scholarly journals Improving Nursing Facility Care Through an Innovative Payment Demonstration Project: Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care Phase 2

2018 ◽  
Vol 66 (8) ◽  
pp. 1625-1631 ◽  
Author(s):  
Kathleen T. Unroe ◽  
Nicole R. Fowler ◽  
Jennifer L. Carnahan ◽  
Laura R. Holtz ◽  
Susan E. Hickman ◽  
...  
Keyword(s):  
Institutional Care ◽  
Demonstration Project ◽  
Phase 2 ◽  
Nursing Facility ◽  
Patient Transfers ◽  
Medical Quality

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.

scholarly journals Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California

2018 ◽  
Vol 55 ◽  
pp. 004695801876831 ◽  
Author(s):  
Michelle Ko ◽  
Robert J. Newcomer ◽  
Charlene Harrington ◽  
Denis Hulett ◽  
Taewoon Kang ◽  
...  
Keyword(s):  
Older Adults ◽  
Institutional Care ◽  
Nursing Facilities ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Persons With Disabilities ◽  
Cognitive Limitations ◽  
Substance Abuse Disorders ◽  
Services And Supports

Nearly one-third of adult Medicaid beneficiaries who receive long-term services and supports (LTSS) consist of older adults and persons with disabilities who are not eligible for Medicare. Beneficiaries, advocates, and policymakers have all sought to shift LTSS to home and community settings as an alternative to institutional care. We conducted a retrospective cohort study of Medicaid-only adults in California with new use of LTSS in 2006-2007 (N = 31 849) to identify unique predictors of entering nursing facilities versus receiving Medicaid home and community-based services (HCBS). Among new users, 18.3% entered into nursing facilities, whereas 81.7% initiated HCBS. In addition to chronic conditions, functional and cognitive limitations, substance abuse disorders (odds ratio [OR] 1.35; 95% confidence interval [CI]: 1.23, 1.48), and homelessness (OR: 4.35, 9% CI: 3.72, 5.08) were associated with higher odds of nursing facility entry. For older adults and persons with disabilities covered by Medicaid only, integration with housing and behavioral health services may be key to enabling beneficiaries to receive LTSS in noninstitutional settings.

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.

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