scholarly journals Identifying the Implementation Conditions Associated With Positive Outcomes in a Successful Nursing Facility Demonstration Project

2020 ◽  
Vol 60 (8) ◽  
pp. 1566-1574 ◽  
Author(s):  
Susan E Hickman ◽  
Edward J Miech ◽  
Timothy E Stump ◽  
Nicole R Fowler ◽  
Kathleen T Unroe
Keyword(s):  
Institutional Care ◽  
Demonstration Project ◽  
Successful Implementation ◽  
Implementation Barriers ◽  
Nursing Facility ◽  
Patient Transfers ◽  
Avoidable Hospitalizations ◽  
Medical Quality ◽  
Hospitalization Rates ◽  
Director Of Nursing

Abstract Background and Objectives To identify the implementation barriers, facilitators, and conditions associated with successful outcomes from a clinical demonstration project to reduce potentially avoidable hospitalizations of long-stay nursing facility residents in 19 Indiana nursing homes. Research Design and Methods Optimizing Patient Transfers, Impacting Medical quality, Improving Symptoms—Transforming Institutional Care (OPTIMISTIC) is a multicomponent intervention that includes enhanced geriatric care, transition support, and palliative care. The configurational analysis was used to analyze descriptive and quantitative data collected during the project. The primary outcome was reductions in hospitalizations per 1,000 eligible resident days. Results Analysis of barriers, facilitators, and conditions for success yielded a model with 2 solution pathways associated with a 10% reduction in potentially avoidable hospitalizations per 1,000 resident days: (a) lower baseline hospitalization rates and investment of senior management; or (b) turnover by the director of nursing during the observation period. Conditions for success were similar for a 20% reduction, with the addition of increased resident acuity. Discussion and Implications Key conditions for successful implementation of the OPTIMISTIC intervention include strong investment by senior leadership and an environment in which baseline hospitalization rates leave ample room for improvement. Turnover in the position of director of nursing also linked to successful implementation; this switch in leadership may represent an opportunity for culture change by bringing in new perspectives and viewpoints. These findings help define the conditions for the successful implementation of the OPTIMISTIC model and have implications for the successful implementation of interventions in the nursing facility more generally.

scholarly journals Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) Project

2017 ◽  
Vol 58 (6) ◽  
pp. 1177-1187 ◽  
Author(s):  
Mary Ersek ◽  
Susan E Hickman ◽  
Anne C Thomas ◽  
Brittany Bernard ◽  
Kathleen T Unroe
Keyword(s):  
Institutional Care ◽  
Patient Transfers ◽  
Stakeholder Perspectives ◽  
Medical Quality

scholarly journals Pneumonia in Indiana nursing homes: a retrospective case series

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Andrew Shearn ◽  
Kathleen Unroe, MD, MHA ◽  
Jennifer Carnahan, MD, MPH, MA
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Institutional Care ◽  
Case Series ◽  
Nursing Home Residents ◽  
The Elderly ◽  
Nursing Facilities ◽  
Retrospective Case ◽  
Avoidable Hospitalizations ◽  
Medical Quality

Background  The Optimizing Patient Transfers, Impacting Medical Quality, & Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project is a Centers for Medicare and Medicaid (CMS) demonstration project, tasked with reducing potentially avoidable hospitalizations of nursing home residents. OPTIMISTIC-enrolled nursing homes are reimbursed by CMS for treating residents with pneumonia in place. The purpose of this study is to examine the diagnosis, treatment, and outcomes of episodes of pneumonia in OPTIMISTIC nursing homes.  Project Methods  This case series uses data from nursing home medical records of the seven facilities with the highest pneumonia caseload identified from the OPTIMISTIC database. Cases are from billing episodes spanning November 2017 through April 2018. Within each facility, cases of pneumonia were randomly selected for inclusion. Data were entered into an extraction tool designed by the study team.  Results  Data were extracted from 41 records of unique patients. Despite CMS reimbursing for a maximum of 7 days for treatment of pneumonia, 78.0% of patients were monitored beyond that time and with greater attention than usual care. Of all 41 patients treated with antibiotics, 53.7% were given a fluoroquinolone and 24.4% were given amoxicillin/clavulanate.  CURB-65 scores showed 58.3% scored in a range recommending hospitalization. Most patients (87.8%) were stabilized in the nursing home; three (7.3%) were hospitalized, one (2.4%) transferred to hospice, and one (2.4%) died.  Conclusion and Potential Impact  OPTIMISTIC-affiliated nursing facilities successfully provide enhanced care for most patients diagnosed with pneumonia in the facilities. Given the high incidence of fluoroquinolone use, one area for improvement is reduction of this medication contraindicated in the elderly.

scholarly journals Skin Infections in Indiana Nursing Homes

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Kayla Brown ◽  
Kathleen Unroe, MD, MHA ◽  
Jennifer Carnahan, MD, MPH, MA
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Institutional Care ◽  
Nursing Home Care ◽  
Skin Infections ◽  
Patient Transfers ◽  
Medical Quality ◽  
Using Data ◽  
Care Improvement

Background and Hypothesis: OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical Quality, & Improving Symptoms: Transforming Institutional Care) is a CMS (Centers for Medicare and Medicaid Services) demonstration project that aims to improve nursing home care. CMS provides enhanced reimbursement to nursing homes in the project when they are able to treat six conditions in the facility rather than being transferred to a hospital, one of which being skin infections. The purpose of this study is to examine the diagnosis, treatments, and outcomes of skin infections of residents in nursing homes enrolled in OPTIMISTIC. Experimental Design or Project Methods: A chart review of 26 cases was conducted using data from nursing home medical records of nine OPTIMISTIC facilities. Cases were randomly selected from billing episodes between November 2018 and May 2019. Data was entered into an Excel extraction tool created for the project and analyzed. Results: Of the randomly selected skin infections, 46.2% were diagnosed as non-purulent cellulitis and 23.1% as purulent cellulitis. Other infections included abscesses, infected pressure injuries, and shingles. Doxycycline was the most common antibiotic prescribed, used in 42.3% of the total skin infections. For non-purulent cellulitis, cephalexin was the next most used antibiotic (41.7%). Twelve of the skin infections were recurrent, and the most common antibiotic used for those infections was doxycycline. Of the twenty-six cases, twenty-three were resolved in the facility, one was recertified for a longer length of time, one was transferred to the hospital, and one was transferred to hospice. Conclusion and Potential Impact: This project provides a unique opportunity to examine diagnosis and treatment patterns of skin infections in nursing homes. The results of this study will be used to bolster and augment future efforts at nursing home care improvement for patients diagnosed with skin infections in the facility.

ISM-MICMAC approach for analysis of project-based learning barriers

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Syed Khalid Perwez ◽  
Goutam Kumar Kundu
Keyword(s):  
Structural Model ◽  
Educational Institution ◽  
Project Based Learning ◽  
Educational Institutions ◽  
Successful Implementation ◽  
Implementation Barriers ◽  
Higher Educational Institutions ◽  
Content Type ◽  
Barriers To Implementation ◽  
Higher Educational

Purpose This paper aims to identify and model the key barriers to implementation of project-based learning (PjBL) in higher educational institution. Design/methodology/approach Using the interpretive structural modelling (ISM) technique, the study has developed a hierarchical-based model, depicting the mutual relationships amongst the key barriers to implementation of PjBL. Additionally, the paper has performed Matrice d’ Impacts Croises Multiplication Appliqué an Classement (MICMAC) analysis to categorize the barriers in terms of their driving and dependence power. Findings The study has identified the key barriers to implementation of PjBL and presented an integrated model using ISM. Higher educational institutions need to pay attention to diagnose and overcome these hindrances for effective implementation of PjBL in their programmes. Research limitations/implications The study adopts a systematic way to model the relevant barriers to implementation of PjBL. The ISM-based model would help higher education institutions to prioritize the issues as the barriers are hierarchically structured. As the input to model development is based on the experts’ opinions, it may be biased, influencing the final output of the structural model. Originality/value The presentation of PjBL implementation barriers in the form of an ISM-based model is a new effort. The model would be useful to understand the barriers and overcome these for the successful implementation of PjBL in higher educational institutions.

scholarly journals Effects of Hurricane Katrina on Nursing Facility Resident Mortality, Hospitalization, and Functional Decline

2010 ◽  
Vol 4 (S1) ◽  
pp. S28-S32 ◽  
Author(s):  
David Dosa ◽  
Zhanlian Feng ◽  
Kathy Hyer ◽  
Lisa M. Brown ◽  
Kali Thomas ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hurricane Katrina ◽  
Functional Decline ◽  
Secondary Data ◽  
Hospitalization Rate ◽  
Minimum Data Set ◽  
Nursing Facility ◽  
Data Set ◽  
Hospitalization Rates ◽  
Minimum Data

ABSTRACTBackground: The study was designed to examine the 30- and 90-day mortality and hospitalization rates among nursing facility (NF) residents in the affected areas of Louisiana and Mississippi following Hurricane Katrina and to assess the rate of significant posthurricane functional decline.Methods: A secondary data analysis was conducted using Medicare claims merged with NF resident data from the Minimum Data Set. Thirty- and 90-day mortality and hospitalization rates for long-stay (>90 days) residents residing in 141 at-risk NFs during Hurricane Katrina were compared to rates for residents residing at the same facilities during the same time period in prior nonhurricane years (2003 and 2004). Functional decline was assessed as a 4+ drop in function using a 28-point Minimum Data Set Activities of Daily Living Scale.Results: There were statistically significant differences (all P < .0001) in mortality, hospitalization, and functional decline among residents exposed to Hurricane Katrina. At 30 days, the mortality rate was 3.88% among the exposed cohort compared with 2.10% and 2.28% for residents in 2003 and 2004, respectively. The 90-day mortality rate was 9.27% compared with 6.71% and 6.31%, respectively. These mortality differences translated into an additional 148 deaths at 30 days and 230 deaths at 90 days. The 30-day hospitalization rate was 9.87% compared with 7.21% and 7.53%, respectively. The 90-day hospitalization rate was 20.39% compared with 18.61% and 17.82%, respectively. Finally, the rate of significant functional decline among survivors was 6.77% compared with 5.81% in 2003 and 5.10% in 2004.Conclusions: NF residents experienced a significant increase in mortality, hospitalization, and functional decline during Hurricane Katrina.(Disaster Med Public Health Preparedness. 2010;4:S28-S32)

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