scholarly journals 1416. Medicare Spending on Urinary Tract Infections: A Retrospective Database Analysis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S793-S793
Author(s):  
Kate Sulham ◽  
Eric Hammelman
Keyword(s):  
Care Facility ◽  
The Elderly ◽  
The United States ◽  
Fee For Service ◽  
Multicenter Cohort Study ◽  
Term Care ◽  
Long Term Care Facility ◽  
Home Based ◽  
Tract Infections ◽  
Medicare Spending

Abstract Background Medical visits for UTIs represent 1%-6% of all healthcare visits (~7 million visits) and are estimated to cost the United States (US) healthcare system at least &1.6 billion annually. UTIs are associated with significant morbidity; particularly among the elderly, where UTIs are most prevalent. Little is known about the specific costs to Medicare of UTI; here, we seek to examine overall Medicare spending on UTI. Methods We conducted a retrospective multicenter cohort study of the Medicare fee-for-service (FFS) data. Patients were included for analysis if the following criteria were met: (1) enrolled in Medicare FFS from January 1, 2016 through December 31, 2019, (2) not enrolled in Medicare Advantage during that time period, (3) did not have any UTI diagnoses in 2016, and (4) enrolled in Medicare Part D. Individuals were categorized as having uncomplicated UTI (uUTI), complicated UTI (cUTI), or those who first had a uUTI that progressed to a cUTI (uUTI to cUTI). Medicare spending in the 12 months post-diagnosis was calculated, and patients were stratified by home- or institutionally-based (eg, nursing home, long-term care facility, etc.). Results 2,330,123 patients were included for analysis; 92% were home-based, 8% were institutionally-based. Mean Charlson Comorbidity Index (CCI) across all patients was 2.16. In the 12 months after initial diagnosis, average Medicare spend was &33,984, &9,941 of which was UTI-related. Annual UTI-related costs were approximated &9,000 for home-based vs. &21,444 for institutionally-based patients. Mean drug spend per patient on antibiotics was &872. Broadly, uUTI patients were least expensive, followed by cUTI patients, with uUTI to cUTI patients being most expensive. Higher costs for were observed for institutionally-based patients, largely due to more frequent acute hospitalizations and more Part A-paid skilled nursing stays. Conclusion UTI-related spending represents approximately one-third of total annual Medicare spend for patients diagnosed with a UTI. Given average Medicare spending of approximately &12,000 per person in 2019, UTI is associated with substantially increased per patient cost and represents a significant source of spending for Medicare. Disclosures Kate Sulham, MPH, Spero Therapeutics (Consultant) Eric Hammelman, MBA, AbbVie Pharmaceuticals (Consultant)Edwards Lifesciences (Consultant)Genentech (Consultant)Spero Therapeutics (Consultant)Vertex Pharmaceuticals (Consultant)

Bilateral Inferior Altitudinal Defects Secondary to Stroke: A Case Series

2015 ◽  
Vol 77 (3) ◽  
pp. 23
Author(s):  
Stacey Chong ◽  
Tammy :abreche ◽  
Patricia Hrynchak ◽  
Michelle Steenbakkers
Keyword(s):  
Newborn Infants ◽  
Case Series ◽  
Care Facility ◽  
The Elderly ◽  
The United States ◽  
Visual Field Defects ◽  
Term Care ◽  
Long Term Care Facility ◽  
Risk Of Death ◽  
Increased Risk

Strokes or cerebrovascular accidents are the third leading cause of death in Canada, comprising 6% of all deaths in the country.1 The elderly and the very young (fetus or newborn infants) are at highest risk for having a stroke with an associated increased risk of death or lasting neurological disability. According to the National Stroke Association recovery guidelines, 10% of stroke survivors will recover almost completely, 25% will recover with minor impairments, 40% will survive with moderate to severe impairments that require specialized care, 10% will require care in a long-term care facility, and 15% will die shortly after the stroke. The National Stroke Association estimates that there are 7 million people in the United States that have survived a stroke and are living with impairments. The Heart and Stroke Foundation’s 2013 Stroke Report has estimated that 315,000 Canadians are living with the effects of stroke. This case series serves as a reminder that, although rare, bilateral inferior altitudinal visual field defects can also occur as the result of a stroke, to highlight the difficulties of orientation and mobility that can result, and to offer potential rehabilitative strategies.

scholarly journals FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
Rebecca L Mauldin ◽  
Kathy Lee ◽  
Antwan Williams
Keyword(s):  
Long Term Care ◽  
Federal Policy ◽  
Care Facility ◽  
Well Being ◽  
The United States ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities

Abstract Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.

scholarly journals Silencing and Silence: Language and Specialized Listening in a Long-Term Institution for the Elderly

2020 ◽  
pp. 1-9
Author(s):  
Simone Maximo Pelis ◽  
Nirvana Ferraz Santos Sampaio
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
The Elderly ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Methodological Perspective ◽  
Alternative System

This article presents the result of research developed with the language of elderly residents at the Long Term Care Facility for the Elderly - ILPI, in Vitória da Conquista, Bahia, Brazil. In response to the initial questions as to whether institutionalization affects the language of the elderly, whether the re-signification of verbal by non-verbal speech occurs, and whether silence, as language is part of an alternative system of possible meaning for the elderly, it was perceived that language in institutionalized long-lived individuals it reveals that in response to diversified processes of silencing, they have instituted silence as a possibility of reframing, and structuring of meaning. We collected data through the filming and recording of the elderly in enunciative-discursive situations, considering the uniqueness of each subject's history and their respective crossings as well as the condition of production of the narratives based on the concept of data-finding by Maria HadlerCoudry (1), aligned with notions relevant to Linguistics in the theoretical-methodological perspective of Discursive Neurolinguistics.

scholarly journals 972. Asymptomatic Carriage of Clostridiodes difficile and Risk of Subsequent Infection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S38-S38
Author(s):  
Katrina Espiritu ◽  
Michael Vernon ◽  
Donna Schora ◽  
Lance Peterson ◽  
Kamaljit Singh
Keyword(s):  
Care Facility ◽  
The United States ◽  
Term Care ◽  
Asymptomatic Carriers ◽  
Long Term Care Facility ◽  
Patient Demographics ◽  
Asymptomatic Carriage ◽  
Admission Screening ◽  
History Of ◽  
Healthcare Associated

Abstract Background C. difficile is one of the most common healthcare-associated infections in the United States. Studies of patients with asymptomatic carriage of toxigenic C. difficile have reported conflicting results on the risk of subsequent C. difficile infection (CDI). Older studies suggest that the risk was low and colonization may be protective. Subsequent studies indicate that asymptomatic carriers have a 6-fold greater risk of developing CDI. The aims of our study were to assess the burden of asymptomatic C. difficile carriage and risk of subsequent CDI. Methods Adult inpatients at NorthShore University HealthSystem, Illinois hospitals between August 1, 2017 and February 28, 2018 were eligible for the study. Focused admission screening of patients at high risk of C. difficile carriage was performed: (1) history of CDI or colonization, (2) prior hospitalization past 2 months, or (3) admission from a long-term care facility. A rectal swab was collected and tested using the cobas® Cdif Test (Roche) real-time PCR. The development of hospital onset CDI (HO-CDI) in colonized patients was monitored prospectively for at least 2 months. HO-CDI testing of colonized patients was performed using the Cepheid GeneXpert RT-PCR. HO-CDI was defined as patients hospitalized for at least 72 hours with 3 or more episodes of diarrhea/24 hours, in the absence of other potential causes of diarrhea. Patient demographics were collected using a standardized form and data analyzed using VassarStats. Results There were 6,104 patients enrolled in the study and 528 (8.7%) were positive on admission for toxigenic C. difficile carriage. The mean age of colonized patients was 75.5 years (range 24–103) and 56.4% (298 patients) were females. Of 528 colonized patients, 21 (4%) had a positive CDI test. A total of 7 patients (1.3%) developed HO-CDI. Mean time to positive HO-CDI was 46.1 days (range 5–120 days). Of 5,576 patients that were negative for C difficile carriage on admission, 14 (0.3%) patients developed HO-CDI. The relative risk of HO-CDI was 5.28 (95% CI: 2.14–13.03, P = 0.05). Conclusion We found that 8.7% of at-risk admissions were asymptomatic toxigenic C. difficile carriers. While only 1.3% developed HO-CDI, asymptomatic carriers had a 5 times higher risk of subsequent CDI compared with non-carriers. Disclosures All authors: No reported disclosures.

Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

2020 ◽  
Vol 42 (1) ◽  
pp. 31-36
Author(s):  
Taniece R. Eure ◽  
Nimalie D. Stone ◽  
Elisabeth A. Mungai ◽  
Jeneita M. Bell ◽  
Nicola D. Thompson
Keyword(s):  
Urinary Tract ◽  
Nursing Homes ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Long Term Care Facility ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Tract Infections

AbstractObjective:Antibiotic resistance (AR) is a growing and highly prevalent problem in nursing homes. We describe selected AR phenotypes from pathogens causing urinary tract infections (UTIs) reported by nursing homes to the National Healthcare Safety Network (NHSN).Design:Pathogens and antibiotic susceptibility testing results for UTI events in nursing homes between January 2013 and December 2017 were analyzed. The pathogen distribution and pooled mean proportion of isolates that tested resistant to select antibiotic agents are reported.Setting and Participants:US nursing homes voluntarily participating in the Long-Term Care Facility component of the NHSN.Results:Overall, 243 nursing homes reported 1 or more UTIs: 121 (50%) were nonprofit facilities, median bed size was 91 (range: 9–801), and average occupancy was 87%. In total, 6,157 pathogens were reported for 5,485 UTI events. Moreover, 9 pathogens accounted for 90% of all reported UTIs; the 3 most frequently identified were Escherichia coli (41%), Proteus species (14%), and Klebsiella pneumoniae/oxytoca (13%). Among E. coli, fluoroquinolone, and extended-spectrum cephalosporin resistance were most prevalent (50% and 20%, respectively). Although Staphylococcus aureus and Enterococcus faecium represented <5% of pathogens reported, they had the highest rates of resistance (67% methicillin resistant and 60% vancomycin resistant, respectively). Multidrug resistance was most common in Pseudomonas aeruginosa (11%). For the resistant phenotypes we assessed, 36% of all UTIs reported were associated with a resistant pathogen.Conclusions:This is the first summary of AR among common pathogens causing UTIs reported to NHSN by nursing homes. Improved understanding of the resistance burden among common infections helps inform facility infection prevention and antibiotic stewardship efforts.

Geriatric Teams in the Long-term Care Facility

1988 ◽  
Vol 1 (3) ◽  
pp. 195-201
Author(s):  
Ruthanne R. Ramsey
Keyword(s):  
Health Care ◽  
Long Term Care ◽  
Care Delivery ◽  
Care Facility ◽  
The Elderly ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Inpatient Settings

Geriatric teams have emerged as an accepted method of health care delivery to the elderly patient in ambulatory and acute inpatient settings. As one model of specialized health care teams, geriatric teams vary in structure, membership, and type. The purposes may be diverse, ranging from providing primary care to multidimensional functional and diagnostic assessment. Geriatric teams have convincingly demonstrated benefit to the care of the elderly. Overcoming significant barriers to their formation, geriatric teams are beginning to develop in long-term care facilities as a result of economic and educational pressures. However, the unique environment and needs of the long-term care facility have resulted in differences in leadership, membership, and structure of long-term care teams. Pharmacist involvement in the long-term care geriatric team could benefit the facility, patient care, and the profession. The key to future involvement by pharmacists in teams appears to depend on their interest, ability to acquire necessary skills, and demonstration of unique professional contributions.

Prevalence and Nosocomial Spread of Methicillin-ResistantStaphylococcus aureusin a Long-Term-Care Facility in Slovenia

2005 ◽  
Vol 26 (2) ◽  
pp. 184-190 ◽  
Author(s):  
Tjasa Zohar Cretnik ◽  
Petra Vovko ◽  
Matjaz Retelj ◽  
Borut Jutersek ◽  
Tatjana Harlander ◽  
...  
Keyword(s):  
Potential Role ◽  
Long Term Care ◽  
Genetic Relatedness ◽  
Care Facility ◽  
The Elderly ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Mrsa Colonization

AbstractObjectives:To determine the prevalence and incidence of methicillin-resistantStaphylococcus aureus(MRSA) colonization among residents and healthcare workers (HCWs) of a long-term-care facility (LTCF), to assess possible routes of nosocomial spread, and to determine genetic relatedness of the isolates.Setting:A 351-bed community LTCF for the elderly.Design and Participants:Study investigators made two visits, approximately 3 months apart, to the facility. Samples for cultures were obtained from 107 residents during the first visit, 91 residents during the second visit, and 38 HCWs.Results:The prevalence of MRSA colonization among residents was 9.3% during the first visit and 8.8% during the second visit. During the first visit, two HCWs were colonized. During the second visit, no HCWs were colonized. The colonization of HCWs suggested a potential role in the transmission of MRSA. Molecular typing showed that two of three roommates in one room had the same strain, whereas two in another room differed from one another. All isolates, except one, belonged to two related clonal groups. It seems that the clonal group to which most isolates belonged had the greatest potential for spreading among both residents and HCWs.Conclusions:Similar prevalence rates of MRSA colonization have been found in other European countries, but such studies have usually involved residents with better functional status than that of the participants in this study. Nosocomial spread of MRSA occurred in the facility examined, but not frequently. More attention should be focused on the hand hygiene of HCWs.

scholarly journals Institutional routines and interpersonal conflicts among elderly in a Long-Term Care Facility

2021 ◽  
Vol 55 ◽  
Author(s):  
Jamile Lais Bruinsma ◽  
Margrid Beuter ◽  
Zulmira Newlands Borges ◽  
Caren da Silva Jacobi ◽  
Eliane Raquel Rieth Benetti ◽  
...  
Keyword(s):  
Long Term Care ◽  
Elderly Women ◽  
Participant Observation ◽  
Care Facility ◽  
The Elderly ◽  
Term Care ◽  
Interpersonal Conflicts ◽  
Term Care Facility ◽  
Long Term Care Facility

ABSTRACT Objective: To describe the influence of institutional routines on interpersonal conflicts among institutionalized elderly women. Method: A qualitative study, with an ethnographic framework, performed with 17 elderly women in a Long-Term Care Facility. The field immersion occurred from August 2017 to May 2018. The data were produced by participant observation and fieldnotes and analyzed through the sociocultural perspective with theoretical tools related to the total institutions described by Erving Goffman. Results: External bonds outside the institution and the routines were trigger factors of conflicts in the Long-Term Care Facility. The dissatisfaction with the lack of external bonds was noticed in the impossibility of leaving with family members, receiving visits, objects, money, foods, or attention. The standardization and collectivization of internal routines of basic activities generated dissatisfaction and challenged the elderly women’s tolerance towards the norms. Such situations facilitated interpersonal conflicts in the institutional environment. Conclusion: The conflicts occurred among elderly women and professionals, and among them, from the insubordination of the elderly, based on the idea of reaffirming their individualities.

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