Factors Associated With Variation in Long-term Acute Care Hospital vs Skilled Nursing Facility Use Among Hospitalized Older Adults

OBJECTIVETo determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR)Acinetobacter baumannii.DESIGNOutbreak investigation.SETTING AND PARTICIPANTSResidents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.METHODSA case was defined as the incident isolate from clinical or surveillance cultures of XDRAcinetobacter baumanniiresistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.RESULTSWe identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDRA. baumanniiisolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase geneblaOXA-237was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.CONCLUSIONSInterfacility transmission of XDRA. baumanniicarrying the rare blaOXA-237was facilitated by transfer of affected patients without communication to receiving facilities.Infect Control Hosp Epidemiol2017;38:1335–1341

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Reduction in the Incidence of Clostridium difficile-Associated Diarrhea in an Acute Care Hospital and a Skilled Nursing Facility following Replacement of Electronic Thermometers with Single-Use Disposables

Infection Control and Hospital Epidemiology ◽

10.2307/30147068 ◽

1992 ◽

Vol 13 (2) ◽

pp. 98-103 ◽

Cited By ~ 67

Author(s):

Steven E. Brooks ◽

Rebecca O. Veal ◽

Martin Kramer ◽

Laura Dore ◽

Nicole Schupf ◽

...

Keyword(s):

Clostridium Difficile ◽

Acute Care ◽

Skilled Nursing Facility ◽

Acute Care Hospital ◽

Care Hospital ◽

Nursing Facility ◽

Skilled Nursing ◽

Single Use ◽

Clostridium Difficile Associated Diarrhea

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Factors Associated with Functional Decline in Older Adults After Discharge from an Acute-Care Hospital

Asian Nursing Research ◽

10.1016/j.anr.2019.05.001 ◽

2019 ◽

Vol 13 (3) ◽

pp. 192-199

Author(s):

Hai-Won Yoo ◽

Myo-Gyeong Kim ◽

Doo-Nam Oh ◽

Jeong-Hae Hwang ◽

Kun-Sei Lee

Keyword(s):

Older Adults ◽

Acute Care ◽

Functional Decline ◽

Acute Care Hospital ◽

Care Hospital ◽

Factors Associated

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Factors Associated with Short- Versus Long-Term Skilled Nursing Facility

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.1990.tb01378.x ◽

1990 ◽

Vol 38 (10) ◽

pp. 1139-1144 ◽

Cited By ~ 78

Author(s):

Susan K. Bonar ◽

Mary E. Tinetti ◽

Mark Speechley ◽

Leo M. Cooney

Keyword(s):

Skilled Nursing Facility ◽

Nursing Facility ◽

Skilled Nursing ◽

Factors Associated

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Influence of Social Support and Illness Perception on Depression among Hospitalized Older Adults Prior to Discharge from an Acute Care Hospital

Korean Journal of Adult Nursing ◽

10.7475/kjan.2017.29.3.246 ◽

2017 ◽

Vol 29 (3) ◽

pp. 246 ◽

Cited By ~ 3

Author(s):

Jeung Heui Yeom ◽

Yong Soon Shin

Keyword(s):

Social Support ◽

Older Adults ◽

Acute Care ◽

Illness Perception ◽

Acute Care Hospital ◽

Care Hospital ◽

Hospitalized Older Adults

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70. Lack of SARS-CoV-2 Antibody Seroconversion After Prompt Identification and Cohorting of Sentinel sars-cov-2-positive Residents in a Skilled Nursing Facility

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.380 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S165-S166

Author(s):

Debika Bhattacharya ◽

Alexander Winnett ◽

Jennifer A Fulcher ◽

Linda Sohn ◽

Feliza Calub ◽

...

Keyword(s):

Acute Care ◽

Serological Test ◽

Skilled Nursing Facility ◽

Acute Care Hospital ◽

Nasopharyngeal Swab ◽

Care Hospital ◽

Nursing Facilities ◽

Antibody Testing ◽

Skilled Nursing ◽

Serologic Testing

Abstract Background Despite numerous outbreaks, antibody responses to SARS-CoV-2 in residents of skilled nursing facilities (SNF) are not well described. We reviewed serological test results in a cohort of SNF residents who had been repetitively screened for SARS-CoV-2 infection by nasopharyngeal swab PCR. Methods In late March 2019, we identified symptomatic SARS-CoV-2 PCR positive residents at a SNF. In response, all remaining SNF patients were serially screened, and all SARS-CoV-2 PCR positive patients were transferred to the acute care hospital or cohorted in a separate COVID Recovery Unit (CRU) in the SNF. In early June, all SNF residents (SARS-CoV-2 PCR positive and negative) underwent serologic testing for SARS-CoV-2 Spike (S1/S2) IgG (DiaSorin). DiaSorin IgG-positive results for patients that were SARS-CoV-2 PCR-negative were reflexed to nucleocapsid IgG (Abbott). Antibody testing occurred a median of 69 days (63–70 IQR) after PCR positivity. Results Nineteen SARS-CoV-2 PCR positive residents were identified from the outbreak and an additional 9 were transferred from the acute care hospital to the CRU; 1 died and 1 received convalescent plasma leaving 26 SARS-CoV-2 PCR positive residents, including 6 who were asymptomatic, that were eligible for serologic testing. Twenty-four of the 26 were positive for IgG by the DiaSorin assay; one seronegative resident was one of the asymptomatic residents. There were an additional 121 residents in the SNF whose SARS-CoV-2 PCR was negative at least once. Among these 121 SNF residents with negative SARS-CoV-2 RT-PCR, all but two were seronegative by the Diasorin assay. The two seropositive residents had no nucleocapsid antibodies when reflex tested by the Abbott assay. Conclusion In a limited sample of SNF residents with SARS-CoV-2 PCR positivity, the sensitivity of the Diasorin assay was 92% (24/26) and the specificity was 98% (119/121). None of the residents with negative SARS-CoV-2 PCR had confirmed positive antibody results using reflex testing (DiaSorin/Abbott). Despite high risk exposure in congregate living facilities, we found no evidence of additional SARS-CoV-2 exposure, reinforcing the importance of serial surveillance SARS-CoV-2 testing and early cohorting in SNF settings. Disclosures All Authors: No reported disclosures

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Comparative Effectiveness of Long-Term Acute Care Hospital versus Skilled Nursing Facility Transfer

10.21203/rs.3.rs-66171/v1 ◽

2020 ◽

Author(s):

Anil Makam ◽

Oanh Kieu Nguyen ◽

Michael E. Miller ◽

Sachin J Shah ◽

Kandice A. Kapinos ◽

...

Keyword(s):

Acute Care ◽

Inpatient Care ◽

Acute Care Hospital ◽

Healthcare Spending ◽

Care Hospital ◽

Skilled Nursing ◽

Medicare Claims ◽

One Year ◽

At Home

Abstract BACKGROUND: Long-term acute care hospital (LTACH) use varies considerably across the U.S., which may reflect uncertainty about the effectiveness of LTACHs vs. skilled nursing facilities (SNF), the principal post-acute care alternative. Given that LTACHs receive over triple the reimbursement of SNFs for comparable diagnoses, we sought to compare outcomes and spending between LTACH versus SNF transfer. METHODS: Using Medicare claims linked to electronic health record (EHR) data from six Texas Hospitals between 2009-2010, we conducted a retrospective cohort study of patients hospitalized on a medicine service in a high-LTACH use region and discharged to either an LTACH or SNF and followed for one year. The primary outcomes included mortality, 60-day recovery without inpatient care, days at home, and healthcare spending.RESULTS: Of 3,503 patients, 18% were transferred to an LTACH. Patients transferred to LTACHs were younger (median 71 vs. 82 years), less likely to be female (50.5 vs 66.6%) and white (69.0 vs. 84.1%), but were sicker (24.3 vs. 14.2% for prolonged intensive care unit stay; median diagnosis resource intensity weight of 2.03 vs. 1.38). In unadjusted analyses, patients transferred to an LTACH vs. SNF were less likely to survive (59.1 vs. 65.0%) or recover (62.5 vs 66.0%), and spent fewer days at home (186 vs. 200). Adjusting for demographic and clinical confounders available in Medicare claims and EHR data, LTACH transfer was not significantly associated with differences in mortality (HR, 1.12, 95% CI, 0.94-1.33), recovery (SHR, 1.07, 0.93-1.23), and days spent at home (IRR, 0.96, 0.83-1.10), but was associated with greater Medicare spending ($16,689 for one year, 95% CI, $12,216-$21,162).CONCLUSION: LTACH transfer for Medicare beneficiaries is associated with similar clinical outcomes but with higher healthcare spending compared to SNF transfer. LTACH use should be reserved for patients who require complex inpatient care and cannot be cared for in SNFs.

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Validity of the Sitting Balance Scale in older adults who are non-ambulatory or have limited functional mobility

Clinical Rehabilitation ◽

10.1177/0269215512452879 ◽

2012 ◽

Vol 27 (2) ◽

pp. 166-173 ◽

Cited By ~ 1

Author(s):

Mary Thompson ◽

Ann Medley ◽

Steve Teran

Keyword(s):

Older Adults ◽

Acute Care ◽

Skilled Nursing Facility ◽

Inpatient Rehabilitation ◽

Functional Mobility ◽

Timed Up And Go ◽

Nursing Facility ◽

Skilled Nursing ◽

Balance Scale ◽

Sitting Balance

Objective: To determine whether the Sitting Balance Scale is an acceptable alternative to the Trunk Impairment Scale for measuring the construct of sitting balance, to examine relationships with other clinical outcomes and to establish discriminative validity. Design: Prospective descriptive methodological study. Setting: Acute care, inpatient rehabilitation, skilled nursing facility and home health. Participants: Patients receiving physical therapy ( N = 98; n = 20 acute care, n = 18 inpatient rehabilitation, n = 30 skilled nursing facility, n = 30 home setting) mean (SD) age, 80.5 (7.9) years. Nineteen were non-ambulatory and 79 had limited functional mobility with Timed Up and Go scores ≥20 seconds. Main measures: Sitting Balance Scale, Trunk Impairment Scale, Timed Up and Go, length of stay and setting specific clinical measures of sitting balance (OASIS-C M1850; MDS G-3b). Results: Moderate association between ambulatory status and sitting balance measures (Sitting Balance Scale r = 0.67, Trunk Impairment Scale r = 0.61; P = 0.0001). Moderate to strong relationships between Sitting Balance Scale, Trunk Impairment Scale and clinical outcomes varying by setting. MANOVA results revealed differences between ambulators and non-ambulators and among diagnostic categories for both instruments ( P < 0.001). Conclusions: The Sitting Balance Scale is comparable to the Trunk Impairment Scale for measuring sitting balance in older adults who are non-ambulatory or have limited mobility.

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