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
1 to 25 of 327 Research Studies DisplayedClark SE, Bautista L, Neeb K
Post-acute sequelae of SARS-CoV-2 (PASC) in nursing home residents: a retrospective cohort study.
This retrospective cohort study was conducted at two nursing homes in Michigan to explore post-acute sequelae of SARS-CoV-2 (PASC) among residents. Minimum Data Set was used to examine trajectories of functional dependence and cognitive function. The results suggested that nursing-home residents experienced a significant functional decline persisting for nine months following acute infection. The authors concluded that further research is needed to determine whether increased rehabilitation services after COVID-19 may help mitigate this decline.
AHRQ-funded; 1HS025451.
Citation: Clark SE, Bautista L, Neeb K .
Post-acute sequelae of SARS-CoV-2 (PASC) in nursing home residents: a retrospective cohort study.
J Am Geriatr Soc 2024 Feb; 72(2):551-58. doi: 10.1111/jgs.18678.
Keywords: COVID-19, Nursing Homes
Powell KR, Farmer M, Liu J
A survey of technology abandonment in US nursing homes.
This study examined abandonment of health information technology (HIT) by US nursing homes (NHs) and its association with organizational characteristics among a national sample of US NHs. This longitudinal, retrospective analysis used data from 2 sources: the HIT Maturity Survey and Staging model and public data from the Care Compare database. The authors used a random sample of 299 NHs representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019-August 2020 and year 2 (Y2) was June 2020-August 2021. The primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain; and independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating. Results were that over the 2-year period HIT abandonment occurred in 28% of NHs compared with 44% that experienced growth in HIT systems. Capabilities in resident care was abandoned most frequently. They found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities. They concluded that technology abandonment can increase strain on scarce resources and may impact administrators' ability to oversee clinical operations, especially in large NHs.
AHRQ-funded; HS022497.
Citation: Powell KR, Farmer M, Liu J .
A survey of technology abandonment in US nursing homes.
J Am Med Dir Assoc 2024 Jan; 25(1):6-11. doi: 10.1016/j.jamda.2023.09.002..
Keywords: Nursing Homes, Health Information Technology (HIT), Long-Term Care
Jones KM, Krein SL, Mantey J
Characterizing infection prevention programs and urinary tract infection prevention practices in nursing homes: a mixed-methods study.
This study assessed nursing home (NH) infection prevention and control (IPC) resources and practices related to catheter and non-catheter-associated urinary tract infection (CAUTI and UTI). This mixed-methods study was conducted from April 2018 through November 2019 using quantitative surveys and semistructured qualitative interviews. Surveys were completed by 51 NH infection preventionists (IPs), and interviews were conducted with 13 participants from 7 NHs. The participating IPs had limited experience and/or additional roles, and in 36.7% of NHs, IPs had no specific IPC training, with a high turnover rate often mentioned during interviews. Most NHs were aware of their CAUTI and UTI rates and reported using prevention practices, such as hydration (85.7%) or nurse-initiated catheter discontinuation (65.3%). Interviewees expressed concerns about overuse of urine testing and antibiotics. Transfer sheets were used by 84% to communicate about infection, but the information received was described as suboptimal.
AHRQ-funded; HS25451.
Citation: Jones KM, Krein SL, Mantey J .
Characterizing infection prevention programs and urinary tract infection prevention practices in nursing homes: a mixed-methods study.
Infect Control Hosp Epidemiol 2024 Jan; 45(1):40-47. doi: 10.1017/ice.2023.127..
Keywords: Urinary Tract Infection (UTI), Nursing Homes, Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Prevention
Joyce NR, Robertson SE, McCreedy E
Assessing the representativeness of cluster randomized trials: evidence from two large pragmatic trials in United States nursing homes.
Researchers linked data from two large nursing home-based pragmatic cluster randomized trials, the high-dose influenza vaccine trial and the Music & Memory Pragmatic TRIal for Nursing Home Residents with ALzheimer's Disease (METRICaL), to nursing home assessments and Medicare fee-for-service claims. Their objective was to compare nursing home and resident characteristics in randomized facilities to non-randomized and ineligible facilities. Facility-level characteristics of randomized nursing homes in both trials were found to differ considerably from those of non-randomized and ineligible facilities; little difference was found in resident-level characteristics between the three groups. The researchers concluded that future investigation should assess the characteristics of clusters that participate in cluster randomized trials when examining the applicability of trial results beyond participating clusters.
AHRQ-funded; HS022998.
Citation: Joyce NR, Robertson SE, McCreedy E .
Assessing the representativeness of cluster randomized trials: evidence from two large pragmatic trials in United States nursing homes.
Clin Trials 2023 Dec; 20(6):613-23. doi: 10.1177/17407745231185055..
Keywords: Nursing Homes, Research Methodologies
Taylor LN, Wilson BM, Singh M
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
The goal of this survey study was to determine if providing nursing home (NH) clinicians with syndromic antibiograms improves antibiotic treatment urinary tract infections (UTIs). The researchers concluded providing the NH clinicians with urinary antibiograms is associated with selection of active and optimal antibiotics when empirically treating UTIs under simulated conditions.
AHRQ-funded; HS027820.
Citation: Taylor LN, Wilson BM, Singh M .
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
JAMA Netw Open 2023 Dec; 6(12):e2349544. doi: 10.1001/jamanetworkopen.2023.49544..
Keywords: Nursing Homes, Antibiotics, Medication, Urinary Tract Infection (UTI)
Miller LG, McKinnell JA, Singh RD
Decolonization in nursing homes to prevent infection and hospitalization.
Researchers conducted a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. Data were obtained from 28 nursing homes. The results indicated that universal decolonization with chlorhexidine and nasal iodophor led to a significantly lower risk of transfer to a hospital due to infection than routine care.
AHRQ-funded; HS024286.
Citation: Miller LG, McKinnell JA, Singh RD .
Decolonization in nursing homes to prevent infection and hospitalization.
N Engl J Med 2023 Nov 9; 389(19):1766-77. doi: 10.1056/NEJMoa2215254..
Keywords: Nursing Homes, Long-Term Care, Healthcare-Associated Infections (HAIs)
Wang J, Mao Y, McGarry B
Assisted living or nursing home: who is moving in?
The purpose of this study was to examine the traits of older adults at the time of assisted living (AL) community admission and how those traits compare to individuals newly admitted to nursing homes (NH) to explore the differences. This study examined the individual, facility, and geographic factors associated with new AL admission. The study found that demographic, socioeconomic, and health service use traits were related with new admission to long-term care. those age 75 years and older, male, Medicare fee-for-service beneficiaries, having one skilled nursing facility (SNF) stay or any hospital stay within the prior 6 months have a greater likelihood of being newly admitted to AL, whereas those who are racial/ethnic minorities, dually eligible, and with two or more SNF stays within the past 6 months have a greater likelihood of being admitted to an NH.
AHRQ-funded; HS026893.
Citation: Wang J, Mao Y, McGarry B .
Assisted living or nursing home: who is moving in?
J Am Geriatr Soc 2023 Nov; 71(11):3480-88. doi: 10.1111/jgs.18503..
Keywords: Elderly, Long-Term Care, Nursing Homes
Chen Z, Gleason LJ, Konetzka RT
Accuracy of infection reporting in US nursing home ratings.
The objective of this study was to assess the accuracy of publicly reported nursing home data on urinary tract infections (UTIs) and of pneumonia data, which are not publicly reported. Researchers developed a claims-based nursing home-level measure of hospitalized infections and estimated correlations between this and publicly reported ratings. Subjects were Medicare fee-for-service beneficiaries who were nursing home residents and hospitalized for UTI or pneumonia during the study period. Findings suggested that both UTI and pneumonia were substantially underreported in data used for national public reporting. The researchers concluded that alternative approaches were needed to improve surveillance of nursing home quality.
AHRQ-funded; HS026957.
Citation: Chen Z, Gleason LJ, Konetzka RT .
Accuracy of infection reporting in US nursing home ratings.
Health Serv Res 2023 Oct; 58(5):1109-18. doi: 10.1111/1475-6773.14195..
Keywords: Provider Performance, Nursing Homes, Long-Term Care, Pneumonia, Urinary Tract Infection (UTI), Elderly
Thompson MP, Stewart JW, Hou H
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
The purpose of this study was to assess determinants and outcomes related with Skilled nursing facility (SNF) use after isolated coronary artery bypass grafting. The study sample included 8,614 patients, with an average age of 73.3 years. A skilled nursing facility (SNF) was used by 22.3% of patients within 90 days of discharge and ranged from 3.2% to 58.3% across the 33 hospitals. Patients utilizing SNFs had a greater likelihood of being female, older, non-White, with greater comorbidities, worse cardiovascular function, a perioperative morbidity, and longer hospital lengths of stay. Outcomes were significantly worse for users of SNFs, including higher rates of 90-day readmissions and ED visits and lower use of home health and rehabilitation services. Compared with non-SNF users, users of SNFs had a greater risk-adjusted hazard of mortality and had 2.7-percentage point greater 5-year mortality rate in a propensity-matched cohort of patients.
AHRQ-funded; HS027830.
Citation: Thompson MP, Stewart JW, Hou H .
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009639. doi: 10.1161/circoutcomes.122.009639..
Keywords: Elderly, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Medicare, Surgery
Hua Y, Temkin-Greener H, Cai S
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
The purpose of this study was to explore primary care telemedicine use among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) who resided in Assisted Living Facilities (Als) during the early stage of the COVID-19 pandemic, with a focus on possible racial and socioeconomic differences. The study found that at the start of the pandemic in quarter 2 of 2020, Black residents were less likely to have telemedicine visits than their White counterparts. In the following two quarters, Black residents were more likely to receive primary care via telemedicine than White residents; a similar difference was observed between Hispanic and White residents, but with smaller effect sizes. Compared with nondual residents, dual residents were more likely to receive primary care via telemedicine in Q3. In addition, residents in AL communities with a higher proportion of dual residents, compared with those in low-dual ALs, were less likely to receive primary care via telemedicine throughout the study period. However, the difference in telemedicine use between higher vs lower dual ALs narrowed over time.
AHRQ-funded; HS026893.
Citation: Hua Y, Temkin-Greener H, Cai S .
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
J Am Med Dir Assoc 2023 Aug; 24(8):1157-58.e3. doi: 10.1016/j.jamda.2023.05.005..
Keywords: COVID-19, Primary Care, Telehealth, Health Information Technology (HIT), Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Racial and Ethnic Minorities, Elderly
Sharma H, Xu L
Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes.
The objective of this study was to estimate the effect of participation in the intergovernmental transfers-based Medicaid supplemental payment program on nursing home revenue and expenditures. Data was taken from all Medicare and Medicaid-certified nursing homes in Indiana from 2009-17. The findings indicated that nursing homes owned or operated by nonstate governmental organizations received a fraction of the total supplemental payments on average, but the authors observed increased payments in later years. Participating nursing homes did not increase clinical expenses. The authors concluded that these findings raised questions regarding the transparency of financing arrangements between nonstate governmental organizations and nursing homes and the need to link supplemental payments to clinical expenses.
AHRQ-funded; HS027235.
Citation: Sharma H, Xu L .
Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes.
Med Care 2023 Aug; 61(8):546-53. doi: 10.1097/mlr.0000000000001875..
Keywords: Nursing Homes, Medicare, Medicaid, Healthcare Costs
Di M, Keeney T, Belanger E
Functional status and therapy for older adults with diffuse large B-cell lymphoma in nursing homes: a population-based study.
The purpose of this study was to describe the prevalence of functional and cognitive impairments, and relationships between impairments and treatment in older patients with diffuse large B cell lymphoma (DLBCL) receiving nursing home (NH) care. The study found that of the eligible 649 NH patients 45% received chemoimmunotherapy; among the recipients, 47% received multi-agent, anthracycline-containing regimens. Those patients in a NH were less likely to receive chemoimmunotherapy, had higher 30-day mortality, and poorer OS compared with community-dwelling patients. NH patients with severe functional (61%) or any cognitive impairment (48%) were less likely to receive chemoimmunotherapy.
AHRQ-funded; HS000011.
Citation: Di M, Keeney T, Belanger E .
Functional status and therapy for older adults with diffuse large B-cell lymphoma in nursing homes: a population-based study.
J Am Geriatr Soc 2023 Jul; 71(7):2239-49. doi: 10.1111/jgs.18302..
Keywords: Elderly, Nursing Homes, Medicare, Cancer, Treatments
Wretman CJ, Boynton MH, Preisser JS
Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: a discrete choice experiment.
The purpose of this study was to address the overdiagnosis of UTIs in nursing home residents as a significant public health threat by exploring which patient-level information was related with the overdiagnosis. The study found that the results of urinalyses and lower urinary tract status were most related with the overdiagnosis of UTIs.
AHRQ-funded; HS024519.
Citation: Wretman CJ, Boynton MH, Preisser JS .
Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: a discrete choice experiment.
Infect Control Hosp Epidemiol 2023 Jul; 44(7):1151-54. doi: 10.1017/ice.2022.171..
Keywords: Urinary Tract Infection (UTI), Nursing Homes, Long-Term Care, Diagnostic Safety and Quality, Elderly
Mao Y, Li Y, McGarry B
Are online reviews of assisted living communities associated with patient-centered outcomes?
The purpose of this study was to explore the relationship between assisted living (AL) online quality review ratings and AL residents' home time. The researchers identified Medicare beneficiaries who entered AL communities in 2018, with the main outcome of resident home time in the year after AL admission. Additional outcomes were the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. The study sample included 59,831 residents in 12,143 ALs. AL online Google reviews for 2013-2017 were linked to 2018-2019 Medicare data. AL average rating score and rating status were generated using Google reviews. The study found that from 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one-unit increase in the AL's average online rating was associated with an increase in residents' risk-adjusted home time by 0.33 percentage points. Residents in high-rated ALs had a 0.64 pp increase in home time compared with residents in ALs without ratings. Thet study concluded that higher online rating scores were positively associated with residents' home time, and a lack of ratings was related with decreased home time.
AHRQ-funded; HS026893.
Citation: Mao Y, Li Y, McGarry B .
Are online reviews of assisted living communities associated with patient-centered outcomes?
J Am Geriatr Soc 2023 May; 71(5):1505-14. doi: 10.1111/jgs.18192..
Keywords: Elderly, Long-Term Care, Patient-Centered Healthcare, Nursing Homes, Provider Performance, Medicare, Medicaid
Sanghavi P, Chen Z
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
The purpose of this study was to evaluate the relationship between nursing home characteristics and reporting of 2 of 3 specific clinical outcomes reported by the Nursing Home Care Compare (NHCC) website: major injury falls and pressure ulcers. The researchers of this quality improvement study utilized hospitalization data for all Medicare fee-for-service beneficiaries between January 1, 2011, and December 31, 2017. Hospital admission claims for major injury falls and pressure ulcers were linked with facility-reported evaluations at the nursing home resident level. For each linked hospital claim, it was determined whether the nursing home had reported the event and rates of reporting were computed. To evaluate whether nursing homes reported similarly on both measures, the researchers estimated the relationship between reporting of major injury falls and pressure ulcers within a nursing home, and explored racial and ethnic disparities that could otherwise explain the associations. The study sample included 13,179 nursing homes where 131,000 residents experienced major injury fall or pressure ulcer hospitalizations. Of the 98,669 major injury fall hospitalizations, 60.0% were reported, and of the 39,894 stage 3 or 4 pressure ulcer hospitalizations, 67.7% were reported. Underreporting for both conditions was pervasive, with 69.9% and 71.7% of nursing homes having reporting rates less than 80% for major injury fall and pressure ulcer hospitalizations, respectively. Lower reporting rates had few correlations with facility characteristics other than racial and ethnic composition. Facilities with high vs low fall reporting rates had significantly more White residents (86.9% vs 73.3%), and facilities with high vs low pressure ulcer reporting rates had significantly fewer White residents (69.7% vs 74.9%).
AHRQ-funded; HS026957.
Citation: Sanghavi P, Chen Z .
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
JAMA Netw Open 2023 May; 6(5):e2314822. doi: 10.1001/jamanetworkopen.2023.14822..
Keywords: Quality Measures, Quality of Care, Elderly, Disparities, Racial and Ethnic Minorities, Nursing Homes, Pressure Ulcers, Healthcare-Associated Infections (HAIs), Quality Indicators (QIs), Long-Term Care
Temkin-Greener H, Mao Y, Li Y
Using Medicare enrollment data to identify beneficiaries in assisted living.
The authors developed an approach for identifying Medicare beneficiaries residing in US assisted living (AL) communities in 2018. Data sources included a national directory of licensed ALs, a file of US addresses and their associated 9-digit ZIP codes (ZIP+4), the Medicare Enrollment Database (EDB), the Master Beneficiary Summary File (MBSF), and the Minimum Data Set (MDS). The cohorts of beneficiaries identified as AL residents exhibited good construct validity; AL residents also showed similar demographic characteristics to the 2018 sample from the National Survey of Long-Term Care Providers. The authors concluded that, as this residential setting continues to grow, future studies will need effective approaches such as their proposed methodology for identifying Medicare beneficiaries who reside in AL facilities in order to evaluate the quality of care they receive.
AHRQ-funded; HS026893.
Citation: Temkin-Greener H, Mao Y, Li Y .
Using Medicare enrollment data to identify beneficiaries in assisted living.
J Am Med Dir Assoc 2023 Mar;24(3):277-83. doi: 10.1016/j.jamda.2022.01.062.
Keywords: Medicare, Nursing Homes, Research Methodologies
Hakimjavadi R, Karunananthan S, Alexander G
What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol.
As the number of Canadians aged 75 years and older is projected to double in the next two decades, long-term care (LTC) systems will face increasing pressure. Health information technology (IT) has demonstrated its ability to enhance the quality, safety, and efficiency of care across various clinical environments and could potentially improve LTC for residents. The purpose of this cross-sectional study will be to thoroughly assess the extent of health IT adoption in Ontario's LTC homes and establish a baseline comprehension for future planning. The researchers will utilize the LTC IT Maturity Instrument to evaluate IT capabilities, the extent of IT usage, and the degree of internal/external IT integration across the domains of resident care, clinical support, and administrative activities. All LTC homes in Ontario will be invited to participate.
AHRQ-funded; HS022497.
Citation: Hakimjavadi R, Karunananthan S, Alexander G .
What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol.
BMJ Open 2023 Feb 10; 13(2):e064745. doi: 10.1136/bmjopen-2022-064745..
Keywords: Health Information Technology (HIT), Long-Term Care, Nursing Homes
Kalata S, Howard R, Diaz A
Association of skilled nursing facility ownership by health care networks with utilization and spending.
The objective of this cross-sectional study was to determine the association of vertical integration of skilled nursing facilities (SNFs) within hospital networks with SNF utilization, readmissions, and spending. Claims data from Medicare beneficiaries aged 66 to 99 who had undergone elective hip replacement in nonfederal acute care hospitals during the study period was analyzed. Results showed that vertical SNF integration was associated with a higher rate of SNF utilization and a lower 30-day readmission rate; in spite of higher utilization, 30-day episode payments were slightly lower. Adjusted readmission rates were especially low for patients who were not sent to an SNF but were significantly higher for patients with a length of stay of less than 5 days. The authors concluded these findings support the value of integrating SNFs into hospital networks, but there is room for improvement in postoperative care early in the SNF patients’ stay.
AHRQ-funded; HS028606.
Citation: Kalata S, Howard R, Diaz A .
Association of skilled nursing facility ownership by health care networks with utilization and spending.
JAMA Netw Open 2023 Feb; 6(2):e230140. doi: 10.1001/jamanetworkopen.2023.0140..
Keywords: Nursing Homes, Healthcare Utilization, Healthcare Costs, Medicare
Zuo SW, Ackenbom MF, Harris J
Racial differences in urinary catheter use among female nursing home residents.
This study assessed racial differences in prevalence of indwelling urinary catheterization and intermittent catheterization among female nursing home (NH) residents in the US. This cross-sectional analysis used the 2019 Minimum Data Set 3.0 and looked at a cohort of 597,966 women predominantly White race with a median age of 80 years. Eight percent of female residents had indwelling catheters, and 0.5% used intermittent catheterization. Black residents had a 7% lower odds of having an indwelling catheter, and a 38% lower odds of utilizing intermittent catheterization compared to White residents when controlling for common factors associated with catheter use.
AHRQ-funded; HS026943.
Citation: Zuo SW, Ackenbom MF, Harris J .
Racial differences in urinary catheter use among female nursing home residents.
Urology 2023 Feb; 172:105-10. doi: 10.1016/j.urology.2022.11.026..
Keywords: Elderly, Racial and Ethnic Minorities, Nursing Homes, Women
Powell KR, Winkler AE, Liu J
A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic.
The objective of this study was to investigate the implementation of telehealth in nursing homes during the COVID-19 pandemic. Researchers conducted a secondary analysis of data from a national survey of nursing home administrative leaders using six survey questions and semi-structured interviews. Their conclusions indicate that training, restructuring teams and tasks, and adaptation of work processes to support communication could improve usability and sustainability of telehealth in nursing homes.
AHRQ-funded; HS02249.
Citation: Powell KR, Winkler AE, Liu J .
A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic.
J Am Geriatr Soc 2022 Dec;70(12):3493-502. doi: 10.1111/jgs.18020..
Keywords: COVID-19, Elderly, Telehealth, Health Information Technology (HIT), Nursing Homes, Implementation
Crnich CJ
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
This paper provides an overview of nursing home (NH) infection and control, reviews the 2016 CMS changes to federal regulations, and proposes recommendations to sustain improvements. COVID-19 put further pressure on nursing homes who were already strained by rising numbers of infections from C. difficile and multidrug-resistant organisms. The author puts out a call for reimagining infection prevention and control using the Systems Engineering Initiative for Patient Safety framework. Additional recommendations are made to enhance NH infection prevention and control programs in the areas of people, tasks, tools, organization, built environment, and external environment.
AHRQ-funded; HS022465.
Citation: Crnich CJ .
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc 2022 Dec;23(12):1909-15. doi: 10.1016/j.jamda.2022.10.022..
Keywords: Elderly, COVID-19, Public Health, Infectious Diseases, Nursing Homes, Healthcare-Associated Infections (HAIs), Prevention
Chen Z, Gleason LJ, Sanghavi P
Accuracy of pressure ulcer events in US nursing home ratings.
This study investigated the accuracy of the government website Nursing Home Compare (NHC) pressure ulcer measures, which are chief indicators of nursing home patient safety. The authors identified hospital admissions for pressure ulcers and linked them to the nursing home-reported data at the patient level using Medicare fee-for-service beneficiaries who were nursing home residents between 2011 and 2017. Percentages of pressure ulcers that were appropriately reported by stage, long-stay versus short-stay status, and race was calculated. Reporting rates were low for both short-stay (70.2%) and long-stay (59.7%) for stage 2-4 pressure ulcer hospitalizations. Black residents experienced more severe pressure ulcers than White residents. Correlations between claims-based measures and NHC ratings were found to be poor.
AHRQ-funded; HS026957.
Citation: Chen Z, Gleason LJ, Sanghavi P .
Accuracy of pressure ulcer events in US nursing home ratings.
Med Care 2022 Oct;60(10):775-83. doi: 10.1097/mlr.0000000000001763.
AHRQ-funded; HS026957..
AHRQ-funded; HS026957..
Keywords: Elderly, Nursing Homes, Long-Term Care, Pressure Ulcers, Quality Measures, Quality of Care, Patient Safety
Uribe-Cano D, Bahranian M, Jolles SA
Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes.
Researchers studied the extent to which the revised McGeer and Loeb criteria overlap and can be used interchangeably for tracking antibiotic appropriateness in nursing homes. Using a cross-sectional chart review in 5 Wisconsin nursing homes, they found that levels of agreement between the revised McGeer and Loeb criteria were moderate for urinary tract infections, fair for skin and soft-tissue infections, and slight for respiratory tract infections. They concluded that agreement between the revised McGeer and Loeb criteria is limited, and that nursing homes should employ the revised McGeer and Loeb criteria for their intended purposes.
AHRQ-funded; HS022465.
Citation: Uribe-Cano D, Bahranian M, Jolles SA .
Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes.
Infect Control Hosp Epidemiol 2022 Jul;43(7):860-63. doi: 10.1017/ice.2021.221..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Antimicrobial Stewardship, Medication
Liu MA, Keeney T, Papaila A
Functional status and survival in older nursing home residents with advanced non-small-cell lung cancer: a SEER-Medicare analysis.
The purpose of this study was to examine the association between activities of daily living (ADL) impairment and overall survival in patients 65 and older with advanced non-small-cell lung cancer (NSCLC) receiving care in nursing homes from 2011 to 2015. The researchers examined the association between ADL scores and overall survival among 3,174 patients who received systemic cancer chemotherapy or immunotherapy within 3 months of NSCLC diagnosis; and among patients who did not receive any treatment. The study found that the ADL score was associated with increased risk of death. One standard deviation increase in the ADL score was associated with lower overall survival rate among treated and untreated patients The median overall survival was 3.1 months for patients with an ADL score of less than 14, 2.8 months for patients with an ADL score between 14 and 17, 2.3 months for patients with ADL score between 18-19, and 1.8 months for patients with ADL score of 20+. The researchers concluded that the ADL assessment may be a useful clinical tool in nursing home adults aged 65 and older with advanced non-small-cell lung cancer.
AHRQ-funded; HS000011.
Citation: Liu MA, Keeney T, Papaila A .
Functional status and survival in older nursing home residents with advanced non-small-cell lung cancer: a SEER-Medicare analysis.
JCO Oncol Pract 2022 Jun;18(6):e886-e95. doi: 10.1200/op.21.00460..
Keywords: Elderly, Nursing Homes, Cancer: Lung Cancer, Cancer
Dube WC, Kellogg JT, Adams C
Quantifying risk for SARS-CoV-2 infection among nursing home workers for the 2020-2021 winter surge of the COVID-19 pandemic in Georgia, USA.
This study’s objective was to estimate incidence of risks for COVID-19 infection among nursing home staff in the state of Georgia during the 2020-2021 Winter surge in the US. Staff at fourteen nursing homes were given a survey and serologic testing at 2 time points with 3-month interval exposure assessment. At the first time point, 203 study eligible contracted or employed staff members from these participating nursing homes were seronegative. At the second time point, 72 (35.5%) had evidence of interval infection. Among unvaccinated staff, infection rates were significantly higher among nurses and certified nursing assistants accounting for race and interval infection incidence in both the community and facility.
AHRQ-funded; HS025987.
Citation: Dube WC, Kellogg JT, Adams C .
Quantifying risk for SARS-CoV-2 infection among nursing home workers for the 2020-2021 winter surge of the COVID-19 pandemic in Georgia, USA.
J Am Med Dir Assoc 2022 Jun;23(6):942-46.e1. doi: 10.1016/j.jamda.2022.02.014..
Keywords: COVID-19, Nursing Homes, Provider: Health Personnel, Risk, Public Health