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 158 Research Studies DisplayedPowell 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
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
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
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
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
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
Wang J, Mao Y, McGarry B
Post-acute care transitions and outcomes among Medicare beneficiaries in assisted living communities.
This study examined the post-acute care transitions among assisted living (AL) residents and their association with outcomes in the first 30 and 60 days after hospital discharge. Findings showed that the most common post-acute care referral was to skilled nursing facilities (SNF), followed by home without home health care (HHC), home with HHC, and others. Compared to discharge home without HHC, discharge to SNF was associated with a lower likelihood of ED visits and hospital readmissions, and higher likelihood of long-stay nursing home placement and mortality. Discharge home with HHC was associated with a higher likelihood of hospital readmissions and a lower likelihood of long-stay nursing home placement than discharge home without HHC. The results were similar within the first 30 days and 60 days after hospital discharge.
AHRQ-funded; HS026893.
Citation: Wang J, Mao Y, McGarry B .
Post-acute care transitions and outcomes among Medicare beneficiaries in assisted living communities.
J Am Geriatr Soc 2022 May;70(5):1429-41. doi: 10.1111/jgs.17669..
Keywords: Elderly, Medicare, Nursing Homes, Long-Term Care
Kistler 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, Decision Making
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
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
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, 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
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