Using powerful data from the interRAI MDS to support care and a learning health system: A case study from long-term care

2018 ◽  
Vol 31 (4) ◽  
pp. 153-159 ◽  
Author(s):  
Darly Dash ◽  
George A. Heckman ◽  
Veronique M. Boscart ◽  
Andrew P. Costa ◽  
Jaimie Killingbeck ◽  
...  
Keyword(s):  
Long Term Care ◽  
Care Plan ◽  
Full Potential ◽  
Term Care ◽  
Data Set ◽  
Non Profit ◽  
Other Information ◽  
The Individual ◽  
Administrative Task

interRAI is a non-profit international consortium of clinicians and scientists who have developed the Minimum Data Set (MDS) 2.0 assessment to systematically identify the health status and care plan of residents in Long-Term Care (LTC). However, LTC staff often fail to realize the clinical utility of this information, viewing it as “data collection for funding purposes” and an administrative task adding to the daily workload. This article reports how one research institute and senior living organization work together to use MDS 2.0 and other information to support better care for residents, plan resource allocation and staffing models, and conduct applied research for older Canadians. A multi-level approach is described on how MDS 2.0 provides a robust infrastructure at the individual, team, organizational, and system levels. Long-term care stakeholders can do much more to unleash the full potential of this powerful tool, and other healthcare sectors can take advantage of this approach.

scholarly journals Hearing and Cognitive Impairments Increase the Risk of Long-term Care Admissions

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Nicole Williams ◽  
Natalie A Phillips ◽  
Walter Wittich ◽  
Jennifer L Campos ◽  
Paul Mick ◽  
...  
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Individual Level ◽  
The Individual

Abstract Background and Objectives The objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions. Research Design and Methods This retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants’ most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan–Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC. Results In this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer’s dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11). Discussion and Implications Although CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients.

scholarly journals Evidence for Publicly Reported Quality Indicators in Residential Long-Term Care: A Systematic Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 181-181
Author(s):  
Franziska Zúñiga ◽  
Magdalena Osinska ◽  
Franziska Zuniga
Keyword(s):  
New Zealand ◽  
Quality Indicators ◽  
Long Term Care ◽  
Grey Literature ◽  
Public Reporting ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Residential Long Term Care

Abstract Quality indicators (QIs) are used internationally to measure, compare and improve quality in residential long-term care. Public reporting of such indicators allows transparency and motivates local quality improvement initiatives. However, little is known about the quality of QIs. In a systematic literature review, we assessed which countries publicly report health-related QIs, whether stakeholders were involved in their development and the evidence concerning their validity and reliability. Most information was found in grey literature, with nine countries (USA, Canada, Australia, New Zealand and five countries in Europe) publicly reporting a total of 66 QIs in areas like mobility, falls, pressure ulcers, continence, pain, weight loss, and physical restraint. While USA, Canada and New Zealand work with QIs from the Resident Assessment Instrument – Minimal Data Set (RAI-MDS), the other countries developed their own QIs. All countries involved stakeholders in some phase of the QI development. However, we only found reports from Canada and Australia on both, the criteria judged (e.g. relevance, influenceability), and the results of structured stakeholder surveys. Interrater reliability was measured for some RAI QIs and for those used in Germany, showing overall good Kappa values (>0.6) except for QIs concerning mobility, falls and urinary tract infection. Validity measures were only found for RAI QIs and were mostly moderate. Although a number of QIs are publicly reported and used for comparison and policy decisions, available evidence is still limited. We need broader and accessible evidence for a responsible use of QIs in public reporting.

The Effects of the Opioid Epidemic on Prescribing Practices in Long-Term Care Residents

2019 ◽  
Vol 34 (4) ◽  
pp. 258-267
Author(s):  
Lisa Yamagishi ◽  
Olivia Erickson ◽  
Kelly Mazzei ◽  
Christine O'Neil ◽  
Khalid M. Kamal
Keyword(s):  
Severe Pain ◽  
Long Term Care ◽  
Care Facility ◽  
The United States ◽  
Self Report ◽  
Prescribing Practices ◽  
Term Care ◽  
Data Set ◽  
Opioid Prescribing

OBJECTIVE: Evaluate opioid prescribing practices for older adults since the opioid crisis in the United States.<br/> DESIGN: Interrupted time-series analysis on retrospective observational cohort study.<br/> SETTING: 176-bed skilled-nursing facility (SNF).<br/> PARTICIPANTS: Patients admitted to a long-term care facility with pain-related diagnoses between October 1, 2015, and March 31, 2017, were included. Residents discharged prior to 14 days were excluded. Of 392 residents, 258 met inclusion criteria with 313 admissions.<br/> MAIN OUTCOME MEASURE: Changes in opioid prescribing frequency between two periods: Q1 to Q3 (Spring 2016) and Q4 to Q6 for pre- and postgovernment countermeasure, respectively.<br/> RESULTS: Opioid prescriptions for patients with pain-related diagnoses decreased during period one at -0.10% per quarter (95% confidence interval [CI] -0.85-0.85; P = 0.99), with the rate of decline increasing at -3.8% per quarter from period 1 and 2 (95% CI -0.23-0.15; P = 0.64). Opioid prescribing from top International Classification of Diseases, Ninth Revision category, "Injury and Poisoning" decreased in prescribing frequency by -3.0% per quarter from Q1 to Q6 (95% CI -0.16-0.10; P = 0.54). Appropriateness of pain-control was obtained from the Minimum Data Set version 3.0 "Percent of Residents Who Self-Report Moderate to Severe Pain (Short Stay)" measure; these results showed a significant increase in inadequacy of pain relief by 0.28% per quarter (95% CI 0.12-0.44; P = 0.009).<br/> CONCLUSION: Residents who self-report moderate- to severe pain have significantly increased since October 2015. Opioid prescriptions may have decreased for elderly patients in SNFs since Spring 2016. Further investigation with a larger population and wider time frame is warranted to further evaluate significance.

scholarly journals THE EXTREME FACE OF SOCIAL ISOLATION: A COHORT STUDY OF UNBEFRIENDED INDIVIDUALS IN LONG-TERM CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S532-S533
Author(s):  
Stephanie Chamberlain ◽  
Wendy Duggleby ◽  
Pamela B Teaster ◽  
Janet Fast ◽  
Carole Estabrooks
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Health Outcomes ◽  
Social Isolation ◽  
Long Term Care ◽  
Poor Health ◽  
Term Care ◽  
Data Set ◽  
Family Contact

Abstract Even though social isolation is a significant predictor of poor health and mortality in older adults, very little is known about social isolation in long-term care (LTC) settings. The aim of this study was to describe the prevalence, demographic characteristics, health outcomes, and disease diagnoses of residents without family contact in Alberta LTC homes. Using data collected between April 2008 and March 2018, we conducted a retrospective cohort study using the Resident Assessment Instrument, Minimum Data Set, (RAI-MDS 2.0) data from 34 LTC facilities in Alberta. We identified individuals who had no contact with family or friends. Using descriptive statistics and binary logistic regression, we compared the characteristics, disease diagnoses, and functional status of individuals who had no contact with family and individuals who did have contact with family. We identified a cohort of 25,330 individuals, of whom 945 had no contact with family or friends. Different from residents who had family, the cohort with no contact was younger (81.47 years, SD=11.79), and had a longer length of stay (2.71 years, SD=3.63). For residents who had contact with family, residents with no contact had a greater number of mental health diagnoses, including depression (OR: 1.21, [95% CI: 1.06-1.39]), bipolar disorder (OR: 1.80, [95% CI: 1.22-2.68]), and schizophrenia (OR: 3.9, [95% CI: 2.96-5.14]). Interpretation: Residents without family contact had a number of unique care concerns, including mental health issues and poor health outcomes. These findings have implications for the training of staff and LTC services available to these vulnerable residents.

scholarly journals Long-term Care Facility Variation in the Incidence of Pneumonia and Influenza

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Elliott Bosco ◽  
Andrew R Zullo ◽  
Kevin W McConeghy ◽  
Patience Moyo ◽  
Robertus van Aalst ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Long Term Care ◽  
Care Facility ◽  
Physician Assistants ◽  
Incidence Rates ◽  
Short Stay ◽  
Term Care ◽  
Data Set ◽  
Facility Level

Abstract Background Pneumonia and influenza (P&I) increase morbidity and mortality among older adults, especially those residing in long-term care facilities (LTCFs). Facility-level characteristics may affect the risk of P&I beyond resident-level risk factors. However, the relationship between facility characteristics and P&I is poorly understood. To address this, we identified potentially modifiable facility-level characteristics that influence the incidence of P&I across LTCFs. Methods We conducted a retrospective cohort study using 2013–2015 Medicare claims linked to Minimum Data Set and LTCF-level data. Short-stay (&lt;100 days) and long-stay (100+ days) LTCF residents were followed for the first occurrence of hospitalization, LTCF discharge, Medicare disenrollment, or death. We calculated LTCF risk-standardized incidence rates (RSIRs) per 100 person-years for P&I hospitalizations by adjusting for over 30 resident-level demographic and clinical covariates using hierarchical logistic regression. Results We included 1 767 241 short-stay (13 683 LTCFs) and 922 863 long-stay residents (14 495 LTCFs). LTCFs with lower RSIRs had more licensed independent practitioners (nurse practitioners or physician assistants) among short-stay (44.9% vs 41.6%, P &lt; .001) and long-stay residents (47.4% vs 37.9%, P &lt; .001), higher registered nurse hours/resident/day among short-stay and long-stay residents (mean [SD], 0.5 [0.7] vs 0.4 [0.4], P &lt; .001), and fewer residents for whom antipsychotics were prescribed among short-stay (21.4% [11.6%] vs 23.6% [13.2%], P &lt; .001) and long-stay residents (22.2% [14.3%] vs 25.5% [15.0%], P &lt; .001). Conclusions LTCF characteristics may play an important role in preventing P&I hospitalizations. Hiring more registered nurses and licensed independent practitioners, increasing staffing hours, and higher-quality care practices may be modifiable means of reducing P&I in LTCFs.

scholarly journals Recommended Common Data Elements for International Research in Long-Term Care Homes: Exploring the Workforce and Staffing Concepts of Staff Retention and Turnover

2019 ◽  
Vol 5 ◽  
pp. 233372141984434 ◽  
Author(s):  
Franziska Zúñiga ◽  
Charlene H. Chu ◽  
Veronique Boscart ◽  
Anette Fagertun ◽  
Montserrat Gea-Sánchez ◽  
...  
Keyword(s):  
Long Term Care ◽  
Intention To Leave ◽  
Rapid Review ◽  
Staff Retention ◽  
Common Data Element ◽  
Term Care ◽  
Common Data Elements ◽  
The Individual ◽  
Staff Level

The aim of this review is to develop a common data element for the concept of staff retention and turnover within the domain of workforce and staffing. This domain is one of four core domains identified by the WE-THRIVE ( Worldwide Elements to Harmonize Research in Long-Term Care Li ving Environments) group in an effort to establish an international, person-centered long-term care research infrastructure. A rapid review identified different measurement methods to assess either turnover or retention at facility level or intention to leave or stay at the individual staff level. The selection of a recommended measurement was guided by the WE-THRIVE group’s focus on capacity rather than deficits, the expected availability of internationally comparable data, and the goal to provide a short, ecologically viable measurement. We therefore recommend to measure staff’s intention to stay with a single item, at the individual staff level. This element, we argue, is an indicator of staff stability, which is important for reduced organizational cost and improved productivity, positive work environment, and better resident–staff relationships and quality of care.

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