scholarly journals Antipsychotic Prescribing in VA-Contracted Community Nursing Homes and Incident Use Among Veterans

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 333-333
Author(s):  
Patience Moyo ◽  
Emily Corneau ◽  
Portia Cornell ◽  
Amy Mochel ◽  
Kate Magid ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Community Nursing ◽  
Veterans Health ◽  
Health Administration ◽  
Antipsychotic Therapy ◽  
Term Care ◽  
Data Set ◽  
Safety Risks ◽  
Adjusted Logistic Regression ◽  
New Diagnosis

Abstract The Veterans Health Administration (VA) is increasingly purchasing long-term care for eligible Veterans from non-VA, community nursing homes (CNHs). Antipsychotics present safety risks for older adults, but it is unknown how the prevalent use of antipsychotics at CNHs influences whether newly admitted Veterans will initiate antipsychotic therapy. This study used 2013-2016 VA data, Medicare claims, Nursing Home Compare, and Minimum Data Set (MDS) assessments. We identified 10,531 long-stay CNH episodes for Veterans not prescribed antipsychotics 6 months before CNH admission. We categorized Veterans by whether, 12 months before admission, they were diagnosed with FDA-approved indications (including schizophrenia, Tourette’s syndrome, Huntington’s disease) for antipsychotic use. The exposure was the proportion of all CNH residents prescribed antipsychotics in the quarter preceding a Veteran’s admission. Using adjusted logistic regression, we analyzed two outcomes measured using MDS assessments collected ~100 days after CNH admission: 1) new antipsychotic use, and 2) new diagnosis for an FDA-approved indication among Veterans without these conditions at admission. Among antipsychotic-naïve Veterans admitted to CNHs, 7,924 (75.2%) lacked an antipsychotic indication. Prevalent antipsychotic use in CNHs ranged 0%-10.9% (quintile 1) and 25.7%-91.4% (quintile 5). The odds of initiating antipsychotic use increased with higher CNH antipsychotic use rates (OR=2.52, 95% CI:2.05-3.10, quintile 5 vs. 1), as did the odds of acquiring a new indication (OR=2.08, 95% CI:1.27-3.40, quintile 5 vs. 1). Provider practices may be influencing new diagnoses indicating antipsychotic use at CNHs with high antipsychotic use. It may be important for VA to consider antipsychotic use when contracting with CNHs.

scholarly journals Automated Nationwide Benchmarking Dashboard for Antimicrobial Stewardship Programs within the Veterans’ Health Administration

2021 ◽  
Vol 1 (S1) ◽  
pp. s23-s24
Author(s):  
Michihiko Goto ◽  
Eli Perencevich ◽  
Alexandre Marra ◽  
Bruce Alexander ◽  
Brice Beck ◽  
...  
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Risk Adjustment ◽  
Long Term Care ◽  
Antimicrobial Use ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care ◽  
Patient Level

Group Name: VHA Center for Antimicrobial Stewardship and Prevention of Antimicrobial Resistance (CASPAR) Background: Antimicrobial stewardship programs (ASPs) are advised to measure antimicrobial consumption as a metric for audit and feedback. However, most ASPs lack the tools necessary for appropriate risk adjustment and standardized data collection, which are critical for peer-program benchmarking. We created a system that automatically extracts antimicrobial use data and patient-level factors for risk-adjustment and a dashboard to present risk-adjusted benchmarking metrics for ASP within the Veterans’ Health Administration (VHA). Methods: We built a system to extract patient-level data for antimicrobial use, procedures, demographics, and comorbidities for acute inpatient and long-term care units at all VHA hospitals utilizing the VHA’s Corporate Data Warehouse (CDW). We built baseline negative binomial regression models to perform risk-adjustments based on patient- and unit-level factors using records dated between October 2016 and September 2018. These models were then leveraged both retrospectively and prospectively to calculate observed-to-expected ratios of antimicrobial use for each hospital and for specific units within each hospital. Data transformation and applications of risk-adjustment models were automatically performed within the CDW database server, followed by monthly scheduled data transfer from the CDW to the Microsoft Power BI server for interactive data visualization. Frontline antimicrobial stewards at 10 VHA hospitals participated in the project as pilot users. Results: Separate baseline risk-adjustment models to predict days of therapy (DOT) for all antibacterial agents were created for acute-care and long-term care units based on 15,941,972 patient days and 3,011,788 DOT between October 2016 and September 2018 at 134 VHA hospitals. Risk adjustment models include month, unit types (eg, intensive care unit [ICU] vs non-ICU for acute care), specialty, age, gender, comorbidities (50 and 30 factors for acute care and long-term care, respectively), and preceding procedures (45 and 24 procedures for acute care and long-term care, respectively). We created additional models for each antimicrobial category based on National Healthcare Safety Network definitions. For each hospital, risk-adjusted benchmarking metrics and a monthly ranking within the VHA system were visualized and presented to end users through the dashboard (an example screenshot in Figure 1). Conclusions: Developing an automated surveillance system for antimicrobial consumption and risk-adjustment benchmarking using an electronic medical record data warehouse is feasible and can potentially provide valuable tools for ASPs, especially at hospitals with no or limited local informatics expertise. Future efforts will evaluate the effectiveness of dashboards in these settings.Funding: NoDisclosures: None

scholarly journals Clostridium difficile Infection Among Veterans Health Administration Patients

2015 ◽  
Vol 36 (9) ◽  
pp. 1038-1045 ◽  
Author(s):  
Yinong Young-Xu ◽  
Jennifer L Kuntz ◽  
Dale N. Gerding ◽  
Julia Neily ◽  
Peter Mills ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Descriptive Analysis ◽  
Outpatient Setting ◽  
Nucleic Acid Amplification ◽  
Veterans Health ◽  
Healthcare Administration ◽  
Health Administration ◽  
Term Care ◽  
Veterans Healthcare Administration

OBJECTIVETo report on the prevalence and incidence of Clostridium difficile infection (CDI) from 2009 to 2013 among Veterans Healthcare Administration patientsDESIGNA retrospective descriptive analysis of data extracted from a large electronic medical record (EMR) databaseSETTINGData were acquired from VHA healthcare records from 2009 to 2013 that included outpatient clinical visits, long-term care, and hospitalized care as well as pharmacy and laboratory information.RESULTSIn 2009, there were 10,207 CDI episodes, and in 2013, there were 12,143 CDI episodes, an increase of 19.0%. The overall CDI rate increased by 8.4% from 193 episodes per 100,000 patient years in 2009 to 209 episodes per 100,000 patient years in 2013. Of the CDI episodes identified in 2009, 58% were identified during a hospitalization, and 42% were identified in an outpatient setting. In 2013, 44% of the CDI episodes were identified in an outpatient setting.CONCLUSIONThis is one of the largest studies that has utilized timely EMR data to describe the current CDI epidemiology at the VHA. Despite an aging population with greater burden of comorbidity than the general US population, our data show that VHA CDI rates stabilized between 2011 and 2013 following increases likely attributable to the introduction of the more sensitive nucleic acid amplification tests (NAATs). The findings in this report will help establish an accurate benchmark against which both current and future VA CDI prevention initiatives can be measured.Infect. Control Hosp. Epidemiol. 2015;36(9):1038–1045

scholarly journals Empirical development of a typology on residential long-term care units in Germany - results of an exploratory multivariate data analysis

2020 ◽  
Author(s):  
Johannes Michael Bergmann ◽  
Armin Michael Ströbel ◽  
Bernhard Holle ◽  
Rebecca Palm
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Long Term Care ◽  
Practical Recommendation ◽  
Term Care ◽  
Data Set ◽  
Convenience Sample ◽  
Agglomerative Hierarchical Cluster Analysis ◽  
Residential Long Term Care

Abstract Background Organizational health care research focuses on describing structures and processes in organizations and investigating their impact on the quality of health care. In the setting of residential long-term care, this effort includes the examination and description of structural differences among the organizations (e.g., nursing homes). The objective of the analysis is to develop an empirical typology of living units in nursing homes that differ in their structural characteristics. Methods Data from the DemenzMonitor Study were used. The DemenzMonitor is an observational study carried out in a convenience sample of 103 living units in 51 nursing homes spread over 11 German federal states. Characteristics of living units were measured by 19 variables related to staffing, work organization, building characteristics and meal preparation. Multiple correspondence analysis (MCA) and agglomerative hierarchical cluster analysis (AHC) are suitable to create a typology of living units. Both methods are multivariate and explorative. We present a comparison with a previous typology (created by a nonexplorative and nonmultivariate process) of the living units derived from the same data set. Results The MCA revealed differences among the living units, which are defined in particular by the size of the living unit (number of beds), the additional qualifications of the head nurse, the living concept and the presence of additional financing through a separate benefit agreement. We identified three types of living units; these clusters occur significantly with a certain combination of characteristics. In terms of content, the three clusters can be defined as: "house community", "dementia special care units” and "usual care". Conclusion A typology is useful to gain a deeper understanding of the differences in the care structures of residential long-term care organizations. In addition, the study provides a practical recommendation on how to apply the results, enabling housing units to be assigned to a certain type. The typology can be used as a reference for definitions.

scholarly journals Longitudinal Pressure Ulcer Rates After Adoption of Culture Change in Veterans Health Administration Nursing Homes

2016 ◽  
Vol 64 (1) ◽  
pp. 151-155 ◽  
Author(s):  
Christine W. Hartmann ◽  
Michael Shwartz ◽  
Shibei Zhao ◽  
Jennifer A. Palmer ◽  
Dan R. Berlowitz
Keyword(s):  
Nursing Homes ◽  
Pressure Ulcer ◽  
Culture Change ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration
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