Nursing Homes That Increased The Proportion Of Medicare Days Saw Gains In Quality Outcomes For Long-Stay Residents

Lepore, Michael; Leland, Natalie E.

doi:10.1377/hlthaff.2015.0303

Cited by 25 publications

(27 citation statements)

References 19 publications

(22 reference statements)

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“…This is a relevant clinical and research consideration given rising numbers of short-stay (i.e., post-acute care) residents and distinct care goals and needs that distinguish them from long-stay residents [15][16][17]. For example, short-stay residents typically require rehabilitative nursing immediately following hospitalization, whereas long-stay residents predominantly receive custodial and chronic care services [18].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study

et al. 2020

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Background: Older adults who reside in long-term care facilities (LTCFs) are at particularly high risk for infection, morbidity and mortality from pneumonia and influenza (P&I) compared to individuals of younger age and those living outside institutional settings. The risk factors for P&I hospitalizations that are specific to LTCFs remain poorly understood. Our objective was to evaluate the incidence of P&I hospitalization and associated person-and facility-level factors among post-acute (short-stay) and long-term (long-stay) care residents residing in LTCFs from 2013 to 2015. Methods: In this retrospective cohort study, we used Medicare administrative claims linked to Minimum Data Set and LTCF-level data to identify short-stay (< 100 days, index = admission date) and long-stay (100+ days, index = day 100) residents who were followed from the index date until the first of hospitalization, LTCF discharge, Medicare disenrollment, or death. We measured incidence rates (IRs) for P&I hospitalization per 100, 000 person-days, and estimated associations with baseline demographics, geriatric syndromes, clinical characteristics, and medication use using Cox regression models.Results: We analyzed data from 1,118,054 short-stay and 593,443 long-stay residents. The crude 30-day IRs (95% CI) of hospitalizations with P&I in the principal position were 26.0 (25.4, 26.6) and 34.5 (33.6, 35.4) among short-and long-stay residents, respectively. The variables associated with P&I varied between short and long-stay residents, and common risk factors included: advanced age (85+ years), admission from an acute hospital, select cardiovascular and respiratory conditions, impaired functional status, and receipt of antibiotics or Beers criteria medications. Facility staffing and care quality measures were important risk factors among long-stay residents but not in short-stay residents.Conclusions: Short-stay residents had lower crude 30-and 90-day incidence rates of P&I hospitalizations than long-stay LTCF residents. Differences in risk factors for P&I between short-and long-stay populations suggest the importance of considering distinct profiles of post-acute and long-term care residents in infection prevention and control strategies in LTCFs. These findings can help clinicians target interventions to subgroups of LTCF residents at highest P&I risk.

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Section: Introductionmentioning

confidence: 99%

Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study

et al. 2020

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“…Medicare is the primary payor for skilled nursing care in the United States; increased antibiotic prescriptions in nursing homes with a greater proportion of residents using Medicare is also consistent with individuals receiving short‐stay care following a hospitalization. Interestingly, this may also indicate enhanced quality of care 24 . Our data also suggest that despite the growing emphasis on antibiotic stewardship, the rate of antibiotic use among the nursing homes in our cohort remained unchanged from 2014 to 2016.…”

Section: Discussionmentioning

confidence: 52%

Antibiotic Use Among Residents Receiving Skilled Nursing Care in 29 U.S. Nursing Homes

Song

Wilson

Bej

et al. 2020

J American Geriatrics Society

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BACKGROUND Data describing antibiotic use in U.S. nursing homes remain limited. We report antibiotic use among skilled nursing facility residents from 29 U.S. nursing homes and assessed correlations between antibiotics prescribed to residents in skilled care and nursing home characteristics. DESIGN Retrospective cohort study. SETTING Twenty‐nine U.S. nursing homes in the same healthcare corporation. PARTICIPANTS Residents receiving skilled care in 2016. MEASUREMENTS We used pharmacy invoice and nursing home census data to calculate the days of antibiotic therapy per 1,000 days of skilled care (1,000 DOSC), the rate of antibiotic starts per 1,000 DOSC, the length of antibiotic therapy, and the average antibiotic spectrum index. We also assessed correlations between antibiotic use and nursing home characteristics. RESULTS Antibiotics accounted for an average of 9.6% (±0.6%) of systemic medications prescribed among residents receiving skilled care. On average, 26.8% (±2.9%) of antibiotics were intravenous. Fluoroquinolones were prescribed at the highest rates (19% across all facilities), followed by beta‐lactam/beta‐lactamase inhibitors (11%), first‐ and second‐generation cephalosporins, sulfonamides, and oral tetracyclines (each at 9%). Both the proportion of residents using enrolled in Medicare and number of unique prescribers responsible for systemic prescriptions positively correlated with the rate of antibiotic starts. CONCLUSIONS Our study demonstrates that pharmacy invoices represent a useful and preexisting source of data for assessing antibiotic prescriptions among individuals receiving skilled nursing care. The correlation between the number of unique prescribers and antibiotic starts suggests that prescribers are central to efforts to improve antibiotic use in nursing homes.

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“…Staffing—itself a frequently used measure of NH quality—has been associated with both consumer satisfaction (Çalkoğlu et al, 2012; Li et al, 2013; Lucas et al, 2007) and NH processes and outcomes (Bostick, Rantz, Flesner, & Riggs, 2006; Harrington, Olney, Carrillo, & Kang, 2012; Hyer et al, 2011; Kim, 2016; McDonald, Wanger, & Castle, 2013; Shippee et al, 2015a; Xu et al, 2013). Moreover, research is increasingly investigating the role of rehabilitative staff in ensuring quality for both short- and long-stay residents (Lepore & Leland, 2015; Livingstone, 2018). Staffing is measured via five types of staffing: hours per resident day for RNs , LPNs , and certified nursing assistants (CNAs), occupational therapy hours per resident day (OT HPRD), and physical therapy hours per resident day (PT HPRD).…”

Section: Methodsmentioning

confidence: 99%

“…Resident acuity and age distribution have been related to satisfaction and quality (Kim, 2016; Shippee et al, 2017; Shippee, Henning-Smith, Kane, & Lewis, 2015b; Shippee, Henning-Smith, Rhee, Held, & Kane, 2016; Shippee, Hong, Henning-Smith, & Kane, 2015a), whereas the proportion of days of care provided annually that were Medicare skilled nursing facility (SNF) covered days has been related to quality outcomes for long-stay residents (Lepore & Leland, 2015). Thus, we adjusted for case mix using the proportion of residents age 65 years or younger, the proportion of SNF days, and the LTCFocus Acuity Index , which is calculated based on the number of residents needing various levels of activities of daily living (ADL) assistance and the number receiving special treatment.…”

Section: Methodsmentioning

confidence: 99%

A National-Level Analysis of the Relationship Between Nursing Home Satisfaction and Quality

et al. 2018

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Little research has explored the relationship between consumer satisfaction and quality in nursing homes (NHs) beyond the few states mandating satisfaction surveys. We examine this relationship through data from 1,765 NHs in the 50 states and District of Columbia using My InnerView resident or family satisfaction instruments in 2013 and 2014, merged with Certification and Survey Provider Enhanced Reporting, LTCfocus, and NH Compare (NHC) data. Family and resident satisfaction correlated modestly; both correlated weakly and negatively with any quality-of-care (QoC) and any quality-of-life deficiencies and positively with NHC five-star ratings; this latter positive association persisted after covariate adjustment; the negative relationship between QoC deficiencies and family satisfaction also remained. Overall, models explained relatively small proportions of satisfaction variance; correlates of satisfaction varied between residents and families.

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Nursing Homes That Increased The Proportion Of Medicare Days Saw Gains In Quality Outcomes For Long-Stay Residents

Cited by 25 publications

References 19 publications

Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study

Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study

Antibiotic Use Among Residents Receiving Skilled Nursing Care in 29 U.S. Nursing Homes

A National-Level Analysis of the Relationship Between Nursing Home Satisfaction and Quality

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