National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Adverse Events (2)
- Ambulatory Care and Surgery (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Behavioral Health (2)
- Burnout (1)
- Cardiovascular Conditions (4)
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- Communication (1)
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- COVID-19 (1)
- Dementia (1)
- Disparities (1)
- Education: Patient and Caregiver (1)
- Elderly (27)
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- Evidence-Based Practice (1)
- Falls (1)
- Healthcare-Associated Infections (HAIs) (3)
- Healthcare Costs (3)
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- Health Information Technology (HIT) (4)
- Health Literacy (1)
- Health Status (1)
- Heart Disease and Health (3)
- Home Healthcare (2)
- Hospital Discharge (9)
- Hospitalization (7)
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- Hospitals (4)
- Human Immunodeficiency Virus (HIV) (2)
- Infectious Diseases (2)
- Injuries and Wounds (5)
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- Medication: Safety (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (2)
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- Neurological Disorders (1)
- (-) Nursing Homes (51)
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- Pressure Ulcers (2)
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- Provider: Nurse (1)
- Provider Performance (8)
- Quality Improvement (6)
- Quality Indicators (QIs) (1)
- Quality Measures (6)
- Quality of Care (13)
- Quality of Life (2)
- Racial and Ethnic Minorities (2)
- Rehabilitation (2)
- Risk (3)
- Shared Decision Making (1)
- Social Determinants of Health (1)
- Social Media (1)
- Stroke (1)
- Surgery (1)
- Surveys on Patient Safety Culture (1)
- Transitions of Care (5)
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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
1 to 25 of 51 Research Studies DisplayedHong I, Goodwin JS, Reistetter TA, I, Goodwin JS, Reistetter TA
Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient rehabilitation vs skilled nursing facilities.
This cohort study compared functional status improvements of poststroke patients who either went to an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF). The study used data from Medicare claims for stroke from January 2013 through November 2014. A total of 99,185 patients were studied. Patients admitted to SNFs tended to be older, female, and had a longer hospital length of stay than those admitted to IRFs. Stroke patients admitted to IRFs had larger improvements for mobility score points and for self-care on admission compared with those admitted to SNFs. There was found to be no statistical difference in the odds of 30- to 365-day mortality.
AHRQ-funded; HS024711; HS022134.
Citation: Hong I, Goodwin JS, Reistetter TA, I, Goodwin JS, Reistetter TA .
Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient rehabilitation vs skilled nursing facilities.
JAMA Netw Open 2019 Dec 2;2(12):e1916646. doi: 10.1001/jamanetworkopen.2019.16646..
Keywords: Stroke, Cardiovascular Conditions, Rehabilitation, Health Status, Hospitalization, Nursing Homes
Werner RM, Konetzka RT, Qi M
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
The objective of this study was to investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. The investigators concluded that Medicare's SNF copayment policy was associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy had unintended and negative effects on patient outcomes.
AHRQ-funded; HS024266.
Citation: Werner RM, Konetzka RT, Qi M .
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
Health Serv Res 2019 Dec;54(6):1184-92. doi: 10.1111/1475-6773.13227..
Keywords: Medicare, Nursing Homes, Payment, Long-Term Care, Healthcare Costs, Elderly, Hospitalization, Hospital Discharge
McCreedy E, Ogarek JA, Thomas KS
The minimum data set agitated and reactive behavior scale: measuring behaviors in nursing home residents with dementia.
Researchers in this study test the internal consistency and construct validity of the Agitated and Reactive Behavior Scale (ARBS), a measure created to measure agitated and aggressive behaviors in dementia residents at nursing homes (NHs). This cross-sectional study used data from the 2016 national sample of 15,326 Centers for Medicare and Medicaid Services-certified NHs. The sample included 489,854 new admissions and 765,367 long-stay residents (defined as 90 days or more) all diagnosed with dementia. The ARBS is a composite measure of physical and verbal agitation or aggressiveness towards other people; other behavioral symptoms not directed at other people; and rejection of care. The study found that 1) the ARBS score has borderline-adequate internal consistency in the national population of NH residents with dementia; 2) only 18% of new admissions, and 21% of long-stay residents with dementia displayed any aggressive or agitated behaviors in the previous week; and 3) the ARBS demonstrated good construct validity. Conclusions were that nationally available MDS data may significantly underestimate the prevalence of agitated and aggressive behaviors among NH dementia patients.
AHRQ-funded; HS000011.
Citation: McCreedy E, Ogarek JA, Thomas KS .
The minimum data set agitated and reactive behavior scale: measuring behaviors in nursing home residents with dementia.
J Am Med Dir Assoc 2019 Dec;20(12):1548-52. doi: 10.1016/j.jamda.2019.08.030..
Keywords: Elderly, Dementia, Neurological Disorders, Nursing Homes, Long-Term Care, Behavioral Health
Palmer JA, Parker VA, Barre LR
Understanding implementation fidelity in a pragmatic randomized clinical trial in the nursing home setting:a mixed-methods examination.
This randomized clinical trial called Pragmatic Trial of Video Education in Nursing Homes (PROVEN) was one of the largest trials to be conducted in nursing homes on education of residents in Advanced Care Planning (ACP). The trial used videos with champions promoting ACP education across two large health-care systems. The trial length was 18 months, with champions offering video education to the residents every six months. At the end of the study 28 interviews involving 33 champions were analyzed. The researchers found different patterns between high- and low-adherence nursing homes. High-adherence nursing homes had more family and patient willingness to engage in the program and champions were better at recruitment. Champions also supplemented the video with ACP conversations.
AHRQ-funded; HS000011.
Citation: Palmer JA, Parker VA, Barre LR .
Understanding implementation fidelity in a pragmatic randomized clinical trial in the nursing home setting:a mixed-methods examination.
Trials 2019 Nov 28;20(1):656. doi: 10.1186/s13063-019-3725-5..
Keywords: Nursing Homes, Long-Term Care, Education: Patient and Caregiver, Health Literacy, Patient and Family Engagement, Elderly
Kapoor A, Field T, Handler S
Characteristics of long-term care residents that predict adverse events after hospitalization.
This study examined the characteristics of long-term care (LTC) residents that predict adverse events (AEs) after discharge from recent hospitalization. This cohort study looked at AEs that occurred at 32 nursing homes from six New England states. AE incidents involving a total of 555 LTC residents with 762 transitions from the hospital back to LTC were reviewed. The association between all AEs and preventable AEs developing in the 45 days following discharge back to LTC was measured. There were 283 discharges with one or more AEs and 212 with preventable AEs. Characteristics independently associated with higher risk of AEs included hospital length of stay (LOS) 9 or more days, 18 or more regularly scheduled medications, and 19 and above on the dependency in activities of daily living (ADL) scale.
AHRQ-funded; HS024422.
Citation: Kapoor A, Field T, Handler S .
Characteristics of long-term care residents that predict adverse events after hospitalization.
J Am Geriatr Soc 2020 Nov;68(11):2551-57. doi: 10.1111/jgs.16770..
Keywords: Elderly, Long-Term Care, Nursing Homes, Hospitalization, Adverse Events, Transitions of Care, Hospital Discharge, Risk
Hua CL, Thomas KS
Coronavirus Disease 19 (COVID-19) restrictions and loneliness among residents in long-term care communities: data from the National Health and Aging Trends Study.
Loneliness has been associated with increased morbidity and mortality among older adults, especially among residents of long-term care (LTC) facilities. COVID-19 disproportionately contributed to deaths in LTC communities during pandemic, especially before the introduction of vaccines. Restrictive measures were instituted in many LTC facilities to try to slow the spread of COVID-19. This report examines whether these restrictive measures were associated with increased loneliness among older adults in LTC communities during the pandemic. Data from the 2020 National Health and Aging Trends Study (NHATS) COVID-19 supplement, a representative sample of Medicare beneficiaries (age 65 and older) was used, with 234 residents participating. Surveys completed by proxies were excluded because loneliness measures were not available. Approximately 28.7% of residents in LTC communities were lonelier during the pandemic than pre-pandemic. Residents who could not leave their rooms appeared to show increased loneliness.
AHRQ-funded; HS000011.
Citation: Hua CL, Thomas KS .
Coronavirus Disease 19 (COVID-19) restrictions and loneliness among residents in long-term care communities: data from the National Health and Aging Trends Study.
J Am Med Dir Assoc 2021 Sep;22(9):1860-61. doi: 10.1016/j.jamda.2021.06.029..
Keywords: COVID-19, Elderly, Long-Term Care, Nursing Homes
Olivieri-Mui BL, Koethe B, Briesacher B
Economic barriers to antiretroviral therapy in nursing homes.
In this study, the investigators’ aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral therapy (ART) when admitted to nursing homes (NHs). They concluded that people living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers.
AHRQ-funded; HS025662.
Citation: Olivieri-Mui BL, Koethe B, Briesacher B .
Economic barriers to antiretroviral therapy in nursing homes.
J Am Geriatr Soc 2020 Apr;68(4):777-82. doi: 10.1111/jgs.16288..
Keywords: Human Immunodeficiency Virus (HIV), Nursing Homes, Long-Term Care, Medication, Access to Care
Sharma H, Konetzka RT, Smieliauskas F
The relationship between reported staffing and expenditures in nursing homes.
AHRQ-funded; HS024967.
Citation: Sharma H, Konetzka RT, Smieliauskas F .
The relationship between reported staffing and expenditures in nursing homes.
Med Care Res Rev 2019 Dec 1;76(6):758-83. doi: 10.1177/1077558717739214..
Keywords: Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Provider Performance, Medicare
McKinnell JA, Singh RD, Miller LG
The SHIELD Orange County project: multidrug-resistant organism prevalence in 21 nursing homes and long-term acute care facilities in Southern California.
The authors reported baseline multidrug-resistant organism (MDRO) prevalence in 21 nursing homes (NHs) and long-term acute care facilities (LTACs). They found that prevalence of MDROs was 65% in NHs and 80% in LTACs. They concluded that the majority of NH residents and LTAC patients harbor MDROs, and that MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.
AHRQ-funded; HS023317.
Citation: McKinnell JA, Singh RD, Miller LG .
The SHIELD Orange County project: multidrug-resistant organism prevalence in 21 nursing homes and long-term acute care facilities in Southern California.
Clin Infect Dis 2019 Oct 15;69(9):1566-73. doi: 10.1093/cid/ciz119.
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Keywords: Nursing Homes, Long-Term Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Patient Safety
Berry SD, Zullo AR, Zhang T
Validation of the FRAiL model to predict non-vertebral and hip fractures in nursing home residents.
This study created a tool to assess non-vertebral and hip fracture risk in long-term nursing home (NH) residents called FRAiL (Fracture Risk Assessment in Long term care). The objective of this retrospective cohort study was to assess the performance of the model to predict 2-year risk of fractures in a separate large cohort of NH residents. The study included most long-stay NH residents in the United States (n = 896,840). Fractures were identified using Medicare claims. The mean age of NH residents was 83.8 years and 70.7% were women. Over the 2-year follow-up period 4.6% were hospitalized with non-vertebral fractures, the majority being hip fractures. In the fully adjusted model, 14 out of 15 model characteristics remained significant predictors of non-vertebral fractures. Female sex, wandering, and falls were strongly associated with non-vertebral fractures.
AHRQ-funded; HS022998.
Citation: Berry SD, Zullo AR, Zhang T .
Validation of the FRAiL model to predict non-vertebral and hip fractures in nursing home residents.
Bone 2019 Nov;128:115050. doi: 10.1016/j.bone.2019.115050..
Keywords: Elderly, Nursing Homes, Long-Term Care, Injuries and Wounds
Paredes AZ, Malik AT, Cluse M
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Emergency general surgery can have a profound impact on the functional status of even previously independent patients. In this study, the investigators examined the role and influence of discharging a patient to a skilled nursing facility. They concluded that after accounting for patient severity and perioperative course, discharge to a skilled nursing facility was an independent risk factor for death, readmission, and postdischarge complications.
AHRQ-funded; HS022694.
Citation: Paredes AZ, Malik AT, Cluse M .
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Surgery 2019 Oct;166(4):489-95. doi: 10.1016/j.surg.2019.04.034..
Keywords: Nursing Homes, Hospital Discharge, Elderly, Ambulatory Care and Surgery, Emergency Department, Outcomes, Hospital Readmissions, Outcomes, Risk
White EM, Aiken LH, McHugh MD
Registered nurse burnout, job dissatisfaction, and missed care in nursing homes.
The purpose of this article was to examine the relationship between registered nurse (RN) burnout, job dissatisfaction, and missed care in nursing homes. The investigators concluded that missed nursing care due to inadequate time or resources is common in nursing homes and is associated with RN burnout and job dissatisfaction; they indicated that improved work environments with sufficient staff hold promise for improving care and nurse retention.
AHRQ-funded; HS000011.
Citation: White EM, Aiken LH, McHugh MD .
Registered nurse burnout, job dissatisfaction, and missed care in nursing homes.
J Am Geriatr Soc 2019 Oct;67(10):2065-71. doi: 10.1111/jgs.16051..
Keywords: Provider: Nurse, Provider, Burnout, Nursing Homes, Long-Term Care, Workforce
Popescu I, Sood N, Joshi S
Trends in the use of skilled nursing facility and home health care under the Hospital Readmissions Reduction Program: an interrupted time-series analysis.
Medicare's Hospital Readmission Reduction Program penalizes hospitals with elevated 30-day readmission rates for acute myocardial infarction, heart failure, or pneumonia. The authors investigated if, in order to reduce readmissions, hospitals may have increased referrals to skilled nursing facilities and home health care. They found that hospitals might be shifting to more intensive postacute care to avoid readmissions among seniors with pneumonia. At the same time, penalized hospitals' efforts to prevent readmissions may be keeping higher proportions of their patients in the community.
AHRQ-funded; HS024284; HS025394.
Citation: Popescu I, Sood N, Joshi S .
Trends in the use of skilled nursing facility and home health care under the Hospital Readmissions Reduction Program: an interrupted time-series analysis.
Med Care 2019 Oct;57(10):757-65. doi: 10.1097/mlr.0000000000001184..
Keywords: Home Healthcare, Nursing Homes, Chronic Conditions, Hospital Readmissions, Long-Term Care, Hospitals, Heart Disease and Health, Pneumonia, Cardiovascular Conditions
Kapoor A, Field T, Handler S
Adverse events in long-term care residents transitioning from hospital back to nursing home.
This study looked at adverse event rates of long-term care residents transitioning back to their nursing home after hospitalization. A prospective cohort study of LTC residents discharged from hospital back to LTC from March 1, 2016, to December 31, 2017 was conducted, and residents were followed up for 45 days. A random sample of 32 nursing homes located in 6 New England states was used, and 555 LTC residents were selected, contributing 762 transitions from hospital back to the same LTC facility. Most of the cohort were female (65.5%) and non-Hispanic white (93.7%). The study used trained nurse abstractors to review nursing home records to determine if an adverse event occurred. Out of 762 discharges there were 379 adverse events. The most common adverse events were pressure ulcers, skin tears, and falls followed by health care-acquired infections. 145 adverse events were considered less serious, with 28 life-threatening, and 8 were fatal. Most of the adverse events were considered preventable or ameliorable.
AHRQ-funded; HS024596.
Citation: Kapoor A, Field T, Handler S .
Adverse events in long-term care residents transitioning from hospital back to nursing home.
JAMA Intern Med 2019 Sep;179(9):1254-61. doi: 10.1001/jamainternmed.2019.2005..
Keywords: Adverse Events, Long-Term Care, Nursing Homes, Transitions of Care, Elderly, Patient Safety, Hospital Discharge, Hospitalization
Chatterjee P, Qi M, Coe NB
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
The authors sought to determine whether patterns of skilled nursing facility (SNF) discharge are associated with the change in Medicare payment responsibility on day 20. They found that Medicare beneficiaries were more often discharged from SNFs on benefit day 20 than on benefit days 19 or 21. Those discharged on day 20 were more likely to be racial/ethnic minorities and to live in areas of lower socioeconomic status compared with those discharged before or after day 20. Their findings suggested an association between disproportionately high SNF discharge rates of vulnerable patients and existing Medicare payment policies. The authors recommended that payment policies be designed with consideration of the potential for such unintended consequences, and that any potential consequences be mitigated by balancing existing payment structures with incentives to provide optimal patient care.
AHRQ-funded; HS024266.
Citation: Chatterjee P, Qi M, Coe NB .
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
JAMA Intern Med 2019 Sep;179(9):1296-98. doi: 10.1001/jamainternmed.2019.1209.
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Keywords: Vulnerable Populations, Nursing Homes, Medicare, Payment, Policy, Social Determinants of Health
Kim KL, LI L, Kuang M
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
The objective of this study was to investigate the association between changes in hospital referral patterns to skilled nursing facilities (SNFs) and Hospital Readmissions Reduction Program (HRRP) penalty pressure. Results showed that HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNFs differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
AHRQ-funded; HS022882.
Citation: Kim KL, LI L, Kuang M .
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
Med Care 2019 Sep;57(9):695-701. doi: 10.1097/mlr.0000000000001169..
Keywords: Hospitals, Nursing Homes, Hospital Readmissions, Payment, Provider Performance
Campbell Britton M, Hodshon B, Chaudhry SI
Implementing a warm handoff between hospital and skilled nursing facility clinicians.
This study focused on increasing better communication during transfers from hospitals and skilled nursing facilities (SNFs). Warm handoffs between hospital and SNF physicians was implemented. Participation in warm handoffs gradually increased – starting at 15.78% in stage 1 and increasing to 46.89% in stage 3. A total of 2417 patient discharges were included in this study.
AHRQ-funded; HS023554.
Citation: Campbell Britton M, Hodshon B, Chaudhry SI .
Implementing a warm handoff between hospital and skilled nursing facility clinicians.
J Patient Saf 2019 Sep;15(3):198-204. doi: 10.1097/pts.0000000000000529..
Keywords: Communication, Patient Safety, Hospital Discharge, Transitions of Care, Care Coordination, Hospitals, Nursing Homes
Zhang T, Lary CW, Zullo AR
Post-hip fracture mortality in nursing home residents by obesity status.
This research letter discusses a study that examined whether obesity status affected mortality in post-hip fracture patients who were nursing home residents. A national cohort of nursing home (NH) residents was examined from national Medicare fee-for-service claims linked to the Minimum Data Set (MDS) from January 2008 through the end of 2009. A total of 33, 622 long-stay residents were identified who had been hospitalized for a hip fracture. They excluded 6918 patients due to a number of factors. They classified residents based on their BMI: normal BMI, overweight, mild obesity, or moderate/severe obesity. They found that being moderate/severely obese did not increase mortality.
AHRQ-funded; HS022998.
Citation: Zhang T, Lary CW, Zullo AR .
Post-hip fracture mortality in nursing home residents by obesity status.
J Am Geriatr Soc 2019 Sep;67(9):1983-85. doi: 10.1111/jgs.16028..
Keywords: Injuries and Wounds, Surgery, Nursing Homes, Obesity, Mortality, Elderly, Long-Term Care, Patient-Centered Outcomes Research
Libertucci J, Bassis CM, Cassone M
Bacteria detected in both urine and open wounds in nursing home residents: a pilot study.
Researchers sought to determine if bacterial species colonizing open wounds are also found in the urine. Their pilot study of nursing home residents provided evidence that bacterial species identified within the urine can also be identified in open wounds in the same patient at one point in time. They recommended further studies to investigate if these species are of the same lineage and if the urinary microbiota are able to seed colonization of open wounds below the umbilicus.
AHRQ-funded; HS019767.
Citation: Libertucci J, Bassis CM, Cassone M .
Bacteria detected in both urine and open wounds in nursing home residents: a pilot study.
mSphere 2019 Aug 28;4(4). doi: 10.1128/mSphere.00463-19..
Keywords: Elderly, Nursing Homes, Long-Term Care, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Patient Safety
Li Y, Cen X, Cai X
Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators.
This study examined the association between the use of “Nursing Home Compare” performance indicators and improved patient safety culture in nursing homes. A survey was conducted in 2017 using AHRQ’s Survey on Patient Safety Culture for Nursing Homes which collects data on 12 core domains of safety culture scores. Out of 2254 nursing homes sampled, there was a response rate of 36%. It was found that for every 10 percentage points increase in overall positive response rate for safety culture, there was an association with 0.56 fewer health care deficiencies, 0.74 fewer substantiated complaints, reduced fines by $2285.20, and 20% increased odds of being designed as 4-star or 5-star.
AHRQ-funded; HS024923.
Citation: Li Y, Cen X, Cai X .
Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators.
Med Care 2019 Aug;57(8):641-47. doi: 10.1097/mlr.0000000000001142..
Keywords: Surveys on Patient Safety Culture, Patient Safety, Nursing Homes, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance
Orth J, Li Y, Simning A
Providing behavioral health services in nursing homes is difficult: findings from a national survey.
This study evaluated access to behavioral health services in nursing homes (NHs). A random sample of 2996 NHs in the United States was identified. Two structured surveys were developed with questions on service availability, quality, satisfaction, staffing, staff education, turnover and service barriers. The surveys were mailed to administrators and directors of nursing in NHs between July and December 2017. The results showed that over 30% reported having inadequate coordination of care between NHs and community providers, and 26.2% had inadequate infrastructure for resident referrals or transport. Staff education was the most important factor associated with subpar provision of behavioral health services in nursing homes.
AHRQ-funded; HS024923.
Citation: Orth J, Li Y, Simning A .
Providing behavioral health services in nursing homes is difficult: findings from a national survey.
J Am Geriatr Soc 2019 Aug;67(8):1713-17. doi: 10.1111/jgs.16017..
Keywords: Elderly, Nursing Homes, Behavioral Health, Access to Care, Long-Term Care, Healthcare Delivery
Perraillon MC, Brauner DJ, Konetzka RT
Nursing home response to Nursing Home Compare: the provider perspective.
This paper examined the validity of quality ratings of nursing homes with Nursing Home Compare (NHC) and assessed the views of nursing home administrators and staff. There was a conflict found between improving ratings and competing goals of maximizing profits and avoidance of litigation. Since the NHC is self-reported there is controversy on its validity due to self-reporting bias.
AHRQ-funded; HS018718.
Citation: Perraillon MC, Brauner DJ, Konetzka RT .
Nursing home response to Nursing Home Compare: the provider perspective.
Med Care Res Rev 2019 Aug;76(4):425-43. doi: 10.1177/1077558717725165..
Keywords: Long-Term Care, Nursing Homes, Provider Performance, Quality of Care, Quality Improvement
Palmer JA, Parker VA, Mor V
Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting.
This research describes the issues encountered while implementing a trial to improve advance care planning (ACP) in nursing homes. The trial, called Pragmatic trial Of Video Education in Nursing homes (PROVEN) was implemented in 119 nursing homes. Semi-structured interviews were conducted at 4 and 15 months of the 18-month implementation period. Forty interviewed were conducted and analyzed using a hybrid deductive/inductive approach. Barriers identified included mandated protocol-driven aspects of the program, time limitations, and lack of perceived relevance and emotional readiness for ACP among stakeholders.
AHRQ-funded; HS000011.
Citation: Palmer JA, Parker VA, Mor V .
Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting.
BMC Health Serv Res 2019 Jul 29;19(1):527. doi: 10.1186/s12913-019-4309-5..
Keywords: Elderly, Nursing Homes
Zhu JM, Navathe A, Yuan Y
Medicare's bundled payment model did not change skilled nursing facility discharge patterns.
The purpose of this study was to evaluate whether participation in Medicare's voluntary Bundled Payments for Care Improvement (BPCI) model was associated with changes in discharge referral patterns to skilled nursing facilities (SNFs), specifically number of SNF partners and discharge concentration. The investigators concluded that hospital participation in BPCI was not associated with changes in the number of SNF partners or in discharge concentration relative to non-BPCI hospitals.
AHRQ-funded; HS024266.
Citation: Zhu JM, Navathe A, Yuan Y .
Medicare's bundled payment model did not change skilled nursing facility discharge patterns.
Am J Manag Care 2019 Jul;25(7):329-34..
Keywords: Medicare, Payment, Practice Patterns, Hospital Discharge, Nursing Homes
Tandan M, Sloane PD, Ward K
Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention.
This study evaluated the impact of a two-year antimicrobial stewardship intervention program at 27 nursing homes. The objective was to identify changes in the prevalence and antimicrobial resistance patterns of potentially pathogenic bacteria in urine cultures. All urine cultures were audited during the time period, and out of 6,718 total urine cultures collected, 68% were positive for potentially antimicrobial resistant bacteria. Most of the bacteria identified were E. coli, Proteus spp, and Klebsiella pneumonia. During the 2-year program there was a significant decrease in nitrofurantoin resistance among E. coli and ciprofloxacin resistant among Proteus spp, but carbanepem resistance increased for Proteus spp. Overall, while there was some reduction in antibiotic resistance, the reductions were too small and scattered to conclude the intervention made a big impact.
AHRQ-funded; HS022846.
Citation: Tandan M, Sloane PD, Ward K .
Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention.
Infect Control Hosp Epidemiol 2019 Jul;40(7):780-86. doi: 10.1017/ice.2019.108..
Keywords: Antibiotics, Antimicrobial Stewardship, Elderly, Long-Term Care, Medication, Nursing Homes