A Multifaceted Intervention to Implement Guidelines Did Not Affect Hospitalization Rates for Nursing Home–Acquired Pneumonia

Hutt, Evelyn; Ruscin, J. Mark; Linnebur, Sunny A.; Fish, Douglas N.; Oman, Kathleen S.; Fink, Regina; Radcliff, Tiffany A.; Dorsten, Brent Van; Liebrecht, Debra; Fish, Ron; McNulty, Monica

doi:10.1016/j.jamda.2010.03.011

Cited by 22 publications

(34 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hutt and colleagues [34] tested the effect of a multifaceted implementation strategy of a national guideline for management of nursing home acquired pneumonia in a cluster-RCT [34]. The risk difference between intervention and control group was a statistically non-significant reduction in hospitalisation for the intervention group (Additional file 1: Table S6).…”

Section: Resultsmentioning

confidence: 99%

Reducing hospital admissions from nursing homes: a systematic review

Graverholt

Forsetlund

Jamtvedt

2014

BMC Health Serv Res

104

View full text Add to dashboard Cite

BackgroundThe geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes.MethodsA systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination.ResultsFive systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach.ConclusionsOverall, eleven interventions to reduce hospital admissions from nursing homes were identified. None of them were tested more than once and the quality of the evidence was low for every comparison. Still, several interventions had effects on reducing hospital admissions and may represent important aspects of nursing home care to reduce hospital admissions.

show abstract

Section: Resultsmentioning

confidence: 99%

Reducing hospital admissions from nursing homes: a systematic review

Graverholt

Forsetlund

Jamtvedt

2014

BMC Health Serv Res

104

View full text Add to dashboard Cite

show abstract

“…The effect of regulations and guidelines, however, might be transferable and translatable to a Norwegian context. Studies on this area point to contrary findings: in one study, the implementation of guidelines for the treatment of pneumonia did not affect rates of hospitalization, primarily as «secular pressure» -in part in the form of families of residents-undermined the guidelines (Hutt et al 2011); while another study found that the implementation of a «clinical pathway» reduced hospitalizations for pneumonia (and similar ailments) by 12 percent, without decreasing quality of life of those hospitalized (Loeb et al 2006). to see what would transpire».…”

Section: The Structurementioning

confidence: 96%

“…described, «pressure from family» is highlighted as highly influential for hospitalizations of nursing home residents (Arendts & Howard 2010, Bottrell et al 2001, Hutt et al 2011, Jablonski et al 2007, Kayser-Jones et al 1989, Lamb et al 2011, Lopez 2009, Phillips et al 2006, Shanley et al 2011. It is argued that families of residents pressure caring staff, physicians and residents, to hospitalize residents, on many occasions contrary to the recommendations of staff and/or the (at times presumed) wishes of residents.…”

Section: Two Examples Of Variationmentioning

confidence: 99%

“…Potential pressure from family to transfer or not to transfer residents (more often the former) is accentuated in several studies and is noticeably missing from other segments of the literature. Family of residents is pointed out to be generally influential, through interaction with physicians, nurses or both (Arendts & Howard 2010, Bottrell et al 2001, Hutt et al 2011, Jablonski et al 2007, Kayser-Jones et al 1989, Lamb et al 2011, Phillips et al 2006, Shanley et al 2011): or in specific cases when the resident's preferences were unknown (Lopez 2009). Staff in nursing homes experience pressure from family, it is generally argued, while the effect of pressure varies, depending on the study.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The Institutional Practice

Ågotnes¹

2017

View full text Add to dashboard Cite

“…6 Up to 48% of these hospital transfers are thought to be avoidable. 7 20 Interventions targeting these admissions, according to a recent systematic review, 20 include, improving palliative care provision, [21][22][23] improving ACP interventions, 24 25 improving treatment of pneumonia and chronic obstructive pulmonary disease within facilities [26][27][28] and providing ambulatory geriatric care through geriatrician review of residents within RACFs. 19 29 30 Dementia, estimated to affect over 50% of RACF residents, 18 31 32 hinders the decision-making capacity of the resident, especially at times of acute illness.…”

Section: Introductionmentioning

confidence: 99%

Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial

et al. 2017

View full text Add to dashboard Cite

IntroductionSystematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) ‘Goals of Patient Care’ (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration.Methods and analysisThis is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration.DisseminationThe results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area.Trial registration numberACTRN12615000298516, Results.

show abstract

A Multifaceted Intervention to Implement Guidelines Did Not Affect Hospitalization Rates for Nursing Home–Acquired Pneumonia

Cited by 22 publications

References 14 publications

Reducing hospital admissions from nursing homes: a systematic review

Reducing hospital admissions from nursing homes: a systematic review

The Institutional Practice

Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial

Contact Info

Product

Resources

About