Volume Matters: Returning Home After Hip Fracture

Gozalo, Pedro; Leland, Natalie E.; Christian, Thomas; Mor, Vincent; Teno, Joan M.

doi:10.1111/jgs.13677

Cited by 39 publications

(38 citation statements)

References 41 publications

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“…One article focused on persons who had a common experience of a motor vehicle accident [ 33 ]. The majority of articles (30/36) included both males and females [ 26 , 28 , 30 – 37 , 39 – 59 ]. The main focus for most articles (21/36) was on resident profiles [ 26 , 28 , 32 , 33 , 35 , 36 , 40 – 47 , 51 , 53 – 57 , 60 ].…”

Section: Resultsmentioning

confidence: 99%

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Factors affecting residents transition from long term care facilities to the community: a scoping review

Freeman

Bishop

Spirgienė

et al. 2017

BMC Health Serv Res

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BackgroundLong-term care facilities (LTCFs) are often places where persons with complex health needs that cannot be met in a community setting, reside and are cared for until death. However, not all persons experience continuous declines in health and functioning. For some residents who experience improvement in personal abilities and increased independence, transition from the LTCF to the community may be an option. This scoping review aimed to synthetize the existing evidence regarding the transition process from discharge planning to intervention and evaluation of outcomes for residents transitioning from LTCFs to the community.MethodsThis review followed a five-stage scoping review framework to describe the current knowledge base related to transition from LTCFs to community based private dwellings as the location of the discharge (example: Person’s own home or shared private home with a family member, friend, or neighbour). Of the 4221 articles retrieved in the search of 6 databases, 36 articles met the criteria for inclusion in this review.ResultsThe majority of studies focussed on an older adult population (aged 65 years or greater), were conducted in the USA, and were limited to small geographic regions. There was a lack of consistency in terminology used to describe both the facilities as well as the transition process. Literature consisted of a broad array of study designs; sample sizes ranged from less than 10 to more than 500,000. Persons who were younger, married, female, received intense therapy, and who expressed a desire to transition to a community setting were more likely to transition out of a LTCF while those who exhibited cognitive impairment were less likely to transition out of a LTCF to the community.ConclusionsFindings highlight the heterogeneity and paucity of research examining transition of persons from LTCFs to the community. Overall, it remains unclear what best practices support the discharge planning and transition process and whether or not discharge from a LTCF to the community promotes the health, wellbeing, and quality of life of the persons. More research is needed in this area before we can start to confidently answer the research questions.

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Section: Resultsmentioning

confidence: 99%

“…Study sample sizes had a large range from less than 20 participants [ 31 ] to more than 500,000 participants in the largest sample [ 37 ]. Almost all studies were conducted in the US [ 27 – 30 , 33 – 39 , 41 , 42 , 44 , 45 , 47 – 55 , 57 – 61 ].…”

Section: Resultsmentioning

confidence: 99%

Factors affecting residents transition from long term care facilities to the community: a scoping review

Freeman

Bishop

Spirgienė

et al. 2017

BMC Health Serv Res

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“…13 The choice may have important implications for the patient’s likelihood of successful rehabilitation and return to his or her previous living situation. 14 …”

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confidence: 99%

Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals

et al. 2017

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Hospitals are now being held at least partly accountable for Medicare patients’ care after discharge, as a result of regulations and incentives imposed by the Affordable Care Act. However, little is known about how patients select a postacute care facility. We used a multiple case study approach to explore both how patients requiring postacute care decide which skilled nursing facility to select and the role of hospital staff members in this decision. We interviewed 138 staff members of sixteen hospitals and twenty-five skilled nursing facilities and 98 patients in fourteen of the skilled nursing facilities. Most patients described receiving only lists of skilled nursing facilities from hospital staff members, while staff members reported not sharing data about facilities’ quality with patients because they believed that patient choice regulations precluded them from doing so. Consequently, patients’ choices were rarely based on readily available quality data. Proposed changes to the Medicare conditions of participation for hospitals that pertain to discharge planning could rectify this problem. In addition, less strict interpretations of choice requirements would give hospitals flexibility in the discharge planning process and allow them to refer patients to higher-quality facilities.

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“…We examined whether the following outcomes varied according to obesity level: 30‐day hospital readmission, SNF or nursing home length of stay (LOS), successful discharge to community, and becoming a long‐stay resident. All outcomes were derived from Medicare claims and MDS assessments using the Residential History File methodology .…”

Section: Methodsmentioning

confidence: 99%

Effect of Obesity on Postacute Outcomes of Skilled Nursing Facility Residents with Hip Fracture

Kosar

Thomas

Gozalo

et al. 2018

J American Geriatrics Society

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OBJECTIVES To examine the effect of obesity (body mass index (BMI)≥ 30.0 kg/m2) on outcomes of older adults admitted to skilled nursing facilities (SNFs) for hip fracture postacute care (PAC). DESIGN Retrospective cohort study. SETTING U.S. Medicare- and Medicaid-certified SNFs from 2008 to 2015. PARTICIPANTS Medicare fee-for-service beneficiaries discharged to a SNF after hospitalization for hip fracture (N=586,683; n=82,768 (14.1%) meeting obesity criteria). Exclusion criteria were aged younger than 65, being underweight (BMI<18.5 kg/m2), and SNF use in the year prior to index hospitalization. MEASUREMENTS Residents were divided into 4 BMI categories according to cutoffs that the World Health Organization has established: not obese (BMI 18.5–29.9 kg/m2), mild obesity (BMI 30.0–34.9 kg/m2), moderate obesity (BMI 35.0–39.9 kg/m2), and severe obesity (BMI≥40.0 kg/m2). Robust Poisson regression was used to compare differences in average nursing facility length of stay (LOS) and rates of 30-day hospital readmission, successful discharge to community, and becoming a long-stay resident (LOS>100) according to obesity level. Models were adjusted for individual-level covariates and facility fixed effects. RESULTS Residents with mild (adjusted relative risk (aRR)=1.16, 95% CI=1.12–1.19), moderate (aRR=1.27, 95% CI=1.20–1.35), and severe (aRR=1.67, 95% CI=1.54–1.82) obesity were more likely to be readmitted within 30 days than those who were not obese. The average difference in LOS between residents without obesity and those with mild obesity was 2.6 days (95% CI=2.2–2.9 days); moderate obesity, 4.2 days (95% CI=3.7–5.1 days); and severe obesity, 7.0 days (95% CI=5.9–8.2 days). Residents with obesity were less likely to be successfully discharged and more likely to become long-stay nursing home residents. CONCLUSION Obesity was associated with worse outcomes in postacute SNF residents with hip fracture. Efforts to provide targeted care to residents with obesity may be essential to improve outcomes. Obesity may be an overlooked risk adjuster in quality-of-care measures and in payment reforms related to PAC for individuals with hip fracture.

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Volume Matters: Returning Home After Hip Fracture

Cited by 39 publications

References 41 publications

Factors affecting residents transition from long term care facilities to the community: a scoping review

Factors affecting residents transition from long term care facilities to the community: a scoping review

Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals

Effect of Obesity on Postacute Outcomes of Skilled Nursing Facility Residents with Hip Fracture

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