Effect of an Innovative Medicare Managed Care Program on the Quality of Care for Nursing Home Residents

Kane, Robert L; Flood, Shannon; Bershadsky, Boris; Keckhafer, Gail

doi:10.1093/geront/44.1.95

Cited by 80 publications

(87 citation statements)

References 18 publications

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“…30 The Evercare model of capitated payments and the assignment of a nurse practitioner to oversee the care of frail nursing home residents were shown to result in fewer hospitalizations and saved $103,000 per nurse practitioner in hospital costs. 12,13 The savings with the Evercare model were achieved with survival and quality outcomes that were similar to those with conventional care.…”

Section: Discussionmentioning

confidence: 91%

End-of-Life Transitions among Nursing Home Residents with Cognitive Issues

et al. 2011

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BACKGROUND Health care transitions in the last months of life can be burdensome and potentially of limited clinical benefit for patients with advanced cognitive and functional impairment. METHODS To examine health care transitions among Medicare decedents with advanced cognitive and functional impairment who were nursing home residents 120 days before death, we linked nationwide data from the Medicare Minimum Data Set and claims files from 2000 through 2007. We defined patterns of transition as burdensome if they occurred in the last 3 days of life, if there was a lack of continuity in nursing homes after hospitalization in the last 90 days of life, or if there were multiple hospitalizations in the last 90 days of life. We also considered various factors explaining variation in these rates of burdensome transition. We examined whether there was an association between regional rates of burdensome transition and the likelihood of feeding-tube insertion, hospitalization in an intensive care unit (ICU) in the last month of life, the presence of a stage IV decubitus ulcer, and hospice enrollment in the last 3 days of life. RESULTS Among 474,829 nursing home decedents, 19.0% had at least one burdensome transition (range, 2.1% in Alaska to 37.5% in Louisiana). In adjusted analyses, blacks, Hispanics, and those without an advance directive were at increased risk. Nursing home residents in regions in the highest quintile of burdensome transitions (as compared with those in the lowest quintile) were significantly more likely to have a feeding tube (adjusted risk ratio, 3.38), have spent time in an ICU in the last month of life (adjusted risk ratio, 2.10), have a stage IV decubitus ulcer (adjusted risk ratio, 2.28), or have had a late enrollment in hospice (adjusted risk ratio, 1.17). CONCLUSIONS Burdensome transitions are common, vary according to state, and are associated with markers of poor quality in end-of-life care. (Funded by the National Institute on Aging.)

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Section: Discussionmentioning

confidence: 91%

End-of-Life Transitions among Nursing Home Residents with Cognitive Issues

et al. 2011

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“…The majority (n = 24) were retrospective. Five studies reported on an intervention or a strategy for reducing transfers to acute care (information not shown in the table) [21,23,26,27,30,38]. …”

Section: Resultsmentioning

confidence: 99%

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

et al. 2014

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BackgroundResidents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.MethodSystematic review of the literature of two databases (PubMed and CINAHL®). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.ResultsTwenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents’ characteristics prior to admission (n = 6), residents’ or families’ wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.ConclusionsMost assessment tools are not comprehensive and do not take into account residents’ individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.

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“…Lessons from national, state, and provider-led initiatives to integrate acute and LTC suggest that decreasing preventable acute care hospitalizations for this population is a desirable and achievable strategy (R. L. Kane, Flood, Bershadsky, & Keckhafer, 2004;R. L. Kane, Keckhafer, Flood, Bershadsky, & Siadaty, 2003).…”

Section: Decreasing Preventable Acute Care Hospitalizationsmentioning

confidence: 99%

Transitions of Elders Between Long-Term Care and Hospitals

Naylor

Kurtzman

Pauly

2009

Policy, Politics, & Nursing Practice

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Elderly long-term care recipients who require acute hospitalizations must navigate a fragmented system with poor "handoffs," often resulting in negative outcomes. This article makes the case that reducing preventable hospitalizations and improving transitions to and from hospitals will enhance health care quality and outcomes among these elders. Immediate action targeting diffusion of evidence-based care is recommended to decrease avoidable rehospitalizations and achieve cost savings. Policy changes are needed to address barriers to high-quality transitional care, including deficits in health professionals' and caregivers' knowledge and resources, regulatory obstacles, and inadequate financial incentives and clinical information systems.

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Effect of an Innovative Medicare Managed Care Program on the Quality of Care for Nursing Home Residents

Abstract: Evercare, with its use of nurse practitioners, represents a model that can provide more efficient care that is of at least comparable quality.

Cited by 80 publications

References 18 publications

End-of-Life Transitions among Nursing Home Residents with Cognitive Issues

End-of-Life Transitions among Nursing Home Residents with Cognitive Issues

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

Transitions of Elders Between Long-Term Care and Hospitals

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