Race and Insurance Status Disparities in Post-discharge Disposition After Hospitalization for Major Trauma

2021 ◽  
pp. 000313482110298
Author(s):  
Adel Elkbuli ◽  
Mason Sutherland ◽  
Toria Gargano ◽  
Kyle Kinslow ◽  
Huazhi Liu ◽  
...  
Keyword(s):  
Secondary Care ◽  
Injury Severity ◽  
Care Facility ◽  
Future Research ◽  
Primary Study ◽  
Insurance Status ◽  
Improvement Program ◽  
Term Care ◽  
Discharge Disposition ◽  
Black Patients

Background Investigations detailing predictive measures of hospital disposition after traumatic injury are scarce. We aim to examine the discharge practices among trauma centers in the US and to identify factors that may influence post-hospital disposition. Methods A retrospective analysis of trauma patients using the American College of Surgeons-Trauma Quality Improvement Program dataset from 2007-2017. Primary study outcome was hospital disposition (including long term care facility [LTC], others). Secondary outcomes included: Intensive Care Unit (ICU)-length of stay (LOS), complications, others). Results 6 899 538 patients were analyzed. Odds of LTC discharge was significantly higher for Black patients (aOR = 1.30, 95% CI:1.24-1.37), abbreviated injury score (AIS) ≥3 (aOR = 4.22, 95% CI: 4.05-4.39), and higher injury severity score (ISS) (aOR = 9.41, 95% CI:9.03-9.80). Significantly more self-pay patients were discharged home compared to other insurance types ( P < .0001). Significantly longer hospital- and ICU-LOS were experienced by those who had an AIS ≥3 (hospital: 4.8 days (±7.1) vs. 7.9 (±10.1); ICU: 4.6 (±6.9) vs. 5.9 (±7.9), P < .0001) and had a high ISS (hospital: 4.5 days (±5.9) vs. 16.8 (±17.9); ICU: 3.6 (±5.0) vs. 10.2 (±11.5), P < .0001). Conclusions Patient race, insurance status, and injury severity were predictive of post-hospitalization care discharge. Self-pay and Black patients were less likely to be discharged to secondary care facilities. These findings have the potential to improve in-hospital patient management and predict discharge secondary care needs, and necessitate the need for future research to investigate the extent of inequalities in access to trauma care.

Insurance Status and Ethnicity Impact Health Disparities in Rates of Advance Directives in Trauma

2021 ◽  
pp. 000313482110111
Author(s):  
Krista L. Haines ◽  
Benjamin P. Nguyen ◽  
Ioana Antonescu ◽  
Jennifer Freeman ◽  
Christopher Cox ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
End Of Life ◽  
Hospice Care ◽  
Private Insurance ◽  
Future Research ◽  
Trauma Patients ◽  
Improvement Program ◽  
Advanced Directives ◽  
Logistic Regression Models ◽  
Discharge Disposition

Introduction Advanced directives (ADs) provide a framework from which families may understand patient’s wishes. However, end-of-life planning may not be prioritized by everyone. This analysis aimed to determine what populations have ADs and how they affected trauma outcomes. Methods Adult trauma patients recorded in the American College of Surgeons Trauma Quality Improvement Program (TQIP) from 2013-2015 were included. The primary outcome was presence of an AD. Secondary outcomes included mortality, length of stay (LOS), mechanical ventilation, ICU admission/LOS, withdrawal of life-sustaining measures, and discharge disposition. Multivariable logistic regression models were developed for outcomes. Results 44 705 patients were included in the analyses. Advanced directives were present in 1.79% of patients. The average age for patients with ADs was 77.8 ± 10.7. African American (odds ratio (OR) .53, confidence intervals [CI] .36-.79) and Asian (OR .22, CI .05-.91) patients were less likely to have ADs. Conversely, Medicaid (OR 1.70, CI 1.06-2.73) and Medicare (OR 1.65, CI 1.25-2.17) patients were more likely to have ADs as compared to those with private insurance. The presence of ADs was associated with increased hospital mortality (OR 2.84, CI 2.19-3.70), increased transition to comfort measures (OR 2.87, CI 2.08-3.95), and shorter LOS (CO −.74, CI −1.26-.22). Patients with ADs had an increased odds of hospice care (OR 4.24, CI 3.18-5.64). Conclusion Advanced directives at admission are uncommon, particularly among African Americans and Asians. The presence of ADs was associated with increased mortality, use of mechanical ventilation, admission to the ICU, withdrawal of life-sustaining measures, and hospice. Future research should target expansion of ADs among minority populations to alleviate disparities in end-of-life treatment.

53 The Development and Education of Fall Prevention Program Through the Multidisciplinary Approach

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Mi Hyun Kim ◽  
Chang Hee Go ◽  
Jung Min Lee ◽  
Ji-Young Kang ◽  
Jae-Young Lim
Keyword(s):  
Fall Prevention ◽  
Prevention Program ◽  
Multidisciplinary Approach ◽  
Care Facility ◽  
Assistive Device ◽  
Future Research ◽  
Term Care ◽  
Fall Prevention Program ◽  
The Mean ◽  
Prevention Activities

Abstract Introduction To reduce the rate of falls in the rehabilitation ward, fall prevention program was developed and educated for physical and occupational therapists, which increased the attitude towards falls and knowledge towards fall prevention activities. Method Participants of this study include 17 therapists currently employed at a university-affiliated hospital located in Gyeongg-do, South Korea. Systematic protocol for fall prevention with the emphasis in the roles of rehabilitation teams was developed. This standardized protocol consists of educating therapists with adequate assistive device use, safe ambulation techniques, and client-centered transfer techniques. The therapists then record the paitent's status related to fall prevention and or risks, which is then shared with other medical professionals including registered nurses and medical doctors. Paper-based questionnaires regarding 9 questions on attitude towards falls and 12 questions on knowledge towards fall prevention activities were done by the participants after the education of systematic protocol. The rate of falls was then compared with the change of attitudes in participants. Rate of falls was calculated by dividing the number of fall by the patient bed days and multiplying by 1000. Result After the education of fall prevention program, the mean score of attitude towards falls significantly increased (t=-3.99, p=0.001). The mean score of knowledge towards fall prevention activities significantly increased (t=-4.79, p&lt;0.001). The rate of falls decreased from 4.2 to 1.4. The effectiveness of systematic protocol regarding therapists' change in attitude and the resulting change in rate of falls was mainly seen in patients' ward. The decline in rate of falls was observed when patients transferred from bed to wheelchair. Conclusion In order to effectively convey the fall prevention education program, the multidisciplinary approach showed promising results in this study. Implications for future research include translation of this program to the community, such as long term care facility.

scholarly journals Marriage Status Predicts Hospital Outcomes Following Orthopedic Trauma

2020 ◽  
Vol 11 ◽  
pp. 215145931989864
Author(s):  
Sanjit R. Konda ◽  
Leah J. Gonzalez ◽  
Joseph R. Johnson ◽  
Scott Friedlander ◽  
Kenneth A. Egol
Keyword(s):  
Hospital Stay ◽  
Marital Status ◽  
Acute Care ◽  
Multinomial Logistic Regression ◽  
Academic Medical Center ◽  
Care Facility ◽  
Unplanned Readmission ◽  
Term Care ◽  
Discharge Disposition ◽  
Post Acute Care

Introduction: Rising costs of post-acute care facilities for both the patient and payers make discharge home after hospital stay, with or without home help, a favorable alternative for all parties. Our objectives were to assess the effect of marital status, a large source of social support for many, on disposition following hospital stay. Methods: Patients were prospectively entered into an institutional review board-approved, trauma database at a large, academic medical center. Patients aged 55 years or older with any fracture injury between 2014 and 2017 were included. Retrospectively, their relationship status was recorded through review of patient records. A status of “married” was separated from those with a status self-reported as “single,” “divorced,” or “widowed.” Multinomial logistic regression was used to assess whether discharge location differs by marital status while controlling for demographics and injury characteristics. Results: Of 1931 patients, 8.3% were divorced, 29.9% were single, 20.0% were widowed, and 41.8% were married. There was a significant correlation between discharge disposition and marital status. Single patients had 1.71 times, and widowed patients had 1.80 times, the odds of being discharged to a nursing home, long-term care facility, or skilled nursing facility compared to married patients after controlling for age, gender, Score for Trauma Triage in the Geriatric and Middle-Aged score, and insurance type. Additionally, single and widowed patients experienced 1.36 and 1.30 times longer length of hospital stay than their married counterparts, respectively. Discussion: Patients who are identified as “single” or “widowed” should have early social work intervention to establish clear discharge expectations. Early intervention in this way would allow time for contact with close, living relatives or friends who may be able to provide sufficient support so that patients can return home. Increasing home discharge rates for these patients would reduce lengths of hospital stay and reduce post-acute care costs for both patient and payers without materially altering unplanned readmission rates.

Recent Advances in Geriatrics: Drug-Related Problems in the Elderly

2000 ◽  
Vol 34 (3) ◽  
pp. 360-365 ◽  
Author(s):  
Joseph T Hanlon ◽  
Leslie A Shimp ◽  
Todd P Semla
Keyword(s):  
Elderly Patients ◽  
Pharmacy Practice ◽  
Care Facility ◽  
The Elderly ◽  
Drug Event ◽  
Inappropriate Drug ◽  
Future Research ◽  
Drug Related Problems ◽  
Related Factors ◽  
Term Care

OBJECTIVE: To review recent articles examining drug-related problems in the elderly and comment on their potential impact on geriatric pharmacy practice. DATA SOURCES: Six articles published in 1997 and 1998. DATA SYNTHESIS: One study estimated that the cost of drug-related morbidity and mortality with the services of consultant pharmacists was $4 billion, compared with $7.6 billion without the services of consultant pharmacists. A study of ambulatory elderly patients with polypharmacy documented that 35% reported experiencing at least one adverse drug event within the previous year. Another study of ambulatory elderly found that in those with discontinued medications, adverse drug withdrawal events were uncommon. Two studies, one from Canada and one from the US, describe the development, by consensus, of explicit criteria for defining and identifying inappropriate drug use in the elderly (i.e., drugs to avoid, drugs with dose limits, drug–drug and drug–disease interactions). Finally, a modified Delphi survey of an expert panel reached consensus on 18 potential risk factors for drug-related factors in long-term care facility residents. CONCLUSIONS: Drug-related problems are considerable for elderly patients. Data from published studies should provide some guidance for today's practitioners as well as direction regarding future research.

Benefits of a Timed Snack Protocol for Geriatric Patients With Dementia and Dysphagia

2005 ◽  
Vol 10 (1) ◽  
pp. 17-18 ◽  
Author(s):  
Faerella Boczko
Keyword(s):  
Care Facility ◽  
Interdisciplinary Team ◽  
Medical Personnel ◽  
Specific Model ◽  
Future Research ◽  
Term Care ◽  
Long Term Care Facility ◽  
Speech Language Pathologist ◽  
Time Specific ◽  
Nutritional Benefits

Abstract The purpose of this study was to determine the efficacy of snack recommendations in promoting weight gain among residents diagnosed with dysphagia and dementia (mild/moderate). A two-part comparison study was performed with residents for whom snack recommendations were made at the time of their dysphagia evaluations: The first part of this pilot study utilized a time-specific medication protocol enforced by interdisciplinary team members, while the second portion of the study intentionally followed no specific model beyond initial recommendation by the speech-language pathologist (SLP). All subjects were residents at a long-term care facility. Initial dysphagia evaluations were conducted because of weight loss. The pilot data support the following conclusions: An interdisciplinary team must ensure complete follow-through of recommendations. In approaching the concept of snacks as “medication,” intake can be prescribed by medical personnel to ensure delivery as well as to encourage the resident who refuses meals. Hand-held snacks of the resident's preference remain a condition of the “medication.” Medical and nursing staff must be educated regarding nutritional benefits. While self-feeding as an aspect of ADL independence represents an ideal scenario, creative methods must be explored to encourage food intake. A need exists for future research to determine appropriate intervention measures that will provide assessment of measurable outcomes regarding improvement in self-feeding ability.

Strategic partnerships enhance resources for care of rural-dwelling older adults

2018 ◽  
Vol 19 (4) ◽  
pp. 242-250
Author(s):  
Lyn M. Holley ◽  
Christopher M. Kelly ◽  
Jerome Deichert ◽  
Silvester Juanes ◽  
Loretta Wolf
Keyword(s):  
Older Adults ◽  
Quality Of Care ◽  
Long Term Care ◽  
Care Facility ◽  
Future Research ◽  
Term Care ◽  
Content Type ◽  
Residential Long Term Care

Purpose The purpose of this paper is to disseminate a new model that addresses the urgent social challenge of providing adequate long-term care in rural circumstances through innovative use of existing resources, and to suggest future research. Design/methodology/approach This paper is exploratory in and is based upon the analysis of qualitative observations (interviews and site visits) framed in the financial and operational records of the facility studied, macro- and micro-level demographics, and the scholarly and practice literatures. Findings Significant cost savings upon implementation, improvements in quality of care and both worker and client satisfaction were observed. Research limitations/implications The model has been in operation only one year; the trend has been positive, however, more research is needed to identify its stability and develop a more refined description of its components: while essential features of this innovative model can be applied in any residential long-term care situation, replicating its success is obviously linked with the skill and authority of the director. Evaluation research is currently in progress. Practical implications The paper suggests budget-neutral solutions to persistent challenges of caring for older adults in rural circumstances. Social implications Quality and financing of long-term residential care for elders is insufficient and worsening. This model addresses problems central to financing and quality of care by connecting existing resources in new ways. It does not require additional funding or changes in qualifications required for jobs. Originality/value The model is the original creation of a residential long-term care facility director working with a network of partnerships that he discovered and developed: partnerships include a broad range of organizations in the public and non-profit sectors, and the state university.

scholarly journals Geographic Variation in Pneumonia and Influenza in Long-Term Care Facilities: A National Study

2020 ◽  
Vol 71 (8) ◽  
pp. e202-e205 ◽  
Author(s):  
Elliott Bosco ◽  
Andrew R Zullo ◽  
Kevin W McConeghy ◽  
Patience Moyo ◽  
Robertus van Aalst ◽  
...  
Keyword(s):  
Geographic Variation ◽  
Long Term Care ◽  
Care Facility ◽  
The United States ◽  
National Study ◽  
Future Research ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities

Abstract There is large county-level geographic variation in pneumonia and influenza hospitalizations among short-stay and long-stay long-term care facility residents in the United States. Long-term care facilities in counties in the Southern and Midwestern regions had the highest rates of pneumonia and influenza from 2013 to 2015. Future research should identify reasons for these geographic differences.

“Music First”

GeroPsych ◽  
2018 ◽  
Vol 31 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Dane L. Shiltz ◽  
Tara T. Lineweaver ◽  
Tim Brimmer ◽  
Alex C. Cairns ◽  
Danielle S. Halcomb ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Facility ◽  
Care Group ◽  
Music Listening ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Risk Of Death ◽  
Extended Care ◽  
Individualized Music

Abstract. Existing research has primarily evaluated music therapy (MT) as a means of reducing the negative affect, behavioral, and/or cognitive symptoms of dementia. Music listening (ML), on the other hand, offers a less-explored, potentially equivalent alternative to MT and may further reduce exposure to potentially harmful psychotropic medications traditionally used to manage negative behavioral and psychological symptoms of dementia (BPSD). This 5-month prospective, naturalistic, interprofessional, single-center extended care facility study compared usual care (45 residents) and usual care combined with at least thrice weekly personalized ML sessions (47 residents) to determine the influence of ML. Agitation decreased for all participants (p < .001), and the ML residents receiving antipsychotic medications at baseline experienced agitation levels similar to both the usual care group and the ML patients who were not prescribed antipsychotics (p < .05 for medication × ML interaction). No significant changes in psychotropic medication exposure occurred. This experimental study supports ML as an adjunct to pharmacological approaches to treating agitation in older adults with dementia living in long-term care facilities. It also highlights the need for additional research focused on how individualized music programs affect doses and frequencies of antipsychotic medications and their associated risk of death and cerebrovascular events in this population.

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