The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care Approach: Preliminary Data from the Implementation of a Centers for Medicare and Medicaid Services Nursing Facility Demonstration Project

2014 ◽  
Vol 63 (1) ◽  
pp. 165-169 ◽  
Author(s):  
Kathleen T. Unroe ◽  
Arif Nazir ◽  
Laura R. Holtz ◽  
Helen Maurer ◽  
Ellen Miller ◽  
...  
Keyword(s):  
Preliminary Data ◽  
Institutional Care ◽  
Demonstration Project ◽  
Nursing Facility ◽  
Patient Transfers ◽  
Medical Quality ◽  
Care Approach

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 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.

Multidisciplinary management from day one: the Neuro-care approach to motor neurone disease

1993 ◽  
Vol 7 (4_suppl) ◽  
pp. 31-36 ◽  
Author(s):  
Marie Oxtoby ◽  
Marit Eikaas
Keyword(s):  
Ethical Issues ◽  
Institutional Care ◽  
Motor Neurone ◽  
Motor Neurone Disease ◽  
Outcomes Of Care ◽  
Neurological Patients ◽  
Team Activity ◽  
Care Approach ◽  
Measuring Outcomes ◽  
High Level

The Neuro-care approach offers a holistic, multidisciplinary, patient-centred, continuous strategy of care to unselected groups of neurological patients and their families including those with motor neurone disease (MND). The strategy for MND patients is an adapted version of one piloted on patients with Parkinson's disease. Between April 1990 and September 1992 12 MND patients were diagnosed, of whom five have died. The main features of the care strategy and the guidelines for giving the diagno sis are described. The characteristics of the patient group are identified and the high level of team activity vis-a-vis other patient groups is noted. The maintenance of patients in the community and the lack of resort to permanent institutional care are also recorded. Ethical issues arising during the project are discussed and the problems of measuring outcomes of care are acknowledged. General conclusions for MND management are drawn.

A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care-Preliminary Data

2015 ◽  
Vol 63 (11) ◽  
pp. 2395-2399 ◽  
Author(s):  
Joshua Chodosh ◽  
Rachel M. Price ◽  
Mary P. Cadogan ◽  
JoAnn Damron-Rodriguez ◽  
Dan Osterweil ◽  
...  
Keyword(s):  
Education Program ◽  
Preliminary Data ◽  
Depression Care ◽  
Nursing Facility ◽  
Practice Improvement

Duelling Band-aids: Debating and Debunking Issues Affecting Primary Health Care to Achieve Deliverance for Australia's Health

2000 ◽  
Vol 6 (4) ◽  
pp. 147 ◽  
Author(s):  
Judi Walker ◽  
Grant Lennox
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Institutional Care ◽  
Health Spending ◽  
Good Health ◽  
Indigenous Populations ◽  
Health And Wellbeing ◽  
Primary Health ◽  
The Status ◽  
Care Approach

The constant pressure for growth on all areas of health spending is not matched by the country's capacity to pay. Despite a progressive shift to a primary health care approach that promotes health and wellbeing, illness prevention, healthy lifestyles, early detection, rehabilitation and public health strategies, not all segments of Australian society enjoy good health. In this paper, general indications of the health and wellbeing of Australians are described, and the health and wellbeing of two important population groups: rural and remote and Indigenous populations are discussed, providing a review of Australia's health system. Anomalies in the status of the health of Australians are apparent. Models of primary healthcare, individual health and urban health are compared with models of acute and institutional care, population health and rural health.

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