scholarly journals Disparities in EOL Care by Dementia Status and Race

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 472-472
Author(s):  
Joann Reinhardt
Keyword(s):  
Ethnic Groups ◽  
Quality Care ◽  
Skilled Nursing Facility ◽  
Secondary Analysis ◽  
Care Quality ◽  
Chi Square ◽  
Skilled Nursing ◽  
Comfort Care ◽  
Race Ethnicity ◽  
Eol Care

Abstract Prior research shows that minority and dementia status are associated with suboptimal end-of-life (EOL) care quality; care that is more aggressive, invasive, and futile. We conducted a retrospective study of EOL care for 300 decedents of varied race/ethnicity in a skilled nursing facility. The purpose of this secondary analysis was to test whether the EOL experience (medical orders in place, treatments, distressing symptoms, discussions with providers) differed by dementia status for different race/ethnic groups (Black, White, Hispanic). Chi-square tests were used to examine the relation between these four sets of EOL variables and dementia status (yes/no) separately for the three groups. Findings showed that for White decedents, PWD were less likely to have had a DNR or a DNI discussion with a provider in the nursing home. Also for White decedents, PWD were less likely to have had shortness of breath or pain. For Black decedents, PWD were more likely to have a DNR order. Also, for Black decedents, PWD were less likely to have been hospitalized. For Hispanic decedents, EOL variables and dementia status were not significantly associated. Overall, findings showed differences by race/ethnic groups in EOL experience based on dementia status. Black decedents with dementia were more likely to have escaped the acute care default. Findings for White decedents with dementia were mixed for aggressive versus comfort care. The EOL experience did not differ by dementia status for Hispanic decedents. Thus, efforts to promote positive EOL care for persons with dementia need to account for differences by race/ethnicity.

scholarly journals Correlates of Skilled Nursing Facility (SNF) Performance in the SNF Value-Based Purchasing Program

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 83-83
Author(s):  
Dan Andersen ◽  
Sherly Binu ◽  
Mike Sacca
Keyword(s):  
Quality Care ◽  
Skilled Nursing Facility ◽  
Prospective Payment System ◽  
Fiscal Year ◽  
Value Based Purchasing ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Actual Performance ◽  
For Profit ◽  
Matched Data

Abstract We examined the results of the 2020 skilled nursing facility (SNF) value-based purchasing (SNF VBP) program to identify correlates and potential drivers of SNF performance in this program. The SNF VBP program provides incentive payments to SNFs based on their performance on a risk-adjusted hospital readmission measure (i.e., the rate at which SNF residents are admitted back to the hospital within 30-days of being admitted to the SNF). SNFs are assessed on this measure for both improvement compared to their historical baseline and overall achievement compared to their peers. All SNFs that are covered under Medicare’s prospective payment system are included in the SNF VBP program. We performed analyses to assess the correlation between individual SNFs’ performance in the 2020 SNF VBP (n=15,201), which is based on actual performance in fiscal year 2018, with contemporaneous matched data related to SNF health inspection results, staffing, and performance on quality measures (these data form the basis of the five-star quality rating system on the Nursing Home Compare website). We also examined longitudinal trends in these non-SNF VBP program variables and their association with changes in SNF performance in the SNF VBP program. We controlled for important SNF-specific factors (e.g., for-profit status, connected to a hospital). We found strong contemporaneous and longitudinal associations between SNF VBP program performance and some, but not all, of these factors. Our findings are supported by decades of empirical research in SNF quality and highlight potential policy alternatives that could further incentivize high quality care in SNFs.

The Association Between Skilled Nursing Facility Care Quality and 30-Day Readmission Rates After Hospitalization for Heart Failure

2014 ◽  
Vol 30 (3) ◽  
pp. 205-213 ◽  
Author(s):  
Owolabi Ogunneye ◽  
Michael B. Rothberg ◽  
Jennifer Friderici ◽  
Mara T. Slawsky ◽  
Vijay T. Gadiraju ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skilled Nursing Facility ◽  
Care Quality ◽  
Readmission Rates ◽  
Nursing Facility ◽  
Skilled Nursing

Hospitalization and hospital discharge destinations after chemotherapy: Using the Oncology Care Model (OCM) methodology in 2012–2015 Medicare data.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 113-113
Author(s):  
Yi Peng ◽  
Jiannong Liu ◽  
Leon Raskin ◽  
Michael Anthony Kelsh ◽  
Rebecca Zaha ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Financial Incentives ◽  
Quality Care ◽  
Skilled Nursing Facility ◽  
Cancer Type ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Practice Performance

113 Background: The Medicare OCM gives financial incentives for efficient, high-quality care. Hospitalizations of cancer patients receiving chemotherapy substantially increases costs. We assessed reasons for hospitalization and hospitalization discharge destinations after chemotherapy in cancer patients. Methods: We applied OCM methodology in a Medicare fee-for-service 20% sample data to estimate 6-month patient episodes triggered by chemotherapy from 2012 to 2015. We summarized the most frequent reasons for hospitalization (using ICD-9-CM codes in the first 5 positions of hospital claims) and the discharge destinations among all episodes and by cancer type. Results: Of 485,186 6-month episodes in 255,229 patients, 121,886 (25%) episodes had ≥1 hospitalization. The most frequent reasons for hospitalization were infection (13%), anemia (7%), dehydration (5%), and congestive heart failure (CHF; 3%; Table). Most hospitalized patients were discharged to home (71%) or a skilled nursing facility (SNF; 13%); some died in the hospital (6%) or went to hospice (5%). Reasons for hospitalization and discharge destination varied by cancer type. Patients with lung cancer had the highest rates of infection and anemia and higher proportions of death and hospice discharge compared with other cancers. Conclusions: Among Medicare beneficiaries receiving chemotherapy, hospitalizations most often occurred as a result of infection or anemia. Patients were most often discharged to home or SNF. Variations across cancer types in the reasons for hospitalization, as well as discharge destinations, should be considered when evaluating OCM practice performance. [Table: see text]

Does Investor-Ownership of Nursing Homes Compromise the Quality of Care?

2002 ◽  
Vol 32 (2) ◽  
pp. 315-325 ◽  
Author(s):  
Charlene Harrington ◽  
Steffie Woolhandler ◽  
Joseph Mullan ◽  
Helen Carrillo ◽  
David U. Himmelstein
Keyword(s):  
Quality Of Care ◽  
Nursing Homes ◽  
Skilled Nursing Facility ◽  
Nurse Staffing ◽  
Care Quality ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Staffing Ratios ◽  
The Impact

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories (“quality of care,” “quality of life,” and “other”) and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

scholarly journals Care transition to skilled nursing facility – A model and a case study

2019 ◽  
Vol 8 (3) ◽  
pp. 38 ◽  
Author(s):  
Mohan Tanniru ◽  
Jacqueline Jones ◽  
Samer Kazziha ◽  
Michelle Hornberger
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Skilled Nursing Facility ◽  
Care Quality ◽  
Care Transition ◽  
Care Providers ◽  
Post Discharge ◽  
Nursing Facility ◽  
Skilled Nursing

Background: Healthcare providers have focused on improving patient care transitions to reduce unanticipated readmission costs, improve patient care quality post-discharge and increase patient satisfaction. This is especially true in US since the introduction of the Affordable Care Act. While there are several practices and evidence-based programs discussed in the literature to address care transition post-discharge, the key challenge remains the same – how to structure the care transition program to influence its effectiveness. In this paper, we focus on modeling one particular care transition – moving a patient from a hospital to a skilled nursing facility (SNF) – and discuss how improved capacity building and use of intermediaries such as advanced nurse practitioners have shown promise in reducing patient readmissions.Method: The methodology proposed here uses service dominant (SD) logic research to inductively derive a model for service exchanges between the two provider ecosystems. This model is then used to analyze service gaps and look for opportunities to innovate within an SNF and improve its capacity to deliver care. Use of intermediation that expands the service model with the addition of more care providers besides the hospital and SNF is also discussed to reduce patient readmissions.   Results: The study demonstrates that a number of actors have to work collaboratively to make care transition effective in meeting the patient and provider goals. Specifically, when two care facilities, hospital and SNF, are involved in care transition, opportunities exist to improve their internal capacity to address care within and across facilities.    Conclusion: The paper makes two important contributions. It shows the role of SD Logic in identifying opportunities for service innovations in support of care transition, and it shows the role of actors in provider-customer ecosystems to make the transition effective.    

scholarly journals Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility

2019 ◽  
Vol 15 (01) ◽  
pp. 22-27 ◽  
Author(s):  
Robert E Burke ◽  
Chelsea Leonard ◽  
Marcie Lee ◽  
Roman Ayele ◽  
Ethan Cumbler ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Biases ◽  
Skilled Nursing Facility ◽  
Secondary Analysis ◽  
The United States ◽  
Halo Effect ◽  
Nursing Facilities ◽  
Framework Analysis ◽  
Skilled Nursing ◽  
Postacute Care

BACKGROUND: Decisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions. OBJECTIVE: To understand whether cognitive biases play an important role in patient and clinician decision-making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases. DESIGN: Secondary analysis of 105 semistructured interviews with patients, caregivers, and clinicians. SETTING: Three hospitals and three SNFs in a single metropolitan area. PATIENTS: Adults over age 65 discharged to SNFs after hospitalization as well as patients, caregivers, and multidisciplinary frontline clinicians in both hospital and SNF settings. MEASUREMENTS: We identified potential cognitive biases from prior systematic and narrative reviews and conducted a team-based framework analysis of interview transcripts to identify potential biases. RESULTS: Authority bias/halo effect and framing bias were the most prevalent and seemed the most impactful, while default/status quo bias and anchoring bias were also present in decision-making about SNFs. CONCLUSIONS: Cognitive biases play an important role in decision-making about postacute care in SNFs. The combination of authority bias/halo effect and framing bias may synergistically increase the likelihood of patients accepting SNFs for postacute care. As postacute care undergoes a transformation spurred by payment reforms, it is increasingly important to ensure that patients understand their choices at hospital discharge and can make high-quality decisions consistent with their goals.

scholarly journals Implications of Racial Differences in the Shifts in the Setting of Care for Alzheimer’s Disease and Related Dementias

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 647-648
Author(s):  
Arseniy Yashkin ◽  
Galina Gorbunova ◽  
Anatoliy Yashin ◽  
Igor Akushevich
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Propensity Score ◽  
Skilled Nursing Facility ◽  
Home Health ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Race Ethnicity

Abstract The prevailing setting of care has strong associations with the progression of a disease at time of first diagnosis, subsequent treatment, resulting health outcomes as well as both long-term and short-term costs. The care of Alzheimer’s Disease (AD) and Related Dementias (ADRD) has been experiencing a shift from skilled nursing facility to home health care. However, changes in practice do not disseminate equally across the race/ethnicity spectrum of the U.S. and disadvantaged race/ethnicity-related groups often encounter differing conditions from those experienced by the majority. In this study, we calculated the race/ethnicity-related direct healthcare costs of individuals with AD and ADRD, stratified by care-provider structure (physician, inpatient, outpatient, skilled nursing facility, home health, hospice), and modeled the trends and the relative contributions of each setting over the 1991-2017 period using administrative claims from a 5% sample of Medicare beneficiaries. Inflation and the gradual switch of Medicare compensation to the HCC model between 2004 and 2007 were accounted for. We then applied an inverse probability weighting algorithm to propensity-score-match the AD/ADRD race/ethnicity-specific groups to Medicare beneficiaries to make them comparable in demographics and co-morbidity status but without AD/ADRD. Finally, we performed a comparison of the Medicare costs and associated survival within (AD/ADRD vs. No AD/ADRD) and between (Black vs. White vs. Hispanic) race/ethnicity-related groups. Comparisons were done for: i)1-year before; ii) 1-year after iii) years 2-11; iv)years 12-21 and v) years 22+ after an AD/ADRD diagnosis. We found significant race/ethnicity-related differences in costs and survival both before and after propensity score matching.

Association between race and in-hospital outcomes in children with spina bifida following inpatient urologic surgery

2021 ◽  
pp. 1-8
Author(s):  
Jason Chandrapal ◽  
Kirsten Simmons ◽  
J. Todd Purves ◽  
John S. Wiener ◽  
Jonathan C. Routh
Keyword(s):  
Spina Bifida ◽  
Ethnic Groups ◽  
Secondary Analysis ◽  
Predictor Variable ◽  
Charge Ratio ◽  
Complication Rates ◽  
Hispanic Ethnicity ◽  
Urologic Surgery ◽  
Black And White ◽  
Race Ethnicity

PURPOSE: Post-operative complication rates may vary among racial and/or ethnic groups and have not been previously described in individuals with spina bifida (SB) undergoing urologic surgery. The aim of this study was to compare in-hospital complication frequencies of individuals with SB following urologic surgery by race/ethnicity. METHODS: The Nationwide Inpatient Sample was used to identify pediatric patients with SB who underwent inpatient urologic procedures. A pediatric cohort (<18 years old) with SB that underwent urologic surgery were assessed. All analyses report weighted descriptive statistics, outcomes, and race/ethnicity was the primary predictor variable. The primary outcome of interest was post-operative complications which were defined using NSQIP ICD-9 code definitions. Secondary analysis included length of stay (LOS), and encounter cost was estimated using the cost-to-charge ratio files provided by the Healthcare Cost and Utilization Project. RESULTS: The unadjusted model showed no differences in complications, LOS, and cost. In the adjusted model there were no differences in complications, LOS, and cost between Black and White encounters. However, Hispanic ethnicity was associated with a 20%(95%CI: 4–40%) increase in LOS and 18%(95%CI: 2–35%, p = 0.02) increase in cost compared to White encounters. CONCLUSION: There was no evidence of variation for in-hospital complication rates among racial/ethnic groups undergoing urologic surgery. Hispanic ethnicity was associated with higher costs and longer LOS in pediatric SB encounters.

Innovative pilot to reimburse nurse and social work-led advance care planning.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 3-3
Author(s):  
Angela Kalisiak ◽  
Lisa Kathryn Hansen ◽  
Jamie Newell ◽  
Lydia Mills
Keyword(s):  
Advance Care Planning ◽  
Metastatic Cancer ◽  
Quality Care ◽  
Care Planning ◽  
Comfort Care ◽  
Health Leadership ◽  
Community Oncology ◽  
Advance Care ◽  
Patient Values ◽  
Eol Care

3 Background: Research has shown that advance care planning (ACP) leads to better patient care and outcomes. The Oregon Health Leadership Council (OHLC) identified ACP as an opportunity to improve care and offset costs. In 2014, the OHLC commissioned a workgroup to pilot a payment model to promote broader adoption of ACP. A community oncology provider and 4 health plans implemented the pilot for nurses (RNs) and licensed clinical social workers (LCSWs) to conduct ACP in an effort to elicit and honor patient preferences at end of life (EOL). Methods: Five RNs and 2 LCSWs underwent specific ACP training (by academic EOL educator or VitalTalk). They conducted one or more substantive ACP conversations (minimum 20 minutes) with 149 patients (89 female, 60 male; median age 64; range 24-92) between 12/5/14 and 5/9/16. Most patients had recurrent and/or metastatic cancer. Charts were reviewed in April 2017 for goals of care (GOC) discussion, ACP documents, preferences for EOL care, hospice enrollment, date of death, and death location. Results: Among all 149 patients, GOC discussion was documented for 126 (85%). Advance directives were in the chart for 34 (23%) and POLST for 53 (36%) patients. Among the 69 patients who died, 80% were on hospice (median days = 14; 15% on hospice < 3 days); 87% preferred comfort care at time of death. Three patients (4%) requested life-prolonging treatment until death. Conclusions: This pilot demonstrated that RNs and LCSWs can provide substantive ACP within robust team-based care. Hospice enrollment, POLST completion, and EOL care consistent with preferences were high. Cost data was inadequate to draw conclusions. While physician management, patient values, disease and treatment factors may also impact EOL choices, pilot data indicates that expanding ACP through trained RNs and LCSWs serves to normalize ACP as an integral component of quality care and promote outcomes congruent with GOC. [Table: see text]

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