Stephen E Gordon1, Alyssa B Dufour2, Sara M Monti3, Melissa L P Mattison4, Angela G Catic3, Cindy P Thomas5, Lewis A Lipsitz2. 1. Beth Israel Deaconess Medical Center, Boston, MA; Hebrew SeniorLife, Roslindale, MA; Harvard Medical School, Boston, MA. Electronic address: stephengordon@hsl.harvard.edu. 2. Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA; Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA. 3. Beth Israel Deaconess Medical Center, Boston, MA. 4. Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA. 5. Schneider Institutes for Health Policy, Brandeis University, Waltham, MA.
Abstract
OBJECTIVES: US nursing homes care for increasing numbers of residents with dementia and associated behavioral problems. They often lack access to specialized clinical expertise relevant to managing these problems. Project ECHO-AGE provides this expertise through videoconference sessions between frontline nursing home staff and clinical experts at an academic medical center. We hypothesized that ECHO-AGE would result in less use of physical and chemical restraints and other quality improvements in participating facilities. DESIGN: A 2:1 matched-cohort study comparing quality of care outcomes between ECHO-AGE facilities and matched controls for the period July 2012 to December 2013. SETTING: Eleven nursing homes in Massachusetts and Maine. PARTICIPANTS: Nursing home staff and a hospital-based team of geriatrician, geropsychiatrist, and neurologist discussed anonymized residents with dementia. INTERVENTION: Biweekly online video case discussions and brief didactic sessions focused on the management of dementia and behavior disorders. MEASUREMENTS: The primary outcome variables were percentage of residents receiving antipsychotic medications and the percentage of residents who were physically restrained. Secondary outcomes included 9 other quality of care metrics from MDS 3.0. RESULTS: Residents in ECHO-AGE facilities were 75% less likely to be physically restrained compared with residents in control facilities over the 18-month intervention period (OR = 0.25, P = .05). Residents in ECHO-AGE facilities were 17% less likely to be prescribed antipsychotic medication compared with residents in control facilities (OR = 0.83, P = .07). Other outcomes were not significantly different. CONCLUSION: Preliminary evidence suggests that participation in Project ECHO-AGE reduces rates of physical restraint use and may reduce rates of antipsychotic use among long-term nursing home residents.
OBJECTIVES: US nursing homes care for increasing numbers of residents with dementia and associated behavioral problems. They often lack access to specialized clinical expertise relevant to managing these problems. Project ECHO-AGE provides this expertise through videoconference sessions between frontline nursing home staff and clinical experts at an academic medical center. We hypothesized that ECHO-AGE would result in less use of physical and chemical restraints and other quality improvements in participating facilities. DESIGN: A 2:1 matched-cohort study comparing quality of care outcomes between ECHO-AGE facilities and matched controls for the period July 2012 to December 2013. SETTING: Eleven nursing homes in Massachusetts and Maine. PARTICIPANTS: Nursing home staff and a hospital-based team of geriatrician, geropsychiatrist, and neurologist discussed anonymized residents with dementia. INTERVENTION: Biweekly online video case discussions and brief didactic sessions focused on the management of dementia and behavior disorders. MEASUREMENTS: The primary outcome variables were percentage of residents receiving antipsychotic medications and the percentage of residents who were physically restrained. Secondary outcomes included 9 other quality of care metrics from MDS 3.0. RESULTS: Residents in ECHO-AGE facilities were 75% less likely to be physically restrained compared with residents in control facilities over the 18-month intervention period (OR = 0.25, P = .05). Residents in ECHO-AGE facilities were 17% less likely to be prescribed antipsychotic medication compared with residents in control facilities (OR = 0.83, P = .07). Other outcomes were not significantly different. CONCLUSION: Preliminary evidence suggests that participation in Project ECHO-AGE reduces rates of physical restraint use and may reduce rates of antipsychotic use among long-term nursing home residents.
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