Nursing Home Physician Specialists: A Response to the Workforce Crisis in Long-Term Care

Katz, Paul R.; Karuza, Jurgis; Intrator, Orna; Mor, Vincent

doi:10.7326/0003-4819-150-6-200903170-00010

Cited by 101 publications

(57 citation statements)

References 29 publications

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“…AMDA is perfectly positioned to incorporate training in the cognitive psychology of medical decision making into its list of core competencies for certification. 95,96 It is my hope that this work will stimulate interest in study of psychophysical principles that impact medical decision making in the SNF.…”

Section: Discussionmentioning

confidence: 98%

The Psychophysics of Transition to Long Term Care

Miles

2013

Journal of the American Medical Directors Association

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Section: Discussionmentioning

confidence: 98%

The Psychophysics of Transition to Long Term Care

Miles

2013

Journal of the American Medical Directors Association

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“…In US nursing homes, physicians have been called "missing in action" because they are frequently not there when families visit [24,165]. Having a dedicated physician who knows the patient and family well is crucial for coordinating care and providing guidance [24,29,[165][166][167][168]. Other members of the multi-disciplinary team of physicians, nurses, nurse practitioners, and social workers may also fulfill a coordination role, especially when specifically trained in palliative care in dementia patients.…”

Section: Continuity Of Carementioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

224

177

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Abstract. Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.

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“…[12][13][14][23][24][25] Involving these health professionals in care transition interventions in which acute hospitals collaborate with NHs and home health agencies would build upon evolving models, 26,27 but the number of healthcare professionals with special training and interest in geriatrics and long-term care medicine is not increasing rapidly enough to meet this need. 28 Financial incentives to obtain certification in geriatrics or work in NHs, such as loan repayment programs, and the development of a specialty in NH medicine 29 may help in this regard. 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.…”

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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Nursing Home Physician Specialists: A Response to the Workforce Crisis in Long-Term Care

Cited by 101 publications

References 29 publications

The Psychophysics of Transition to Long Term Care

The Psychophysics of Transition to Long Term Care

Dying with Dementia: What We Know after More than a Decade of Research

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

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