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- Adverse Events (2)
- Caregiving (2)
- Chronic Conditions (1)
- Comparative Effectiveness (1)
- Decision Making (1)
- Dementia (1)
- (-) Elderly (8)
- Evidence-Based Practice (1)
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- (-) Transitions of Care (8)
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 8 of 8 Research Studies DisplayedGuo W, Cai S, Caprio T
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
This study’s objective was to examine the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations. This cohort study included Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662). The authors found end-of-life care transitions were observed among 34.89% of our study sample in the last 30 days before death, and among 17.25% in the last 7 days. Higher frequency of care transitions in the last 7 days of life was associated with higher regulatory specificity of licensed [incidence risk ratio (IRR) = 1.08] and direct care worker staffing (IRR = 1.22). Greater regulatory specificity of direct care worker training (IRR = 0.75) was associated with fewer transitions. Similar associations were found for direct care worker staffing (IRR = 1.15) and training (IRR = 0.79) and transitions within 30 days of death. There were significant variations in the number of care transitions in different states.
AHRQ-funded; HS026893.
Citation: Guo W, Cai S, Caprio T .
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
J Am Med Dir Assoc 2023 Jun; 24(6):827-32.e3. doi: 10.1016/j.jamda.2023.02.002..
Keywords: Transitions of Care, Long-Term Care, Policy, Palliative Care, Elderly
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
Zmora R, Statz TL, Birkeland RW
Transitioning to long-term care: family caregiver experiences of dementia, communities, and counseling.
Previous analyses of interventions targeting relationships between family caregivers of people with Alzheimer's disease and related dementias and residential long-term care (RLTC) staff showed modest associations with caregiver outcomes. This analysis aimed to better understand interpersonal and contextual factors that influence caregiver-staff relationships and identify targets for future interventions to improve these relationships.
AHRQ-funded; HS022836.
Citation: Zmora R, Statz TL, Birkeland RW .
Transitioning to long-term care: family caregiver experiences of dementia, communities, and counseling.
J Aging Health 2021 Jan;33(1-2):133-46. doi: 10.1177/0898264320963588..
Keywords: Elderly, Caregiving, Dementia, Transitions of Care, Long-Term Care, Chronic Conditions
Makam AN, Nguyen OK, Miller ME
Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer.
This study compared the effectiveness of long-term acute care hospital (LTACH) use versus skilled nursing facility (SNF) transfer after hospitalization. Medicare claims linked to electronic health record (EHR) data from six Texas hospitals between 2009 and 2010 were used to conduct a retrospective cohort study of hospitalized patients transferred to either an LTACH or SNF and followed for one year. Out of 3505 patients, 18% were transferred to an LTACH and overall were younger, less likely to be female, and white, but sicker than transfers to an SNF. Patients transferred to an LTACH were less likely to survive (59 vs. 65%) or recover (62.5 vs 66%). Adjusting for demographic and clinical confounders found in Medicare claims and EHR data, transfer location was not significantly associated with differences in mortality but was associated with greater Medicare spending.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Miller ME .
Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer.
BMC Health Serv Res 2020 Nov 11;20(1):1032. doi: 10.1186/s12913-020-05847-6..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Long-Term Care, Elderly, Medicare, Transitions of Care, Nursing Homes, Hospitals
Abrahamson K, Hass Z, Arling G
Shall I stay or shall I go? The choice to remain in the nursing home among residents with high potential for discharge.
This study examines why private-pay nursing home (NH) residents who expressed a desire for discharge and had relatively low-care needs chose to remain in the NH. The Minnesota Return to Community Initiative (RTCI) is a program that assists those residents to return to the community. Those who remained were more likely to beolder, more cognitively impaired, unmarried, had behavior problems, or diagnosed with dementia. At a 90-day assessment, residents who remained in the facility had a small decline in cognitive status, their continence improved, and they become more independent in activities of daily living (ADLs). Seventy-four percent of those remaining reported a perception of health barriers to discharge.
AHRQ-funded; HS020224.
Citation: Abrahamson K, Hass Z, Arling G .
Shall I stay or shall I go? The choice to remain in the nursing home among residents with high potential for discharge.
J Appl Gerontol 2020 Aug;39(8):863-70. doi: 10.1177/0733464818807818..
Keywords: Elderly, Nursing Homes, Long-Term Care, Transitions of Care, Decision Making
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
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
Makam AN, Nguyen OK, Xuan L
Factors associated with variation in long-term acute care hospital vs skilled nursing facility use among hospitalized older adults.
This study examined factors associated with variation in long-term acute care hospitals (LTACs) vs less costly skilled nursing facilities (SNFs) transfer among hospitalized older adults. It concluded that half of the variation in LTAC vs SNF transfer is independent of patients' illness severity or clinical complexity, and is explained by where the patient was hospitalized and in what region, with far greater use in the South.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Xuan L .
Factors associated with variation in long-term acute care hospital vs skilled nursing facility use among hospitalized older adults.
JAMA Intern Med 2018 Mar;178(3):399-405. doi: 10.1001/jamainternmed.2017.8467.
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Keywords: Elderly, Long-Term Care, Hospitals, Nursing Homes, Transitions of Care