scholarly journals Poor Performance in SNF-VBP Program is Associated with Worse COVID-19 Outcomes in Nursing Homes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1022-1022
Author(s):  
Jennifer Gaudet Hefele ◽  
Matt Aldag ◽  
Riad Elmor ◽  
Charanya Kaushik ◽  
Jessica Simpson Ballard
Keyword(s):  
Nursing Homes ◽  
Skilled Nursing Facility ◽  
Case Fatality ◽  
Poor Performance ◽  
Poor Quality ◽  
Value Based Purchasing ◽  
Important Indicator ◽  
Black African ◽  
Vaccination Rates ◽  
To Receive

Abstract Skilled Nursing Facility Value-Based Purchasing (SNF-VBP) was a new Medicare payment program when COVID-19 began. SNF-VBP aims to improve care through payment bonuses and penalties. However, studies have shown that minority-serving nursing homes (NHs) tend to fare worse under SNF-VBP (more likely to receive penalties, less likely to receive bonuses). This study sought to examine whether SNF-VBP performance prior to the pandemic was associated with COVID-19 outcomes and whether associations varied in NHs where the majority of residents are Black/African American (majority-Black/AA). Using publicly available data on COVID-19 outcomes and vaccinations, SNF-VBP performance, and NH characteristics, we found that majority-Black/AA NHs were less likely to have zero infections; had higher case fatality rates; and had lower resident and staff vaccinations rates compared to NHs where the majority of residents are White. Across all NHs, worse SNF-VBP performance was associated with worse COVID-19 outcomes (the bottom quintile of SNF-VBP performers were more likely to experience COVID-19 infections and had lower vaccination rates; the highest performers had higher vaccination rates). However, in stratified analyses, SNF-VBP performance was not significantly associated with COVID-19 outcomes in majority-Black/AA NHs compared with majority-White NHs. The association between poor SNF-VBP performance and poor COVID-19 outcomes is concerning. Overall findings suggest that SNF-VBP performance prior to the pandemic is an important indicator of subsequent COVID-19 outcomes. However, it is unclear whether poor SNF-VBP performance is signaling overall poor quality or whether it is signaling a financial disadvantage caused by the program itself that in turn impacted COVID-19 outcomes.

scholarly journals Ethnicity and impact on the receipt of cognitive–behavioural therapy in people with psychosis or bipolar disorder: an English cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e034913
Author(s):  
Rohan Michael Morris ◽  
William Sellwood ◽  
Dawn Edge ◽  
Craig Colling ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cohort Study ◽  
Cognitive Behavioural Therapy ◽  
Secondary Care ◽  
Behavioural Therapy ◽  
Single Session ◽  
Black African ◽  
Cognitive Behavioural ◽  
Black Caribbean ◽  
To Receive

Objectives(1) To explore the role of ethnicity in receiving cognitive–behavioural therapy (CBT) for people with psychosis or bipolar disorder while adjusting for differences in risk profiles and symptom severity. (2) To assess whether context of treatment (inpatient vs community) impacts on the relationship between ethnicity and access to CBT.DesignCohort study of case register data from one catchment area (January 2007–July 2017).SettingA large secondary care provider serving an ethnically diverse population in London.ParticipantsData extracted for 30 497 records of people who had diagnoses of bipolar disorder (International Classification of Diseases (ICD) code F30-1) or psychosis (F20–F29 excluding F21). Exclusion criteria were: <15 years old, missing data and not self-defining as belonging to one of the larger ethnic groups. The sample (n=20 010) comprised the following ethnic groups: white British: n=10 393; Black Caribbean: n=5481; Black African: n=2817; Irish: n=570; and ‘South Asian’ people (consisting of Indian, Pakistani and Bangladeshi people): n=749.Outcome assessmentsORs for receipt of CBT (single session or full course) as determined via multivariable logistic regression analyses.ResultsIn models adjusted for risk and severity variables, in comparison with White British people; Black African people were less likely to receive a single session of CBT (OR 0.73, 95% CI 0.66 to 0.82, p<0.001); Black Caribbean people were less likely to receive a minimum of 16-sessions of CBT (OR 0.83, 95% CI 0.71 to 0.98, p=0.03); Black African and Black Caribbean people were significantly less likely to receive CBT while inpatients (respectively, OR 0.76, 95% CI 0.65 to 0.89, p=0.001; OR 0.83, 95% CI 0.73 to 0.94, p=0.003).ConclusionsThis study highlights disparity in receipt of CBT from a large provider of secondary care in London for Black African and Caribbean people and that the context of therapy (inpatient vs community settings) has a relationship with disparity in access to treatment.

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.

scholarly journals Infections during high dose methotrexate therapy in childhood acute lymphoblastic leukemia (ALL)

2016 ◽  
Vol 45 (1) ◽  
pp. 6-13
Author(s):  
Taskina Mosleh ◽  
Gulsan Ara Zahan ◽  
Md Kamrul Ahsan Khan ◽  
Afiqul Islam
Keyword(s):  
Prospective Observational Study ◽  
Lymphoblastic Leukemia ◽  
Case Fatality ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Childhood All ◽  
Dose Methotrexate ◽  
Incidence Risk ◽  
To Receive ◽  
Hdmtx Therapy

High-dose methotrexate (HDMTX) therapy is an effective therapy for childhood ALL, which is frequently associated with side effects like infection in our centre. It prolongs hospital stay, delays chemotherapy and causes more economic burden on patients.This study was done to identify the incidence, risk factors and severity of infection among children with ALL during HDMTX therapy.This prospective observational study was conducted among 50 patients suffering from acute lymphoblastic leukemiascheduled to receive HDMTX at the Department of Pediatric Hemato-oncology of BSMMU. It was carried out from January 2012 to June 2012.The end result showed, 19 (38%) patients su_ered from infection; among them microbiologically documented infections found in 9 occasions, where gram negative bacilli - E.coli 4(44.4%) & Pseudomonas 3(33.33%) were predominant organisms. Gastrointestinal tract (GIT) was the most common site (8,42.11%).The rate of infection is significantly higher in children <5 yrs(78.94%). Mortality rate was 6%. As the infection and case fatality rate is quite high with HDMTX therapy, we recommend to use this drug with caution.Bangladesh Med J. 2016 Jan; 45 (1): 6-13

scholarly journals Responding to Poor-Quality Care During Research in Nursing Homes

2010 ◽  
Vol 4 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Melanie R. Krause ◽  
Janice L. Palmer ◽  
Barbara J. Bowers ◽  
Kathleen C. Buckwalter
Keyword(s):  
Nursing Homes ◽  
Quality Care ◽  
Poor Quality ◽  
Poor Quality Care

Factors That Influenced Rates of Influenza Vaccination Among Employees of Wisconsin Acute Care Hospitals and Nursing Homes During the 2005-2006 Influenza Season

2007 ◽  
Vol 28 (12) ◽  
pp. 1398-1400 ◽  
Author(s):  
Gwen Borlaug ◽  
Alexandra Newman ◽  
John Pfister ◽  
Jeffrey P. Davis
Keyword(s):  
Nursing Homes ◽  
Influenza Vaccination ◽  
Acute Care ◽  
Influenza Season ◽  
Acute Care Hospitals ◽  
Vaccination Programs ◽  
Vaccination Rates

Hospitals and nursing homes were surveyed in 2006 to obtain information on employee influenza vaccination programs and baseline rates of influenza vaccination among employees. Results were used to make recommendations for improving employees' 2007 influenza vaccination rates. Facilities should continue to provide convenient and free vaccination programs, offer education to promote vaccination, and use signed declination forms.

Influenza Vaccination Among Registered Nurses: Information Receipt, Knowledge, and Decision-Making at an Institution With a Multifaceted Educational Program

2008 ◽  
Vol 29 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Cori L. Ofstead ◽  
Sharon J. Tucker ◽  
Timothy J. Beebe ◽  
Gregory A. Poland
Keyword(s):  
Influenza Vaccination ◽  
Registered Nurses ◽  
Educational Program ◽  
Medical Center ◽  
Vaccine Safety ◽  
Educational Interventions ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccination Rates ◽  
To Receive

Objective.To evaluate the receipt of information and knowledge about influenza and vaccination, as well as influenza vaccination status and reasons for declining vaccination, among registered nurses.Design.Cross-sectional survey of registered nurses (RNs).Setting.A large tertiary medical center with a long-standing, multifaceted influenza vaccination program and relatively high vaccination rates among employees overall (76.5%).Participants.Randomly selected group of 990 RNs employed as inpatient staff nurses at the institution.Results.The survey was completed by 513 (51.8%) of 990 RNs. Most RNs (86.7%) had received an influenza vaccination in the past, and 331 (64.5%) intended to receive vaccination during the 2005-2006 influenza season. More than 90% of RNs acknowledged exposure to educational bulletins, and most had received information about influenza severity (383 [74.7%]), transmission (398 [77.6%]), vaccine safety (416 [81.1%]), and the time and location of free vaccination (460 [89.7%]). A majority (436 [85.0%]) felt they had received all the information they needed to make good decisions about vaccination. However, only 49 RNs (9.6%) gave correct answers to more than 85% of the knowledge questions on the survey. The reasons most frequently reported for declining vaccination were doubts about the risk of influenza and the need for vaccination, concerns about vaccine effectiveness and side effects, and dislike of injections.Conclusions.RNs exposed to a longstanding, multifaceted educational program had received information about influenza vaccination, but misconceptions were common and only 331 (64.5%) intended to receive vaccination. Strategies other than educational interventions are needed to increase influenza vaccination rates and thereby to ensure healthcare worker and patient safety.

Inter-Relational Dynamics of Various HR Aspects in High Altitude Illness Attrition

2020 ◽  
pp. 114-132
Author(s):  
Ajeya Jha ◽  
Ajay Dheer ◽  
Vijay Kumar Mehta ◽  
Saibal Kumar Saha
Keyword(s):  
Decision Making ◽  
High Altitude ◽  
Poor Performance ◽  
Working Hours ◽  
Poor Quality ◽  
Relational Dynamics ◽  
Adverse Health Effects ◽  
Personal Stress ◽  
High Altitude Illness ◽  
And Performance

The adverse health effects of high altitude are of considerable importance since they may seriously interfere with working efficiency of an organization that is actively involved with inescapable duties. The objective of the current study is to explore inter-relational dynamics of various HR aspects in HAIA. The HR aspects included are job delay, poor team, motivation, less leave, high working hours, poor decision making, personal stress, family stress, personal discomfort, uncertainty, poor relations, health, accidents, quality and performance. A decision-making trial and an evaluation laboratory have been used to explore the inter-relation dynamics of various factors of HR. The results indicate that personal stress has the highest impact priority which is followed by poor performance, poor team and motivation. Uncertainty, less leave, and high working hours has the least impact priority. It is also found that high working hours, less leave and poor health are the major causes whereas decrease in motivation and poor quality of work are the major results.

Expectancy or primary chemotherapy in patients with advanced asymptomatic colorectal cancer: a randomized trial.

1992 ◽  
Vol 10 (6) ◽  
pp. 904-911 ◽  
Author(s):  
Keyword(s):  
Colorectal Cancer ◽  
Randomized Trial ◽  
Disease Progression ◽  
Advanced Colorectal Cancer ◽  
Poor Performance ◽  
Treatment Allocation ◽  
Asymptomatic Patients ◽  
Leucovorin Rescue ◽  
Study Population ◽  
To Receive

PURPOSE The advantage of chemotherapy in asymptomatic patients with advanced colorectal cancer is debatable. Whether early chemotherapy improves survival and the length of the symptom-free period versus no therapy until symptoms appear was studied in a randomized trial. PATIENTS AND METHODS A total of 183 patients with advanced, but asymptomatic colorectal cancer were randomly allocated to receive either initial treatment with sequential methotrexate 250 mg/m2 during the first 2 hours, and fluorouracil (5-FU) 500 mg/m2 at hours 3 and 23 followed by leucovorin rescue initiated at hour 24 (MFL) for 12 courses or to primary expectancy with chemotherapy not considered until symptoms appeared. One patient was ineligible and excluded from analysis. Nine patients did not fulfill the inclusion criteria and five patients refused treatment allocation; these patients were not excluded from the study population so as not to introduce bias. So far, 51 of 90 (60%) patients in the expectancy group have received chemotherapy. RESULTS Overall survival was better in the MFL group than in the expectancy group (Breslow-Gehan, P less than .02; log-rank, P = .13) with a difference in median survival of approximately 5 months. Also the symptom-free period and the time to disease progression were longer in the MFL group (P less than .001), with median differences of 8 and 4 months, respectively. Toxicity to MFL treatment was low; however, three patients died because of toxicity--none of them should have received therapy because of poor performance or S-creatinine elevation. The patients maintained an excellent performance throughout the MFL treatment unless the disease was progressive. CONCLUSION We concluded that early treatment with MFL in asymptomatic patients with advanced colorectal cancer prolongs survival, the asymptomatic period, and the time to disease progression by approximately 6 months over primary expectancy.

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