scholarly journals Policy in Clinical Practice: Choosing Post-Acute Care in the New Decade

2021 ◽  
Vol 16 (3) ◽  
pp. 171-174 ◽  
Author(s):  
Anil N Makam ◽  
David C Grabowski
Keyword(s):  
Acute Care ◽  
Nursing Facilities ◽  
Care Needs ◽  
Skilled Nursing ◽  
Medically Ill ◽  
Home Health Agencies ◽  
Medicare Patients ◽  
New Policies ◽  
Rehabilitative Services ◽  
Post Acute Care

Nearly half of hospitalized Medicare patients in 2018 were discharged to post-acute care (PAC), accounting for approximately $60 billion in annual spending. There are four PAC settings, and these vary in the intensity and complexity of medical, skilled nursing, and rehabilitative services provided; each setting uses a separate payment system. Due to considerable variation in PAC use, with concerns that similar patients can be treated in different PAC settings, the Centers for Medicare & Medicaid Services (CMS) recently introduced several major policy changes. For home health agencies (HHAs) and skilled nursing facilities (SNFs), CMS implemented new payment models to better align payment with patients’ care needs rather than the provision of rehabilitation. For long-term acute care hospitals, CMS will now decrease payment for less medically ill patients. To choose PAC wisely, hospitalists and hospital leaders must understand how these new policies will change where patients can be discharged and the services these patients receive at these PAC settings.

scholarly journals Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Black and Hispanic Patients

2018 ◽  
Vol 74 (5) ◽  
pp. 689-697 ◽  
Author(s):  
Maricruz Rivera-Hernandez ◽  
Momotazur Rahman ◽  
Dana B Mukamel ◽  
Vincent Mor ◽  
Amal N Trivedi
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Hispanic Patients ◽  
Post Acute Care

scholarly journals Expectations and Experiences with Physician Care among Patients Receiving Post-Acute Care in US Skilled Nursing Facilities

2020 ◽  
Author(s):  
Kira L Ryskina ◽  
Kierra A. Foley ◽  
Jason H. Karlawish ◽  
Joshua D. Uy ◽  
Briana Lott ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Skilled Nursing Facilities ◽  
Theory Approach ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Individualized Care ◽  
Physician Care ◽  
Post Acute Care

Abstract Background and Objectives: In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians (or advanced practitioners such as nurse practitioners) in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment.Research Design and Methods: This qualitative study used grounded theory approach to analyze data collected from semi-structured interviews at five SNFs in January-August 2018. Patients admitted for short-term SNF care 5-10 days prior were eligible to participate. Thematic analysis was performed to detect recurrent themes with a focus on modifiable aspects of physician care. Analysis was stratified by patient cognitive impairment (measured by the Montreal Cognitive Assessment at the time of the interview). Results: Fifty patients and six caregivers were interviewed. Major themes were: (1) patients had poor awareness of the physician in charge of their care; (2) they were dissatisfied with the frequency of interaction with the physician; and (3) participants valued the perception of receiving individualized care from the physician. Less cognitively impaired patients were more concerned about limited interactions with the clinicians and were more likely to report attempts to seek out the physician. Discussion and Implications: Patient and caregiver expectations of SNF physicians were not well aligned with their experiences. SNFs aiming to improve satisfaction with care may focus efforts in this area, such as facilitating frequent communication between physicians, patients and caregivers.

scholarly journals Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Hispanics With Dementia

2020 ◽  
Vol 21 (11) ◽  
pp. 1705-1711.e3
Author(s):  
Maricruz Rivera-Hernandez ◽  
Chanee D. Fabius ◽  
Shekinah Fashaw ◽  
Brian Downer ◽  
Amit Kumar ◽  
...  
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Post Acute Care

scholarly journals Expectations and experiences with physician care among patients receiving post-acute care in US skilled nursing facilities

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kira L. Ryskina ◽  
Kierra A. Foley ◽  
Jason H. Karlawish ◽  
Joshua D. Uy ◽  
Briana Lott ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Acute Care ◽  
Skilled Nursing Facilities ◽  
Theory Approach ◽  
Nursing Facilities ◽  
Structured Interviews ◽  
Skilled Nursing ◽  
Individualized Care ◽  
Physician Care ◽  
Post Acute Care

Abstract Background In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment. Methods This qualitative study used grounded theory approach to analyze data collected from semi-structured interviews at five SNFs in January–August 2018. Patients admitted for short-term SNF care 5–10 days prior were eligible to participate. Thematic analysis was performed to detect recurrent themes with a focus on modifiable aspects of physician care. Analysis was stratified by patient cognitive impairment (measured by the Montreal Cognitive Assessment at the time of the interview). Results Fifty patients and six caregivers were interviewed. Major themes were: (1) patients had poor awareness of the physician in charge of their care; (2) they were dissatisfied with the frequency of interaction with the physician; and (3) participants valued the perception of receiving individualized care from the physician. Less cognitively impaired patients were more concerned about limited interactions with the physicians and were more likely to report attempts to seek out the physician. Conclusion Patient and caregiver expectations of SNF physicians were not well aligned with their experiences. SNFs aiming to improve satisfaction with care may focus efforts in this area, such as facilitating frequent communication between physicians, patients and caregivers.

scholarly journals ECHO-CT: An Interdisciplinary Videoconference Model for Identifying Potential Postdischarge Transition-of-Care Events

2021 ◽  
Vol 16 (2) ◽  
pp. 93-96
Author(s):  
Mariana R Gonzalez ◽  
Lauren Junge-Maughan ◽  
Lewis A Lipsitz ◽  
Amber Moore
Keyword(s):  
Acute Care ◽  
Care Transitions ◽  
Transition Of Care ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Surgical Services ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Post Acute Care

BACKGROUND: Discharge from the hospital to a post–acute care setting can be complex and potentially dangerous, with opportunities for errors and lapses in communication between providers. Data collected through the Extension for Community Health Outcomes–Care Transitions (ECHO-CT) model were used to identify and classify transition-of-care events (TCEs). METHODS: The ECHO-CT model employs multidisciplinary videoconferences between a hospital-based team and providers in post–acute care settings; during these conferences, concerns regarding the patient’s care transition were identified and recorded. The videoconferences took place from January 2016 to October 2018 and included patients discharged from inpatient medical and surgical services to a total of eight participating post–acute care facilities (skilled nursing facilities or long-term acute care hospitals). RESULTS: During the interdisciplinary videoconferences in this period, 675 patients were discussed. A total of 139 TCEs were identified; 58 (41.7%) involved discharge communication or coordination errors and 52 (37.4%) were classified as medication issues. CONCLUSION: The TCEs identified in this study highlight areas in which providers can work to reduce issues arising during the course of discharge to post–acute care facilities. Standardized processes to identify, record, and report TCEs are necessary to provide high-quality, safe care for patients as they move across care settings.

scholarly journals Expectations and Experiences with Physician Care Among Patients Receiving Post-Acute Care in US Skilled Nursing Facilities

2020 ◽  
Author(s):  
Kira L Ryskina ◽  
Kierra A. Foley ◽  
Jason H. Karlawish ◽  
Joshua D. Uy ◽  
Briana Lott ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Skilled Nursing Facilities ◽  
Theory Approach ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Individualized Care ◽  
Physician Care ◽  
Post Acute Care

Abstract Background and Objectives: In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians (or advanced practitioners such as nurse practitioners) in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment.Research Design and Methods: This qualitative study used grounded theory approach to analyze data collected from semi-structured interviews at five SNFs in January-August 2018. Patients admitted for short-term SNF care 5-10 days prior were eligible to participate. Thematic analysis was performed to detect recurrent themes with a focus on modifiable aspects of physician care. Analysis was stratified by patient cognitive impairment (measured by the Montreal Cognitive Assessment at the time of the interview). Results: Fifty patients and six caregivers were interviewed. Major themes were: (1) patients had poor awareness of the physician in charge of their care; (2) they were dissatisfied with the frequency of interaction with the physician; and (3) participants valued the perception of receiving individualized care from the physician. Less cognitively impaired patients were more concerned about limited interactions with the clinicians and were more likely to report attempts to seek out the physician. Discussion and Implications: Patient and caregiver expectations of SNF physicians were not well aligned with their experiences. SNFs aiming to improve satisfaction with care may focus efforts in this area, such as facilitating frequent communication between physicians, patients and caregivers.

scholarly journals Understanding Communication Between Rehabilitation Practitioners and Nurses: Implications for Post-Acute Care Quality

2018 ◽  
Vol 39 (7) ◽  
pp. 795-802
Author(s):  
Carin Wong ◽  
Jenny Martinez ◽  
Brenda Fagan ◽  
Natalie E. Leland
Keyword(s):  
Acute Care ◽  
Secondary Data ◽  
Care Quality ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Licensed Practical Nurses ◽  
Nursing Leaders ◽  
Bidirectional Communication ◽  
Communication Method ◽  
Post Acute Care

Objective: This study examined post-acute care (PAC) rehabilitation practitioner’s perspectives on communication. Method: This is a secondary data analysis of a larger qualitative study, which included PAC rehabilitation provider ( n = 99) focus groups that were held in a purposive sample of 13 skilled nursing facilities (SNFs). Results: Participants emphasized the importance of bidirectional communication between rehabilitation and nursing. Three themes were identified: (a) communication between rehabilitation practitioners and registered nurses or licensed practical nurses, (b) communication between rehabilitation practitioners and certified nursing assistants, and (c) communication between rehabilitation practitioners and nursing leaders. Two subthemes within each of the three themes were further characterized to understand how information was exchanged: (a) static communication and (b) action-oriented communication. Conclusion: Our findings highlight opportunities for better communication in PAC between rehabilitation practitioners and nursing and thus lay a foundation for future efforts to improve care coordination through enhancing interdisciplinary communication.

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