Assessments, evolutions and transformations in French nursing homes

Abstract Background Korian is a private group specialized in medical accommodation for elderly and dependent people. A professional data warehouse EasySoins® set up in 2010 hosted 126 nursing homes (NH) residents’ data. Then in 2013, another data warehouse NetSoins® replaced the former; with a completely new information system (IS). Deployment ended in July 2014 with 151 NH but since then, the number of NH has increased steadily to reach 288 at the end of 2018. Inside both systems, the transmissions’ table fed on a daily basis by the caregiver contains key data about the residents’ care and health. It also allows us to build residents’ life trajectories. A recent study compared the 2011 and 2015 NH populations in France. Other research papers explored similar issues in the USA, Belgium and Great Britain. The objective of this study is to show that our data extraction method offers a vivid image and faithful reflection of the French residents’ population evolution over time. Methods Wanting to replicate and update the French study, we built two sets of Korian residents: those having at least one transmission over the last six weeks of 2014 and 2018. We then joined these two tables with their socio-demographic profile. Finally, we searched among the residents’ autonomy level evaluations (GIR=ISO resource group), the ‘nearest’ ones to each periods. We were then able to assess the residents’ population evolution. Results We found respectively 12,279 residents living in 156 NH and then 23,926 residents, living in 288 NH. In 2014, 9,174 women with a mean age of 87.5 (standard deviation=7.4) and 3,105 men with a mean age of 84.6 (standard deviation=9). In 2018, 3,075 were still there (25%) with 17,561 women, mean age of 88.4 (standard deviation=7.5) and 6,365 men, mean age of 85.2 (standard deviation=9.4). The GIR modal class stayed stable at two for both sexes at 30%. Conclusions As elsewhere, men and women are growing a little older, reaching a glass ceiling, with a narrowed gender gap. Key messages As nursing home residents’ profiles are rapidly changing over time and caregiver resources do not increase accordingly, allocating adequate resources to every resident becomes essential. The transmissions’ table with its nursing care narratives textual content can help us track every resident on almost real time and, through this process, define health paths and health subgroups.

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The Potential Regional Impact of Contact Precaution Use in Nursing Homes to Control Methicillin-ResistantStaphylococcus aureus

Infection Control and Hospital Epidemiology ◽

10.1086/669091 ◽

2013 ◽

Vol 34 (2) ◽

pp. 151-160 ◽

Cited By ~ 28

Author(s):

Bruce Y. Lee ◽

Ashima Singh ◽

Sarah M. Bartsch ◽

Kim F. Wong ◽

Diane S. Kim ◽

...

Keyword(s):

Nursing Homes ◽

Policy Making ◽

Orange County ◽

Nursing Home Residents ◽

Contact Precaution ◽

Agent Based ◽

Contact Precautions ◽

Relative Decrease ◽

Multiple Health ◽

Over Time

Objective.Implementation of contact precautions in nursing homes to prevent methicillm-resistantStaphylococcus aureus(MRSA) transmission could cost time and effort and may have wide-ranging effects throughout multiple health facilities. Computational modeling could forecast the potential effects and guide policy making.Design.Our multihospital computational agent-based model, Regional Healthcare Ecosystem Analyst (RHEA).Setting.All hospitals and nursing homes in Orange County, California.Methods.Our simulation model compared the following 3 contact precaution strategies: (1) no contact precautions applied to any nursing home residents, (2) contact precautions applied to those with clinically apparent MRSA infections, and (3) contact precautions applied to all known MRSA carriers as determined by MRSA screening performed by hospitals.Results.Our model demonstrated that contact precautions for patients with clinically apparent MRSA infections in nursing homes resulted in a median 0.4% (range, 0%–1.6%) relative decrease in MRSA prevalence in nursing homes (with 50% adherence) but had no effect on hospital MRSA prevalence, even 5 years after initiation. Implementation of contact precautions (with 50% adherence) in nursing homes for all known MRSA carriers was associated with a median 14.2% (range, 2.1%–21.8%) relative decrease in MRSA prevalence in nursing homes and a 2.3% decrease (range, 0%–7.1%) in hospitals 1 year after implementation. Benefits accrued over time and increased with increasing compliance.Conclusions.Our modeling study demonstrated the substantial benefits of extending contact precautions in nursing homes from just those residents with clinically apparent infection to all MRSA carriers, which suggests the benefits of hospitals and nursing homes sharing and coordinating information on MRSA surveillance and carriage status.

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Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review

BMC Geriatrics ◽

10.1186/s12877-021-02366-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shen Chen ◽

Bridie Kent ◽

Yan Cui

Keyword(s):

Older Adults ◽

Nursing Homes ◽

Scoping Review ◽

Respiratory Infections ◽

Data Extraction ◽

Nursing Home Residents ◽

Final Analysis ◽

Rehabilitation Program ◽

Cochrane Library ◽

Cognitive State

Abstract Background Dysphagia is highly prevalent condition in older adults living in nursing homes. There is also evidence indicating that aspiration is one of the major health risks for these older adults, which is more likely to result in respiratory infections, aspiration pneumonia and sudden bolus death. Evidence syntheses have demonstrated the effectiveness of interventions for prevention of aspiration among hospitalized older people. The aim of this scoping review is to describe the current spread of interventions to prevent or reduce aspiration in older adults with dysphagia with a specific focus on those who reside in nursing homes. Methods The Joanna Briggs Institute methods and PRISMA-ScR guidelines were used to inform this review. MEDLINE, CINAHL, EMBASE, Cochrane Library, Joanna Briggs Institute EBP Database and Web of Science were searched for related articles from 2010 to 2020 as well as Chinese databases (CNKI, WANFANG DATA and VIP) and databases for unpublished material. A three-step search strategy was utilized, including the use of citation software to manage search results and de-duplication, abstract review and full-text review by two reviewers. Details of included studies were then extracted using a prepared data extraction tool. The resulting map was displayed in tabular form along with a narrative summary. Results Although 637 articles were located, 19 papers were included in the final analysis. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes included: more bedside evaluation, modification of dietary, creating an appropriate environment for swallowing, providing appropriate feeding assistance, appropriate posture or maneuver for swallowing, appropriate rehabilitation program, medication treatment, and stimulation treatment. Conclusion Nursing homes, particularly those in developing countries, require more support for staff training and necessary equipment. Professional interventions provided by speech and language therapists are still limited in the setting of nursing homes. Modification of dietary was the most frequently used intervention to prevent or reduce aspiration. Multi-disciplinary interventions had the best results for aspiration management, but for many nursing homes, access to such teams is limited. Nursing home residents respond well to person-centered interventions that have a comprehensive consideration of their degree of aspiration risk, health condition, individual feelings and cognitive state.

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Interpreting COVID-19 deaths among nursing home residents in the US: The changing role of facility quality over time

PLoS ONE ◽

10.1371/journal.pone.0256767 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0256767

Author(s):

Debasree Das Gupta ◽

Uma Kelekar ◽

Sidney C. Turner ◽

Anupam A. Sule ◽

Taya G. Jerman

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Critical Role ◽

Secondary Analysis ◽

Nursing Home Residents ◽

Cross Sectional ◽

The Us ◽

Prior Literature ◽

Over Time

A report published last year by the Centers for Medicare & Medicaid Services (CMS) highlighted that COVID-19 case counts are more likely to be high in lower quality nursing homes than in higher quality ones. Since then, multiple studies have examined this association with a handful also exploring the role of facility quality in explaining resident deaths from the virus. Despite this wide interest, no previous study has investigated how the relation between quality and COVID-19 mortality among nursing home residents may have changed, if at all, over the progression of the pandemic. This understanding is indeed lacking given that prior studies are either cross-sectional or are analyses limited to one specific state or region of the country. To address this gap, we analyzed changes in nursing home resident deaths across the US between June 1, 2020 and January 31, 2021 (n = 12,415 nursing homes X 8 months) using both descriptive and multivariable statistics. We merged publicly available data from multiple federal agencies with mortality rate (per 100,000 residents) as the outcome and CMS 5-star quality rating as the primary explanatory variable of interest. Covariates, based on the prior literature, consisted of both facility- and community-level characteristics. Findings from our secondary analysis provide robust evidence of the association between nursing home quality and resident deaths due to the virus diminishing over time. In connection, we discuss plausible reasons, especially duration of staff shortages, that over time might have played a critical role in driving the quality-mortality convergence across nursing homes in the US.

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Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-050322 ◽

2021 ◽

Vol 11 (11) ◽

pp. e050322

Author(s):

Ben Li ◽

Jean Jacob-Brassard ◽

Fahima Dossa ◽

Konrad Salata ◽

Teruko Kishibe ◽

...

Keyword(s):

Systematic Review ◽

Gender Gap ◽

Academic Medicine ◽

Data Extraction ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Central Register ◽

Faculty Rank ◽

Geographical Regions ◽

Over Time

ObjectiveMany studies have analysed gender bias in academic medicine; however, no comprehensive synthesis of the literature has been performed. We conducted a pooled analysis of the difference in the proportion of men versus women with full professorship among academic physicians.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Center and PsycINFO were searched from inception to 3 July 2020.Study selectionAll original studies reporting faculty rank stratified by gender worldwide were included.Data extraction and synthesisStudy screening, data extraction and quality assessment were performed by two independent reviewers, with a third author resolving discrepancies. Meta-analysis was conducted using random-effects models.ResultsOur search yielded 5897 articles. 218 studies were included with 991 207 academic physician data points. Men were 2.77 times more likely to be full professors (182 271/643 790 men vs 30 349/251 501 women, OR 2.77, 95% CI 2.57 to 2.98). Although men practised for longer (median 18 vs 12 years, p<0.00002), the gender gap remained after pooling seven studies that adjusted for factors including time in practice, specialty, publications, h-index, additional PhD and institution (adjusted OR 1.83, 95% CI 1.04 to 3.20). Meta-regression by data collection year demonstrated improvement over time (p=0.0011); however, subgroup analysis showed that gender disparities remain significant in the 2010–2020 decade (OR 2.63, 95% CI 2.48 to 2.80). The gender gap was present across all specialties and both within and outside of North America. Men published more papers (mean difference 17.2, 95% CI 14.7 to 19.7), earned higher salaries (mean difference $33 256, 95% CI $25 969 to $40 542) and were more likely to be departmental chairs (OR 2.61, 95% CI 2.19 to 3.12).ConclusionsGender inequity in academic medicine exists across all specialties, geographical regions and multiple measures of success, including academic rank, publications, salary and leadership. Men are more likely than women to be full professors after controlling for experience, academic productivity and specialty. Although there has been some improvement over time, the gender disparity in faculty rank persists.PROSPERO registration numberCRD42020197414.

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Lessons learned from the statewide implementation of the Music & Memory program in nursing homes in Wisconsin in the USA

Dementia ◽

10.1177/1471301220962234 ◽

2020 ◽

pp. 147130122096223

Author(s):

Jung Kwak ◽

Jung-Hwa Ha ◽

Katharine O’Connell Valuch

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Behavioral Problems ◽

Nursing Home Residents ◽

Lessons Learned ◽

Direct Care ◽

Care Staff ◽

Memory Training ◽

Positive Effects ◽

The Usa

The movement of evidence-based interventions into institutional settings such as nursing homes is challenging. Among ecopsychosocial interventions to address behavioral problems of nursing home residents with dementia, Music and Memory, a popular intervention that provides individualized music listening, has shown potential to improve residents’ quality of life. In Wisconsin in the USA, the Music and Memory program has been implemented in nursing home facilities statewide. In the present study, to examine facilitators and barriers related to implementation and sustainability of the Music and Memory program, all nursing homes in Wisconsin were invited to participate in a survey (online or mail). A total of 161 facilities participated, representing a response rate of 41%. Descriptive statistics and content analysis were conducted. Over 80% of responding facilities were providing the Music and Memory program, and 86% of those facilities planned to continue its use. The majority of respondents found Music and Memory to be beneficial to residents, but they also reported that the program was not equally effective for everyone and that it was time and labor intensive. Barriers to sustainability included lack of buy-in by direct care staff, use of technology, costs of equipment, inconsistency of volunteers, and families not supportive or helpful. Facilitators included support of facility personnel, family, and volunteers; observing positive effects of program; Music and Memory training provision and support; and accessibility of equipment. For the program to be successful, facilities must identify the residents most likely to benefit from it, realistically estimate its costs and required labor, and ensure staff buy-in.

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The effect of the implementation of a good medical practice booklet on nursing home residents’ drug prescriptions: a difference-in-differences analysis based on data from electronic pill dispensers (Preprint)

10.2196/preprints.13507 ◽

2019 ◽

Author(s):

Stéphane Sanchez ◽

Cécile Payet ◽

Marie Herr ◽

Anne Dazinieras ◽

Caroline Blochet ◽

...

Keyword(s):

Nursing Homes ◽

Medical Practice ◽

Intervention Group ◽

Medication Use ◽

Nursing Home Residents ◽

Control Group ◽

Multilevel Regression ◽

Difference In Differences ◽

Good Medical Practice ◽

The Impact

BACKGROUND The elderly are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. OBJECTIVE We aimed to evaluate the impact of the implementation of a good medical practice booklet on polypharmacy in nursing homes. METHODS We identified nursing homes belonging to a geriatric care provider that had launched a policy of proper medication use using a good medical practice booklet delivered to prescribers and pharmacists. Data were derived from electronic pill dispensers. The effect of the intervention on polypharmacy was assessed with multilevel regression models, with a control group to account for natural trends over time. The main outcomes were the average daily number of times when medication was administered and the number of drugs with different presentation identifier codes per resident per month. RESULTS 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (-0.05 and -0.06). The good medical practice booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99-1.02, P=.45). CONCLUSIONS Although the good medical practice booklet itself did not seem effective in decreasing medication use, our data show the effectiveness of a higher-level policy to decrease polypharmacy.

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A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial

International Psychogeriatrics ◽

10.1017/s1041610221000818 ◽

2021 ◽

pp. 1-13

Author(s):

Julie L. O’Sullivan ◽

Sonia Lech ◽

Paul Gellert ◽

Ulrike Grittner ◽

Jan-Niklas Voigt-Antons ◽

...

Keyword(s):

Quality Of Life ◽

Randomized Controlled Trial ◽

Nursing Home ◽

Nursing Homes ◽

Psychotropic Medication ◽

Controlled Trial ◽

Nursing Home Residents ◽

Randomized Controlled ◽

Cluster Randomized

Abstract Objectives: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. Design: Cluster-randomized controlled trial. Setting: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). Participants: N = 162 residents with dementia. Intervention: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. Measurements: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer’s Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. Results: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI −3.54, 2.33 for TBI and .36 points, 95% CI −3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen’s d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. Conclusions: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

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A246 THE GLOBAL INCIDENCE OF ACUTE PANCREATITIS IS INCREASING OVER TIME: A SYSTEMATIC REVIEW AND META-ANALYSIS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.244 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 304-306

Author(s):

J Iannuzzi ◽

J H Leong ◽

J Quan ◽

J A King ◽

J W Windsor ◽

...

Keyword(s):

Acute Pancreatitis ◽

Data Extraction ◽

Meta Analysis ◽

Temporal Trends ◽

Western World ◽

Common Disease ◽

Biliary Disease ◽

Comprehensive Overview ◽

Annual Percent Change ◽

Over Time

Abstract Background Acute pancreatitis is a common disease with significant associated morbidity and mortality. Historically, acute pancreatitis has been considered a disease with multiple etiologies and risk factors but is driven by alcohol and biliary disease. Multiple studies have shown that the incidence of acute pancreatitis is increasing globally among both adults and children. Aims The purpose of this study was to assess temporal trends in incidence of acute pancreatitis globally. Methods We performed a systematic literature search to identify population-based studies reporting the annual incidence of acute pancreatitis. Abstracts were independently assessed in duplicate to identify applicable papers for full-text review and data extraction. Joinpoint temporal trend analyses were performed to calculate the average annual percent change (AAPC) with 95% confidence intervals (CI). The AAPCs were pooled in a meta-analysis to capture the overall and regional trends in acute pancreatitis incidence over time. Temporal data were summarized in a static map and an interactive, web-based map to illustrate global differences. Results Forty-five studies reported the temporal incidence of acute pancreatitis (static map provided, online interactive map: https://kaplan-acute-pancreatitis-ucalgary.hub.arcgis.com/). The incidence of acute pancreatitis has increased from 1961 to 2016 (AAPC = 2.89%; 95% CI: 2.26, 3.52; n=41). Increasing incidence was observed in North America (AAPC = 2.71%; 95% CI: 1.93, 3.50; n=10) and Europe (AAPC = 2.79%; 95% CI: 1.95, 3.63; n=24). The incidence of acute pancreatitis was stable in Asia (AAPC = −0.28%; 95% CI: −5.03, 4.47; n=2). Conclusions This meta-analysis provides a comprehensive overview of the global incidence of acute pancreatitis over the last five decades and demonstrates a steadily rising incidence over time in most countries of the Western world. More studies are needed to better define the changing incidence of acute pancreatitis in Asia, Africa and Latin America. Funding Agencies None

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Effect of Environmental Pollutants PM2.5, CO, NO2, and O3 on the Incidence and Mortality of SARS-CoV-2 Infection in Five Regions of the USA

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157810 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7810

Author(s):

Sultan Ayoub Meo ◽

Abdulelah Adnan Abukhalaf ◽

Omar Mohammed Alessa ◽

Abdulrahman Saad Alarifi ◽

Waqas Sami ◽

...

Keyword(s):

New York ◽

New Mexico ◽

Los Angeles ◽

Environmental Pollution ◽

Environmental Pollutants ◽

Daily Basis ◽

First Case ◽

Incidence And Mortality ◽

Unit Increase ◽

The Usa

In recent decades, environmental pollution has become a significant international public problem in developing and developed nations. Various regions of the USA are experiencing illnesses related to environmental pollution. This study aims to investigate the association of four environmental pollutants, including particulate matter (PM2.5), carbon monoxide (CO), Nitrogen dioxide (NO2), and Ozone (O3), with daily cases and deaths resulting from SARS-CoV-2 infection in five regions of the USA, Los Angeles, New Mexico, New York, Ohio, and Florida. The daily basis concentrations of PM2.5, CO, NO2, and O3 were documented from two metrological websites. Data were obtained from the date of the appearance of the first case of (SARS-CoV-2) in the five regions of the USA from 13 March to 31 December 2020. Regionally (Los Angeles, New Mexico, New York, Ohio, and Florida), the number of cases and deaths increased significantly along with increasing levels of PM2.5, CO, NO2 and O3 (p < 0.05), respectively. The Poisson regression results further depicted that, for each 1 unit increase in PM2.5, CO, NO2 and O3 levels, the number of SARS-CoV-2 infections significantly increased by 0.1%, 14.8%, 1.1%, and 0.1%, respectively; for each 1 unit increase in CO, NO2, and O3 levels, the number of deaths significantly increased by 4.2%, 3.4%, and 1.5%, respectively. These empirical estimates demonstrate an association between the environmental pollutants PM2.5, CO, NO2, and O3 and SARS-CoV-2 infections, showing that they contribute to the incidence of daily cases and daily deaths in the five different regions of the USA. These findings can inform health policy decisions about combatting the COVID-19 pandemic outbreak in these USA regions and internationally by supporting a reduction in environmental pollution.

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Validation of the Workplace Integrated Safety and Health (WISH) assessment in a sample of nursing homes using Item Response Theory (IRT) methods

BMJ Open ◽

10.1136/bmjopen-2020-045656 ◽

2021 ◽

Vol 11 (6) ◽

pp. e045656

Author(s):

María Andrée López Gómez ◽

Daniel A Gundersen ◽

Leslie I Boden ◽

Glorian Sorensen ◽

Jeffrey N Katz ◽

...

Keyword(s):

Item Response Theory ◽

Nursing Homes ◽

Item Response ◽

Well Being ◽

P Value ◽

Response Theory ◽

Health Safety ◽

Worker Health ◽

Safety And Health ◽

The Usa

ObjectivesTo validate and test the dimensionality of six constructs from the Workplace Integrated Safety and Health (WISH) assessment, an instrument that assesses the extent to which organisations implement integrated systems approaches for protecting and promoting worker health, safety and well-being, in a sample of nursing homes in the USA.DesignValidation of an assessment scale using data from a cross-sectional survey.SettingNursing homes certified by the Centers for Medicaid and Medicare services in three states of the USA: Ohio, California and Massachusetts.Participants569 directors of nursing from nursing homes serving adults and with more than 30 beds participated in the study.ResultsGraded response Item Response Theory (IRT) models showed that five out of six constructs were unidimensional based on balanced interpretation of model fit statistics—M2 or C2 with p value >0.05, Comparative Fit Index >0.95, lower bound of the root mean squared error of approximation 90% CI <0.06 and standardised root mean square residual <0.08. Overall measure and construct reliability ranged from acceptable to good. Category boundary location parameters indicated that items were most informative for respondents in lower range of latent scores (ie, β1, β2, β3 typically below 0). A few items were recommended to be dropped from future administrations of the instrument based on empirical and substantive interpretation.ConclusionsThe WISH instrument has utility to understand to what extent organisations integrate protection and promotion of worker health, safety and well-being; however, it is most informative in organisations that present lower scores.

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