Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents With Pneumonia

Loeb, Mark; Carusone, Soo Chan; Goeree, Ron; Walter, Stephen D.; Brazil, Kevin; Krueger, Paul; Simor, Andrew E.; Moss, Lorraine; Marrie, Thomas J.

doi:10.1001/jama.295.21.2503

Cited by 235 publications

(209 citation statements)

References 35 publications

(22 reference statements)

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“…There are examples of successful projects that can safely keep medically unwell care-home residents in their preferred environment. Various groups have created clinical pathways for the management of pneumonia in care homes, 25 and have used improved access to geriatrician advice to reduce hospital admissions. 26 When admission was not recommended, we offered respondents choices of 'avoidable' or 'inappropriate' admissiondistinct categories that clearly often coexist because most respondents selected both options.…”

Section: Themes Common To Various Scenariosmentioning

confidence: 99%

Appropriateness of unscheduled hospital admissions from care homes

Harrison

McKay²,

Grant

et al. 2016

Clinical Medicine

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Section: Themes Common To Various Scenariosmentioning

confidence: 99%

Appropriateness of unscheduled hospital admissions from care homes

Harrison

McKay²,

Grant

et al. 2016

Clinical Medicine

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“…An additional strategy for reducing avoidable hospitalizations is the use of practice guidelines, care paths, communication, and other tools that assist NH health professionals in recognizing, reporting, and managing conditions, which may be helpful in bolstering NHs' ability to manage sicker residents. [30][31][32][33][34][35][36] For example, in a randomized trial conducted in several Canadian NHs, implementation of a care path for pneumonia with the support of a trained nurse was shown to be effective in reducing hospitalizations and related costs without greater mortality. 36 Similar tools were created as part of the larger CMS project at the Georgia QIO and are available on-line.…”

mentioning

confidence: 99%

“…[30][31][32][33][34][35][36] For example, in a randomized trial conducted in several Canadian NHs, implementation of a care path for pneumonia with the support of a trained nurse was shown to be effective in reducing hospitalizations and related costs without greater mortality. 36 Similar tools were created as part of the larger CMS project at the Georgia QIO and are available on-line. 37 A Medicare demonstration project that involved a payment to NHs to manage sicker residents without hospital transfer did not show a substantial increase in mortality when a variety of conditions were treated in the NHs.…”

mentioning

confidence: 99%

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Ouslander

Lamb

Perloe

et al. 2010

J American Geriatrics Society

419

387

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OBJECTIVES:To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents. DESIGN: Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization. SETTING: NHs in Georgia. PARTICIPANTS: In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long-and short-stay residents. MEASUREMENTS: Ratings using a structured review by expert NH clinicians. RESULTS: Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on-site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations. CONCLUSION: In this sample of NH residents, experienced long-term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population. J Am Geriatr Soc 58:627-635, 2010.Key words: nursing homes; avoidable hospitalizations; transfers; quality H ospitalization of nursing home (NH) residents can cause discomfort for residents, anxiety for their loved ones, morbidity due to iatrogenic events, and excess healthcare costs. Many of these hospitalizations may be preventable through better care in the NH or inappropriate, because the transfer exposes NH residents to additional risks associated with hospitalization, 1 without substantial potential benefit for the residents' clinical course or quality of life. Previous in-depth research on the overall frequency and costs of potentially avoidable hospitalizations of nursing home residents is limited. One study found that, in 2004, 23% of the $972 million spent on hospitalizations of long-stay NH residents in the state of New York were for ambulatory care-sensitive diagnoses (ACSDs), a proxy measure for potentially unnecessary hospitalizations. 2ACSDs include diagnoses such as angina pectoris, heart failure, chronic obstructive pulmonary disease, pneumonia, urinary tract infection, cellulitis, diabetes mellitus, and dehydration. 3 This is an underestimate of the overall costs of these hospitalizations, because short-stay residents, in whom hospitalizations are more common than long-stay residents, were excluded from this analysis. A study of hospital admissions from Canadian long-term care facilities found 55% to be due to a modified list of ACSD. 4 In an analysis of hospital transfers from eight Los Angeles NHs, experienced physicians using a structured implicit record re...

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“…There is a growing body of research examining the impact of cross-organizational cooperation, which indicates that such cooperation reduces both costs and lengths of stay. 13,14 Studies also suggest that cross-organizational cooperation enables more efficient resource allocation for complex human services. 15 A better understanding of how and when municipal bodies and other depending steps cooperate with hospital administration would constitute an important foundation to initiatives aimed at facilitating the discharge process.…”

Section: Discussionmentioning

confidence: 99%

Attending physicians believe that hospitalized patients are treated at the appropriate level of care: A qualitative study

Mauritzon

Blom

Borna

et al. 2016

International Journal of Healthcare Management

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The purpose of this paper is to investigate the appropriateness of hospitalized patients' level of care as assessed by their treating physicians. The study was conducted as a qualitative study, based on a questionnaire. The study suggests that physicians generally believe that patients who occupy in-hospital beds are cared for at the appropriate level of care. It is worth to note that a relatively large fraction of patients have had their medical needs attended to, but remain hospitalized while waiting for municipal action. Successful downsizing of in-hospital bed-capacity assumes that either a segment of patients who are inappropriately hospitalized exists and could be identified, or that viable alternatives to in-hospital care exist and are available. The results of the present study argue against the first statement. However, we have identified a segment of patients who experience an unnecessarily long in-patient length of stay due to waiting times for municipal action and other post-discharge follow-up measures. Alternatives to in-hospital care which deserve further attention are supporting services in the outpatient setting.

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Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents With Pneumonia

Abstract: clinicaltrials.gov Identifier: NCT00157612.

Cited by 235 publications

References 35 publications

Appropriateness of unscheduled hospital admissions from care homes

Appropriateness of unscheduled hospital admissions from care homes

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Attending physicians believe that hospitalized patients are treated at the appropriate level of care: A qualitative study

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