scholarly journals Facility and resident characteristics associated with variation in nursing home transfers: evidence from the OPTIMISTIC demonstration project

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Justin Blackburn ◽  
Casey P. Balio ◽  
Jennifer L. Carnahan ◽  
Nicole R. Fowler ◽  
Susan E. Hickman ◽  
...  
Keyword(s):  
Nursing Home ◽  
Financial Incentives ◽  
Lower Risk ◽  
Claims Data ◽  
Demonstration Project ◽  
Nursing Facilities ◽  
Data Set ◽  
Payment Model ◽  
Clinical Model ◽  
Avoidable Hospitalizations

Abstract Background Centers for Medicare and Medicaid Services (CMS) funded demonstration project to evaluate financial incentives for nursing facilities providing care for 6 clinical conditions to reduce potentially avoidable hospitalizations (PAHs). The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) site tested payment incentives alone and in combination with the successful nurse-led OPTIMISTIC clinical model. Our objective was to identify facility and resident characteristics associated with transfers, including financial incentives with or without the clinical model. Methods This was a longitudinal analysis from April 2017 to June 2018 of transfers among nursing home residents in 40 nursing facilities, 17 had the full clinical + payment model (1726 residents) and 23 had payment only model (2142 residents). Using CMS claims data, the Minimum Data Set, and Nursing Home Compare, multilevel logit models estimated the likelihood of all-cause transfers and PAHs (based on CMS claims data and ICD-codes) associated with facility and resident characteristics. Results The clinical + payment model was associated with 4.1 percentage points (pps) lower risk of all-cause transfers (95% confidence interval [CI] − 6.2 to − 2.1). Characteristics associated with lower PAH risk included residents aged 95+ years (− 2.4 pps; 95% CI − 3.8 to − 1.1), Medicare-Medicaid dual-eligibility (− 2.5 pps; 95% CI − 3.3 to − 1.7), advanced and moderate cognitive impairment (− 3.3 pps; 95% CI − 4.4 to − 2.1; − 1.2 pps; 95% CI − 2.2 to − 0.2). Changes in Health, End-stage disease and Symptoms and Signs (CHESS) score above most stable (CHESS score 4) increased the risk of PAH by 7.3 pps (95% CI 1.5 to 13.1). Conclusions Multiple resident and facility characteristics are associated with transfers. Facilities with the clinical + payment model demonstrated lower risk of all-cause transfers compared to those with payment only, but not for PAHs.

scholarly journals Facility and Resident Characteristics Associated With Variation in Nursing Home Transfers: Evidence From the OPTIMISTIC Demonstration Project

2021 ◽  
Author(s):  
Justin Blackburn ◽  
Casey P. Balio ◽  
Jennifer L. Carnahan ◽  
Nicole R. Fowler ◽  
Susan E. Hickman ◽  
...  
Keyword(s):  
Nursing Home ◽  
Financial Incentives ◽  
Lower Risk ◽  
Claims Data ◽  
Demonstration Project ◽  
Nursing Facilities ◽  
Data Set ◽  
Payment Model ◽  
Clinical Model ◽  
Avoidable Hospitalizations

Abstract BackgroundCenters for Medicare and Medicaid Services (CMS) funded demonstration project to evaluate financial incentives for nursing facilities providing care for 6 clinical conditions to reduce potentially avoidable hospitalizations (PAHs). The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) site tested payment incentives alone and in combination with the successful nurse-led OPTIMISTIC clinical model. Our objective was to identify facility and resident characteristics associated with transfers, including financial incentives with or without the clinical model.MethodsThis was a longitudinal analysis from April 2017 to June 2018 of transfers among nursing home residents in 40 nursing facilities, 17 had the full clinical + payment model (1,726 residents) and 23 had payment only model (2,142 residents). Multilevel logit models estimated the likelihood of all-cause transfers and PAHs (based on CMS claims data and ICD-codes) associated wtih facility and resident characteristics using CMS claims data, the Minimum Data Set, and Nursing Home Compare. ResultsThe clinical + payment model was associated with 4.1 percentage point (pp) lower risk of all-cause transfers (95% confidence interval [CI] -6.2 to 2.1). Characteristics associated with lower PAH risk included residents aged 95+ years (-2.4 pps; 95% CI -3.8 to -1.1), dual eligible (-2.5 pps; 95% CI -3.3 to -1.7), advanced and moderate cognitive impairment (-3.3 pps; 95% CI -4.4 to -2.1; -1.2 pps; 95% CI -2.2 to -0.2). CHESS score above most stable (CHESS score 4) increased the risk of PAH by 7.3 pps (95% CI 1.5 to 13.1).ConclusionMultiple resident and facility characteristics are associated with transfers. Facilities with the clinical + payment model demonstrated lower risk of all-cause transfers compared to those with payment only, but not for PAHs.

Nursing home residents with multiple sclerosis and dementia compared to other multiple sclerosis residents

2005 ◽  
Vol 11 (5) ◽  
pp. 610-616 ◽  
Author(s):  
Robert J Buchanan ◽  
Raymond A Martin ◽  
Linda Moore ◽  
Suojin Wang ◽  
Hyunsu Ju
Keyword(s):  
Multiple Sclerosis ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Clinical Analysis ◽  
Minimum Data Set ◽  
Nursing Home Admission ◽  
Nursing Facilities ◽  
Data Set ◽  
Minimum Data ◽  
Significant Symptom

Cognitive impairment may be a significant symptom in multiple sclerosis (MS), affecting about one half of MS patients in study samples similar to the general MS population. An interesting question is what role dementia, of any aetiology, plays in the cognitive ability of people with MS. The objective of this research is to learn more about nursing home residents with MS and dementia, identifying how they differ from other residents with MS. We developed profiles of MS residents with dementia using the Minimum Data Set and compared these profiles to other residents with MS. Nursing home residents with MS and dementia are admitted to nursing facilities at an older age and seem less likely to have physical impairments but more mood and behaviour problems than other MS residents at admission. A cortical variant of MS may be more prevalent than previously suspected and may be a factor responsible leading to nursing home admission in this subgroup of patients. Further clinical analysis of this subgroup would be necessary to support this contention.

Analyses of nursing home residents with multiple sclerosis and depression using the Minimum Data Set

2003 ◽  
Vol 9 (2) ◽  
pp. 171-188 ◽  
Author(s):  
Robert J Buchanan ◽  
Suojin Wang ◽  
Ming Tai-Seale ◽  
Hyunsu Ju
Keyword(s):  
Mental Health ◽  
Multiple Sclerosis ◽  
Nursing Home ◽  
Racial Differences ◽  
Nursing Home Residents ◽  
Mental Healthcare ◽  
Minimum Data Set ◽  
Nursing Facilities ◽  
Data Set ◽  
Minimum Data

Depression is the most common psychiatric condition among people with multiple sclerosis (MS). A total of 14 009 people with MS at admission to a nursing facility were analyzed using the Minimum Data Set and 36% also had depression. This study developed profiles of nursing home residents with MS who also had depression and compared them with other residents with MS. MS residents with depression were significantly more likely to be female and younger than other MS residents, with significant racial differences as well. MS residents with depression were significantly more likely than other MS residents to have a history of mental health conditions, exhibit mood indicators, and have unsettled relationships. Both groups of MS residents had high levels of physical disability, although MS residents with depression tended to be slightly less disabled. MS residents with depression were more likely than other MS residents to experience daily pain and more likely to have the diseases common to all residents with MS. This research found that most MS residents with depression did not receive mental health services, demonstrating that nursing facilities must improve the mental healthcare provided to residents with MS with depression.

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.

The Relationship Between Minimum Data Set Ratings and Scores on Measures of Communication and Hearing Among Nursing Home Residents With Dementia

2001 ◽  
Vol 10 (4) ◽  
pp. 370-381 ◽  
Author(s):  
Tammy Hopper ◽  
Kathryn A. Bayles ◽  
Frances P. Harris ◽  
Audrey Holland
Keyword(s):  
Nursing Home ◽  
Rating Scale ◽  
Assessment Tool ◽  
Nursing Home Residents ◽  
Minimum Data Set ◽  
Nursing Facilities ◽  
Data Set ◽  
Minimum Data ◽  
Hearing Function ◽  
The Relationship

The Minimum Data Set (MDS) is a federally mandated assessment tool used to evaluate individuals residing in skilled nursing facilities, a large percentage of whom have dementia. Best described as a rating scale, it comprises items related to 16 domains of functioning, including communication and hearing. Typically, the MDS is completed by a nurse. When a deficit is observed, Resident Assessment Protocols (RAPs) are designed to address the impairment and provide information for appropriate plans of care. The purposes of this study were to: (a) comprehensively assess the communication and hearing function of nursing home residents with dementia, (b) evaluate the relationship between ratings on MDS communication and hearing items and the performance of dementia patients on standardized assessments, and (c) determine the number of residents with MDS-identified deficits who received a referral for further evaluation. Fifty-seven individuals with a medical diagnosis of dementia participated. All exhibited deficits in communication and hearing function; however, the majority of participants were rated as having normal or adequate communication and hearing on the MDS. Of those participants with MDS-identified impairments in communication and hearing, none was referred for further evaluation. Implications for policy and care for nursing home residents with dementia are discussed.

Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD) in adults: Design and pilot study in nursing home residents

2018 ◽  
Vol 27 (4) ◽  
pp. 191-198
Author(s):  
Karen Van den Bussche ◽  
Sofie Verhaeghe ◽  
Ann Van Hecke ◽  
Dimitri Beeckman
Keyword(s):  
Nursing Home ◽  
Pilot Study ◽  
Nursing Home Residents ◽  
Minimum Data Set ◽  
Data Set ◽  
Minimum Data

scholarly journals Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER)

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042941
Author(s):  
Vanja Milosevic ◽  
Aimee Linkens ◽  
Bjorn Winkens ◽  
Kim P G M Hurkens ◽  
Dennis Wong ◽  
...  
Keyword(s):  
Nursing Home ◽  
Fall Risk ◽  
Nursing Home Residents ◽  
High Sensitivity ◽  
Secondary Outcome ◽  
Operating Characteristics ◽  
Retrospective Case ◽  
Data Set ◽  
Fall Incident ◽  
Clinical Rule

ObjectivesTo develop (part I) and validate (part II) an electronic fall risk clinical rule (CR) to identify nursing home residents (NH-residents) at risk for a fall incident.DesignObservational, retrospective case–control study.SettingNursing homes.ParticipantsA total of 1668 (824 in part I, 844 in part II) NH-residents from the Netherlands were included. Data of participants from part I were excluded in part II.Primary and secondary outcome measuresDevelopment and validation of a fall risk CR in NH-residents. Logistic regression analysis was conducted to identify the fall risk-variables in part I. With these, three CRs were developed (ie, at the day of the fall incident and 3 days and 5 days prior to the fall incident). The overall prediction quality of the CRs were assessed using the area under the receiver operating characteristics (AUROC), and a cut-off value was determined for the predicted risk ensuring a sensitivity ≥0.85. Finally, one CR was chosen and validated in part II using a new retrospective data set.ResultsEleven fall risk-variables were identified in part I. The AUROCs of the three CRs form part I were similar: the AUROC for models I, II and III were 0.714 (95% CI: 0.679 to 0.748), 0.715 (95% CI: 0.680 to 0.750) and 0.709 (95% CI: 0.674 to 0.744), respectively. Model III (ie, 5 days prior to the fall incident) was chosen for validation in part II. The validated AUROC of the CR, obtained in part II, was 0.603 (95% CI: 0.565 to 0.641) with a sensitivity of 83.41% (95% CI: 79.44% to 86.76%) and a specificity of 27.25% (95% CI 23.11% to 31.81%).ConclusionMedication data and resident characteristics alone are not sufficient enough to develop a successful CR with a high sensitivity and specificity to predict fall risk in NH-residents.Trial registration numberNot available.

scholarly journals Stakeholder Perspectives on Reducing Hospitalizations Among Nursing Home Residents

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 85-85
Author(s):  
Denise Tyler ◽  
Cleanthe Kordomenos ◽  
Melvin Ingber
Keyword(s):  
New York ◽  
Nursing Home ◽  
Nurse Practitioners ◽  
Hospital Readmissions ◽  
Nursing Home Residents ◽  
Health State ◽  
Frontline Staff ◽  
Avoidable Hospitalizations ◽  
Stakeholder Perspectives ◽  
Advance Care

Abstract Organizations in seven states have been participating in the Center for Medicare and Medicaid Innovation (CMMI) initiative aimed at reducing potentially avoidable hospitalizations among long-stay nursing home (NH) residents. The purpose of this study was to identify market and policy factors that may have affected the initiative in those states. Forty-seven interviews were conducted with key stakeholders in the seven states (e.g., representatives from state departments of health, state Medicaid offices, and nursing, hospital and nursing home associations) and qualitatively analyzed to identify themes across states. Few policies or programs were found that may have affected the initiative; only New York (NY) was found to have state policies or programs specifically aimed at reducing hospitalizations. Market pressures reported in most states were similar. For example, stakeholders reported that the increased availability of home and community-based services and the growing presence of managed care are contributing to higher acuity among both long and short stay residents and that reimbursement rates and staffing have not kept up. Stakeholders suggested greater presence of physicians and nurse practitioners in NHs, better training around behavioral health issues for frontline staff, and more advance care planning and education of families about end of life may help further reduce NH hospitalizations. We also found that all states, except NY, had regional coalitions of health care related organizations focused on improving some aspect of care, such as reducing hospital readmissions. These coalitions may suggest ways that organizations can work together to reduce hospitalizations among NH residents.

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