, Provider: Health Personnel, Workforce
Wang J, Ying M, Temkin-Greener H
Care-partner support and hospitalization in assisted living during transitional home health care.
This study examined the impact of care-partner support on outcomes among assisted living (AL) residents. Variation in care-partner and its impact on hospitalizations among AL residents receiving Medicare home health (HH) services was investigated. Analysis of national data from various databases was used and a total of 741,926 participants were identified with Medicare HH admissions in 2017. Care-partner support during the HH admission was measured in seven domains: activity of daily living (ADLs), instrumental activities of ADLs), medication administration, treatment, medical equipment, home safety, and transportation. Care-partner support was categorized as assistance not needed, care-partner currently providing assistance, care-partner needs additional training/support to provide assistance, and care-partner is unavailable/unlikely to provide assistance. Among the cohort, inadequate care-partner support was identified for all seven domains ranging from 13.1% for transportation to 49.8% for treatment and was unavailable for 0.9% for transportation to 11.0% for treatment. Having inadequate or unavailable care-partner support was related to increased risk of hospitalization by 8.9% for treatment to 41.3% for medication administration.
AHRQ-funded; HS026893.
Citation: Wang J, Ying M, Temkin-Greener H .
Care-partner support and hospitalization in assisted living during transitional home health care.
J Am Geriatr Soc 2021 May;69(5):1231-39. doi: 10.1111/jgs.17005..
Keywords: Elderly, Transitions of Care, Caregiving, Hospitalization, Home Healthcare, Long-Term Care
Olivieri-Mui B, McGuire J, Griffith J
Exploring the association between the quality of HIV care in nursing homes and hospitalization.
Persons living with HIV/AIDS (PLWH) are living long enough to need age-related and HIV-related nursing home (NH) care. Nursing home quality of care has been associated with risk for hospitalization, but it is unknown if quality of HIV care in NHs affects hospitalization in this population. In this study, the investigators assessed HIV care quality with four national measures adapted for the NH setting.
AHRQ-funded; R36 HS025662.
Citation: Olivieri-Mui B, McGuire J, Griffith J .
Exploring the association between the quality of HIV care in nursing homes and hospitalization.
J Healthc Qual 2021 May-Jun;43(3):174-82. doi: 10.1097/jhq.0000000000000277..
Keywords: Elderly, Human Immunodeficiency Virus (HIV), Nursing Homes, Long-Term Care, Quality of Care, Quality Measures
Mack DS, Baek J, Tjia J
Geographic variation of statin use among US nursing home residents with life-limiting illness.
The authors described regional variation in statin use among residents with life-limiting illness. Statin usage was determined by examination of Medicare Part D claims. Findings suggested extensive geographic variation in US statin prescribing across hospital referral regions, especially for those aged 76 years or older. This variation may reflect clinical uncertainty given the largely absent guidelines for statin use in nursing home residents.
AHRQ-funded; HS026840.
Citation: Mack DS, Baek J, Tjia J .
Geographic variation of statin use among US nursing home residents with life-limiting illness.
Med Care 2021 May;59(5):425-36. doi: 10.1097/mlr.0000000000001505..
Keywords: Elderly, Nursing Homes, Long-Term Care, Medicare, Practice Patterns
Mack DS, Hume AL, Tjia J
National trends in statin use among the United States nursing home population (2011-2016).
AHRQ-funded; HS026840.
Citation: Mack DS, Hume AL, Tjia J .
National trends in statin use among the United States nursing home population (2011-2016).
Drugs Aging 2021 May;38(5):427-39. doi: 10.1007/s40266-021-00844-8..
Keywords: Elderly, Nursing Homes, Long-Term Care, Blood Thinners, Medication
Hua CL, Cornell PY, Zimmerman S
Trends in serious mental illness in US assisted living compared to nursing homes and the community: 2007-2017.
This study examined trends in the prevalence of serious mental illness (SMI) in assisted living (AL) communities in the United States over time and in relationship to characteristics such as dual eligibility and health conditions. Using Medicare data, findings showed that the prevalence of SMI in AL increased by 54% from 2007 to 2017. Residents with SMI were more likely to be dually eligible for Medicare and Medicaid than residents without SMI. Approximately 10% of AL communities had over half of the sample's AL residents with SMI.
AHRQ-funded; HS000011.
Citation: Hua CL, Cornell PY, Zimmerman S .
Trends in serious mental illness in US assisted living compared to nursing homes and the community: 2007-2017.
Am J Geriatr Psychiatry 2021 May;29(5):434-44. doi: 10.1016/j.jagp.2020.09.011..
Keywords: Elderly, Behavioral Health, Nursing Homes, Long-Term Care, Medicare
Reistetter TA, Eschbach K K, Prochaska J
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
This study’s goal was to demonstrate a method for developing rehabilitation service areas for post-acute care. A secondary analysis of 2013-2014 Medicare records for older patients in Texas (n = 469,172) was conducted. The analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The authors used Ward’s algorithm to cluster patient ZIP code tabulation areas based on which facilities patients were admitted to for rehabilitation. They set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions. Interclass Correlation Coefficient (ICC) and variance in the number of rehabilitation beds across areas were the methods used to evaluate rehabilitation service areas. The service areas had a higher ICC and variance in beds than the hospital referral regions.
AHRQ-funded; HS024711.
Citation: Reistetter TA, Eschbach K K, Prochaska J .
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
Am J Phys Med Rehabil 2021 May;100(5):465-72. doi: 10.1097/phm.0000000000001577..
Keywords: Elderly, Rehabilitation, Medicare, Nursing Homes, Long-Term Care, Home Healthcare, Access to Care
Hua CL, Thomas KS, Peterson LJ
Emergency department use among assisted living residents after Hurricane Irma.
This retrospective cohort study examined whether rates of emergency department (ED) use for injuries and other medical reasons increased after Hurricane Irma in 2017 among assisted living (AL) residents in Florida. The researchers found that heart failure was a leading cause of ED visits within 90 days of September 1 in 2017, unlike in 2016. They recommended increased attention to AL communities in disaster preparedness and response efforts, given the increased likelihood of ED visits following a hurricane.
AHRQ-funded; T32 HS000011.
Citation: Hua CL, Thomas KS, Peterson LJ .
Emergency department use among assisted living residents after Hurricane Irma.
J Am Med Dir Assoc 2021 Apr;22(4):918-22.e1. doi: 10.1016/j.jamda.2020.10.010..
Keywords: Elderly, Emergency Department, Long-Term Care
Griffey RT, Schneider RM, Adler L
Post-acute and long-term care patients account for a disproportionately high number of adverse events in the emergency department.
This retrospective observation study compares emergency department (ED) rates for adverse events (AEs) between post-acute and long-term care settings (PA/LTC) residents and non-PA/LTC residents. The authors describe all-cause harm among patients from PA/LTC setting seen in the ED. The study used the ED Trigger Tool, with dual independent nurse reviews of 5582 ED records with triggers. Data was captured for all adult patients at an urban, academic ED over a 13-month period. PA/LTC patients tended to be older (median 69 vs 50 years old). They accounted for 21% of all AEs (26% present on arrival, 13% in ED). Present on arrival AEs from a PA/LTC setting were most commonly patient-care related (39%), medication (34%) and infections (16%). The analysis showed that a disproportionate number of ED visits from PA/LTC are for AEs, which is an admission rate double that for non-PA/LTC patients.
AHRQ-funded; R18 HS025052.
Citation: Griffey RT, Schneider RM, Adler L .
Post-acute and long-term care patients account for a disproportionately high number of adverse events in the emergency department.
J Am Med Dir Assoc 2021 Apr;22(4):907-12.e1. doi: 10.1016/j.jamda.2020.06.043..
Keywords: Elderly, Long-Term Care, Emergency Department, Adverse Events
Enyioha C, Khairat S, Kistler CE
Adoption of electronic health records by practices of nursing home providers and Wi-Fi availability in nursing homes.
This study evaluated the rate of electronic health record (EHR) adoption by nursing homes (NHs) and nursing home providers and Wi-Fi availability in nursing homes by geographical region. The authors conducted a cross-sectional survey on a convenience sample of NH primary care providers (PCPs) serving 867 NHs recruited from the Medefield Primary Care research panel. They also sought to evaluate the proportion of NHs with Wi-Fi access. The states were categorized into four geographical locations: Midwest, Northeast, South, and West. Participants included a total of 515 physicians, 209 nurse practitioners, and 143 physician assistants. Mean age of participants was 49 years, 56% were male, and 76% white. The mean number of days per week participants worked in a NH was 1.8 and number of hours per week 32.3. Overall, 89.4% reported EHR adoption in their practice, and 73.2% reported Wi-Fi presence in their primary NH. The three most EHRs were EpicCare Ambulatory (24.0%), Vitera (20.4%), and eClinicalWorks (14.4%) Wi-Fi access was highest in the Northeast (78.1%) and lowest in the West (63.9%). Rates of EHR adoption was also highest in the Northeast (94.5%). These differences may help explain continued deficiencies in care coordination between NH and other sites of clinical care.
AHRQ-funded; HS024519.
Citation: Enyioha C, Khairat S, Kistler CE .
Adoption of electronic health records by practices of nursing home providers and Wi-Fi availability in nursing homes.
J Am Med Dir Assoc 2021 Feb;22(2):475-76. doi: 10.1016/j.jamda.2020.09.028..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing Homes, Long-Term Care