Factors Associated with Potentially Preventable Hospitalization in Nursing Home Residents in New York State: A Survey of Directors of Nursing

Young, Yuchi; Barhydt, Nancy R.; Broderick, Suzanne; Colello, Anna; Hannan, Edward L.

doi:10.1111/j.1532-5415.2010.02804.x

Cited by 37 publications

(38 citation statements)

References 21 publications

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“…All NHs had access to laboratory and radiology services. 27 The TIP intervention included the following: (1) preemptive barrier precautions; (2) active surveillance for MDROs and infections, with data feedback; and (3) NH staff education on key infection prevention practices and hand hygiene promotion (Table 1). The control group NHs continued to practice according to their own infection prevention policies.…”

Section: Methodsmentioning

confidence: 99%

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

et al. 2015

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Indwelling devices (eg, urinary catheters and feeding tubes) are often used in nursing homes (NHs). Inadequate care of residents with these devices contributes to high rates of multidrug-resistant organisms (MDROs) and device-related infections in NHs.OBJECTIVE To test whether a multimodal targeted infection program (TIP) reduces the prevalence of MDROs and incident device-related infections. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at 12 community-based NHs from May 2010 to April 2013. Participants were high-risk NH residents with urinary catheters, feeding tubes, or both. INTERVENTIONS Multimodal, including preemptive barrier precautions, active surveillance for MDROs and infections, and NH staff education. MAIN OUTCOMES AND MEASURESThe primary outcome was the prevalence density rate of MDROs, defined as the total number of MDROs isolated per visit averaged over the duration of a resident's participation. Secondary outcomes included new MDRO acquisitions and new clinically defined device-associated infections. Data were analyzed using a mixed-effects multilevel Poisson regression model (primary outcome) and a Cox proportional hazards model (secondary outcome), adjusting for facility-level clustering and resident-level variables. RESULTSIn total, 418 NH residents with indwelling devices were enrolled, with 34 174 device-days and 6557 anatomic sites sampled. Intervention NHs had a decrease in the overall MDRO prevalence density (rate ratio, 0.77; 95% CI, 0.62-0.94). The rate of new methicillin-resistant Staphylococcus aureus acquisitions was lower in the intervention group than in the control group (rate ratio, 0.78; 95% CI, 0.64-0.96). Hazard ratios for the first and all (including recurrent) clinically defined catheter-associated urinary tract infections were 0.54 (95% CI, 0.30-0.97) and 0.69 (95% CI, 0.49-0.99), respectively, in the intervention group and the control group. There were no reductions in new vancomycin-resistant enterococci or resistant gram-negative bacilli acquisitions or in new feeding tube-associated pneumonias or skin and soft-tissue infections.CONCLUSIONS AND RELEVANCE Our multimodal TIP intervention reduced the overall MDRO prevalence density, new methicillin-resistant S aureus acquisitions, and clinically defined catheter-associated urinary tract infection rates in high-risk NH residents with indwelling devices. Further studies are needed to evaluate the cost-effectiveness of this approach as well as its effects on the reduction of MDRO transmission to other residents, on the environment, and on referring hospitals. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01062841

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Section: Methodsmentioning

confidence: 99%

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

et al. 2015

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“…Education initiatives were also identified as important to support and prepare the client to self-manage transition as well as assist interprofessional team members with understanding their role and responsibilities during care transitions. [66][67][68][69][70] This review of the literature identified the need for organizations to provide adequate resources to support care transitions. 71 …”

Section: Research Questionmentioning

confidence: 99%

Care Transitions

Dusek

Pearce

Harripaul

et al. 2015

Journal of Nursing Care Quality

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This article reports results from a systematic review used to inform the development of a best practice guideline to assist nurses in understanding their roles and responsibilities in promoting safe and effective client care transitions. A care transition is a set of actions designed to ensure safe and effective coordination and continuity of care as clients experience a change in health status, care needs, health care providers, or location.

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“…31 In another study of preventable (avoidable) hospitalizations of NH residents in New York state, training of nursing staff on how to communicate effectively with physicians about a resident's condition showed the strongest association with preventable hospitalizations after controlling for other factors. 32 These studies begin to highlight the importance of understanding effective processes of care surrounding NH communication and coordination among medical and nursing staff.…”

Section: Introductionmentioning

confidence: 99%

Physicians in Nursing Homes: Effectiveness of Physician Accountability and Communication

Lima

Intrator

Wetle

2015

Journal of the American Medical Directors Association

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Objectives To develop a measure of the perceptions of nursing home (NH) Directors of Nursing (DON) on the adequacy of physician care and to examine its variation as well as its construct validity. Design A nationwide cross-sectional study with primary data collection Setting 2043 NHs surveyed August 2009 – April 2011 Participants Directors of Nursing (DONs) and NH Administrators responded to questions pertaining to their perceptions of the care provided by physicians in their NH. Measurements Ten items were used to create three domains: medical staff attentiveness, physician communication, and staff concerns about physician practice. These were combined into an overall summary score measure called “Effectiveness of Physician Accountability and Communication” (EPAC). EPAC construct validity was ascertained from other DON questions and from a complementary survey of NH Administrators. RESULTS The established EPAC score is the first measure to capture specific components of the adequacy of physician care in NHs. EPAC exhibited good construct validity: more effective practices were correlated with greater physician involvement in discussions of Do-Not-Resuscitate orders, the frequency that the Medical Director checked on the medical care delivered by attending physician, the tightness of nursing home's control of its physician resources, and the DON's perception of whether or not avoidable hospitalizations and ER visits could be reduced with greater physician attention to resident needs. Conclusion As increased attention is given to the quality of care provided to vulnerable elders, effective measures of processes of care are essential. The EPAC measure provides an important new metric that can be used in these efforts. The goal is that future studies could use EPAC and its individual domains to shed light on the manner through which physician presence is related to resident outcomes in the NH setting.

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Factors Associated with Potentially Preventable Hospitalization in Nursing Home Residents in New York State: A Survey of Directors of Nursing

Cited by 37 publications

References 21 publications

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling Devices

Care Transitions

Physicians in Nursing Homes: Effectiveness of Physician Accountability and Communication

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