Consultant Pharmacist Drug Therapy Recommendations Acceptance and Rejection from Monthly Drug Regimen Reviews in a Geriatric Nursing Facility: Fourth Year Results and Cost Analysis

2007 ◽  
Vol 42 (8) ◽  
pp. 729-736 ◽  
Author(s):  
James W. Cooper ◽  
William E. Wade ◽  
Christopher L. Cook ◽  
Allison H. Burfield
Keyword(s):  
Repeated Measures ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Rejection Rate ◽  
Drug Regimen ◽  
Acceptance Rate ◽  
Adverse Outcomes ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Monthly Drug

Purpose To document and compare the outcomes from monthly drug regimen review recommendation acceptance and rejection in one skilled nursing facility by one consultant pharmacist (CP) in the fourth year of evaluation with the prior 3 years' data. Method A non-randomized, observational, prospective cohort study with all patients being residents for at least 30 days over the 12-month period (October 1, 1997 to September 30, 1998) in a skilled nursing facility with more than 100 beds. The admission problem-oriented records of all patients and their respective CP reports were screened for pharmacotherapy recommendations and subsequent acceptance and rejection on a monthly, repeated-measures basis for 12 months. There were 2,004 monthly drug regimen review (DRR) reports. The percentage of DRR reports that made recommendations was tabulated. Written recommendations made to attending physicians that were either accepted or rejected within 3 months were analyzed. The charges for adverse outcomes were calculated from billing records or prior studies of the outcome. These results were compared with prior 1- and 2-year studies of outcomes within the same setting. Carryover effects of recommendations implemented in prior periods were also calculated. Results There were 178 recommendations made in 2,004 DRR reports (8.9%). A low acceptance rate, 27 of 178 recommendations (15.2%), resulted and was combined with carryover of prior acceptance in a cost savings of $113,962. The 151 recommendations that were rejected resulted in $226,503 of presumed unnecessary costs to the health care system. A prior 2-year study of recommendations with an acceptance rate of 89% showed costs savings of $111,609 per year with acceptance and $112,297 added costs per year with 11% rejection. The first-year study had a 93% acceptance rate at a projected cost savings of $43,854 and costs increased by $60,825 with a 7% rejection. The costs of recommendation rejection in the fourth year were substantially higher, with a higher rejection rate than was seen in the prior 3 years of observation. Conclusion Documentation of the costs from CP intervention should factor in costs of rejection that may increase with the percentage rejection of recommendations, length of observation period, and may vary between facilities.

scholarly journals Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington

2016 ◽  
Vol 96 (2) ◽  
pp. 252-259 ◽  
Author(s):  
Alan Chong W. Lee ◽  
Michael Billings
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Human Factors ◽  
Clinical Outcomes ◽  
Physical Therapist ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Pilot Program ◽  
Nursing Facility ◽  
Skilled Nursing

Background and Purpose Telehealth is defined as the delivery of health-related services and information via telecommunication technologies. The purposes of this case report are: (1) to describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in an SNF delivered via telehealth. Case Description In 2009, Infinity Rehab conducted a pilot program to determine whether telehealth could be used to meet physical therapist supervision requirements in an SNF. In 2011, language allowing telehealth physical therapy was approved by the Washington Board of Physical Therapy (Board). In 2014–2015, telehealth outcomes were evaluated in a 51-person sample at an Infinity Rehab SNF. Cost savings of telehealth implementation from 2011 to 2015 were estimated. Outcomes The Board deemed the telehealth pilot program a success and subsequently established telehealth practice language for physical therapy. Both human factors and clinical outcomes were required to implement a successful telehealth practice. Clinical outcomes and user satisfaction in telehealth and nontelehealth groups were equivalent. Cost savings were identified. Discussion Human factors, such as the need for provider education in appropriate bedside manner with a telehealth session, were identified. Since 2011, more than 1,000 telehealth physical therapy sessions were conducted at Infinity Rehab SNFs in Washington State. In the future, alternative payment models focused on valued-based clinical outcomes may facilitate wider telehealth adoption in physical therapy. Future research on efficacy and cost-effectiveness is needed to promote broader adoption of telehealth physical therapy in SNFs. This experience demonstrates that telehealth implementation in an SNF for the purpose of physical therapy re-evaluation is a feasible alternative to in-person encounters.

scholarly journals TRANSITIONAL CARE OUTCOMES IN VETERANS RECEIVING POST-ACUTE CARE IN A SKILLED NURSING FACILITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S732-S732
Author(s):  
Robert Burke ◽  
Anne Canamucio ◽  
Thomas Glorioso ◽  
Anna Baron ◽  
Kira Ryskina
Keyword(s):  
Acute Care ◽  
Transitional Care ◽  
Adverse Outcome ◽  
Skilled Nursing Facility ◽  
Adverse Outcomes ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Episodes Of Care ◽  
Va Hospitals ◽  
Post Acute Care

Abstract More than 200,000 Veterans transition between hospital and skilled nursing facility (SNF) annually. Capturing outcomes of these transitions has been challenging because older adult Veterans receive care at VA and non-VA hospitals, and four different kinds of SNFs: VA-owned and -operated Community Living Centers (CLCs), VA-contracted community nursing homes (CNHs), State Veterans Homes (SVHs), and non-VA community SNFs. We used a novel data source which concatenates VA, Medicare, and Medicaid data into longitudinal episodes of care for Veterans, to calculate the rate of adverse outcomes associated with the transition from hospital to SNF in all enrolled Veterans age 65 and older undergoing this transition 2012-2014. The composite primary outcome included Emergency Department (ED) visits, rehospitalizations, and mortality (not in the context of hospice) within 7 days of hospital discharge to SNF. We used multivariable logistic regression to adjust for Veteran and hospital characteristics and hospital random effects. In the 388,339 Veterans discharged from 1502 hospitals in our sample, we found more than 4 in 5 Veteran transitions (81.7%) occurred entirely outside the VA system. The overall 7-day outcome rate was 10.7%. After adjustment, VA hospitals had lower adverse outcome rates than non-VA hospitals (OR 0.80, 95% CI 0.74-0.86). VA hospital-CLC transitions had the lowest adverse outcome rates; in comparison, non-VA hospital-CNH (OR 2.51, 95% CI 2.09-3.02) and non-VA hospital-CLC (OR 2.25, 95% CI 1.81-2.79) had the highest rates. These findings raise important questions about the VA’s role as a major provider and payer of post-acute care in SNF.

scholarly journals A Simple Physical Therapy Algorithm Is Successful in Decreasing Skilled Nursing Facility Length of Stay and Increasing Cost Savings After Hip Fracture With No Increase in Adverse Events

2021 ◽  
Vol 12 ◽  
pp. 215145932199861
Author(s):  
Murillo Adrados ◽  
Kaicheng Wang ◽  
Yanhong Deng ◽  
Janis Bozzo ◽  
Tara Messina ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Physical Therapy ◽  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Therapy Algorithm ◽  
Program Participant ◽  
Significant Difference

Introduction: Shorter length of stays (LOS) at a Skilled Nursing Facility (SNF) after hip fracture surgery would be expected to lead to costs savings for the healthcare system. Evidence also suggests that shorter SNF stays also leads to improved 30-day outcomes, thus compounding this value proposition. Our Integrated Fragility Hip Fracture Program created a simple algorithm at discharge to provide each post-operative hip fracture patient with an expected SNF LOS. We studied whether this intervention produced a shorter SNF LOS and other observable short-term outcomes. Methods: We retrospectively reviewed all original Medicare hip fracture patients treated with operative fixation who were admitted to our hospital in 2015, 2017 and 2018. We selected patients who were discharged to a single SNF following hospitalization, and excluded patients with incomplete records. The algorithm for the expected LOS recommendation was based on the degree of assistance the patient needed for ambulation: 7 days (“0-person assist”), 14 days (“1-person assist”), or 21 days (“2-person assist”). We compare the SNF LOS of our hip fracture patient population between those discharged to a program participant, those SNF that agreed to this algorithm, and those discharged to a non-program participant SNF. Results: We identified 246 patients meeting our selection criteria. 69 were discharged to a program participant SNF. Patients discharged to a participant SNF had similar baseline demographics and ASA distributions to those discharged to a non-participant provider. There was a statistically significant difference in length of stay between the groups, with program participant patients spending an average of 23 days at the SNF while the control group spent an average of 31 days. (p < 0.001). Program participant discharges were also associated with additional cost savings. There was no significant difference in ED visits within 90 days of discharge. Discussion: SNF LOS for geriatric hip fractures can be decreased with implementation of a simple physical therapy driven algorithm based on the patient’s ambulatory independence at hospital discharge. Conclusion: This is a simple, yet completely unique program that seems to have increased the value of healthcare provided.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

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