Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents With Heart Failure

Heckman, George A.; Hirdes, John P.; Hébert, Paul C.; Morinville, Anne; Amaral, Andre Carlos Kajdacsy-Balla; Costa, Andrew P.; McKelvie, Robert S.

doi:10.1016/j.jamda.2018.10.031

Cited by 16 publications

(17 citation statements)

References 30 publications

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“…Therefore, mechanisms to identify residents at highest risk of an early health event and prioritizing ACP conversations may be required. Potential targeting mechanisms could include certain diagnoses (e.g., heart failure) or inter-RAI indicators (e.g., Changes in Health, End-stage Disease, and Signs and Symptoms [CHESS], "leaving 25% food uneaten") (Heckman et al, 2019;Tjam et al, 2012). Additional stakeholder engagement is required in order to understand how best to implement such a strategy without compromising the effectiveness of ACP conversations.…”

Section: Resultsmentioning

confidence: 99%

Applying the Knowledge-to-Action Framework to Engage Stakeholders and Solve Shared Challenges with Person-Centered Advance Care Planning in Long-Term Care Homes

et al. 2021

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As they near the end of life, long term care (LTC) residents often experience unmet needs and unnecessary hospital transfers, a reflection of suboptimal advance care planning (ACP). We applied the knowledge-to-action framework to identify shared barriers and solutions to ultimately improve the process of ACP and improve end-of-life care for LTC residents. We held a 1-day workshop for LTC residents, families, directors/administrators, ethicists, and clinicians from Manitoba, Alberta, and Ontario. The workshop aimed to identify: (1) shared understandings of ACP, (2) barriers to respecting resident wishes, and (3) solutions to better respect resident wishes. Plenary and group sessions were recorded and thematic analysis was performed. We identified four themes: (1) differing provincial frameworks, (2) shared challenges, (3) knowledge products, and 4) ongoing ACP. Theme 2 had four subthemes: (i) lacking clarity on substitute decision maker (SDM) identity, (ii) lacking clarity on the SDM role, (iii) failing to share sufficient information when residents formulate care wishes, and (iv) failing to communicate during a health crisis. These results have informed the development of a standardized ACP intervention currently being evaluated in a randomized trial in three Canadian provinces.

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Section: Resultsmentioning

confidence: 99%

Applying the Knowledge-to-Action Framework to Engage Stakeholders and Solve Shared Challenges with Person-Centered Advance Care Planning in Long-Term Care Homes

et al. 2021

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“…Our results are confirmed by other large scale studies of skilled nursing facilities in the United States that found that previous hospitalizations were strong predictors for readmission within 30 days and 180 days of admission to LTC. (8,23,47) This risk factor is particularly notable, given that 43% individuals living with HF entered LTC from a hospital setting. Prior hospitalizations and admission to LTC from a hospital setting may reflect the complexities of the residents’ health status.…”

Section: Discussionmentioning

confidence: 99%

“…(17) Early identification and optimal management of HF in residents experiencing health instability can help prevent further exacerbations and thus maintain their functional capacity and quality of life, or alternatively, appropriate end-of-life measures can be put in place. (23)…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only two Canadian studies examined individual factors associated with hospitalizations among newly admitted residents with HF. (8,23) However, the authors of the first study sampled residents in three medium-sized urban centers in Southwestern Ontario, limiting the generalizability of the results at a provincial level. (8) A recent study in three Canadian provinces showed the importance of health instability and frailty as critical drivers of acute care transfers among newly admitted LTC residents.…”

Section: Introductionmentioning

confidence: 99%

“…(8) A recent study in three Canadian provinces showed the importance of health instability and frailty as critical drivers of acute care transfers among newly admitted LTC residents. (23) Secondly, information from surveys and medical chart audits is often used to examine the association between hospitalization and HF-management practices (e.g., treatment with angiotensin-converting enzyme (ACE) inhibitors or use of advanced directives). (8,24,25) There is value in using information derived from routinely collected clinical assessments that capture the resident care journey, from the point of admission to discharge from the LTC setting.…”

Section: Introductionmentioning

confidence: 99%

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Risk of Hospitalization in Long-Term Care Residents Living with Heart Failure: a Retrospective Cohort Study

et al. 2019

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BackgroundOlder adults living with heart failure (HF) in long-term care (LTC) experience frequent hospitalization. Using routinely available clinical information, we examined resident-level factors that precipitate hospitalization within 90 days of admission to LTC.MethodsThis was a retrospective cohort study of older adults diagnosed with HF, who were admitted to LTC in Ontario, Canada, between 2011 and 2013. Multivariate logistic regression models using generalized estimating equations were developed to determine predictors of hospitalization in residents with HF.ResultsEntry to LTC from a hospital was the strongest predictor of future hospitalization (OR: 8.1, 95% CI: 7.1–9.3), followed by a score of three or greater on the Changes in Health, End-stage Signs and Symptoms scale, a measure of moderate to severe medical instability (O.R 4.2, 95% CI: 3.1–5.9). Other variables that increased the likelihood of hospitalization included being flagged as a high risk for falls, two or more physician visits, and increased monitoring for acute medical illness within 14 days of admission.ConclusionOur findings highlight that health instability and transitions from acute to LTC will increase the likelihood of transitioning back into the hospital setting. The identified predisposing factors suggest the need for targeted prevention strategies for those in high-risk groups.

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Assessments of Heart Failure and Frailty-Related Health Instability Provide Complementary and Useful Information for Home-Care Planning and Prognosis

Heckman

Hirdes

Hébert

et al. 2021

Canadian Journal of Cardiology

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Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents With Heart Failure

Cited by 16 publications

References 30 publications

Applying the Knowledge-to-Action Framework to Engage Stakeholders and Solve Shared Challenges with Person-Centered Advance Care Planning in Long-Term Care Homes

Applying the Knowledge-to-Action Framework to Engage Stakeholders and Solve Shared Challenges with Person-Centered Advance Care Planning in Long-Term Care Homes

Risk of Hospitalization in Long-Term Care Residents Living with Heart Failure: a Retrospective Cohort Study

Assessments of Heart Failure and Frailty-Related Health Instability Provide Complementary and Useful Information for Home-Care Planning and Prognosis

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