Hanna T Webb1, Kristi M Lieb2, Timothy E Stump3, Kathleen T Unroe4, Jennifer L Carnahan5. 1. Indiana University School of Medicine, Indianapolis, IN, USA. 2. Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush VA Medical Center, Indianapolis, IN, USA. 3. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA. 4. Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, IU Center for Aging Research, Indianapolis, IN, USA. 5. Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, IU Center for Aging Research, Indianapolis, IN, USA; Roudebush VA Medical Center, Indianapolis, IN, USA. Electronic address: jenncarn@iupui.edu.
Abstract
OBJECTIVES: Potentially avoidable hospitalizations are harmful to nursing home residents. Despite extensive care transitions research, no studies have described transfers originating outside the nursing home (eg, visiting family members or at a dialysis center). This article describes 82 out-of-facility (community) transfers and compares them to transfers originating within the nursing home (direct transfers). DESIGN: Secondary data analysis with multivariable model for community transfer risk factors. SETTING AND PARTICIPANTS: Eighty-two community transfers and 1362 transfers originating in the nursing home, involving 870 residents enrolled in the OPTIMISTIC demonstration project between January 1, 2015, and June 30, 2016. METHODS: Transfers were compared using data from the Minimum Data Set and root cause analyses performed at time of transfer. Multivariable associations were assessed at the transfer level to define risk factors for community transfers. Project nurses collected data on community transfers to inform a root cause analysis. RESULTS: Residents with community transfers were younger (74.4 years vs 78.2 years), with lower prevalence of cognitive impairment (44.8% vs 70.3%) and higher rates of heart failure (38.7% vs 23.3%) than residents with direct transfers. Community transfers were more likely due to cardiovascular illness (31.2% vs 8.7%), whereas less likely to be for cognitive, behavioral, and psychiatric concerns (11.7% vs 22.7%). Nearly half (46%) of community transfers originated at dialysis centers. Residents transferred outside the nursing home were less likely to have documented limitations to care such as a do not resuscitate code status. Communication during community transfers was identified on root cause analyses as a potential area for improvement. CONCLUSIONS AND IMPLICATIONS: Community transfers were more likely to occur in younger residents with higher rates of cardiovascular disease and lower rates of cognitive impairment. Improved communication between nursing home staff and outside providers as well as more extensive advance care planning for residents with cardiovascular disease may reduce community transfers. Published by Elsevier Inc.
OBJECTIVES: Potentially avoidable hospitalizations are harmful to nursing home residents. Despite extensive care transitions research, no studies have described transfers originating outside the nursing home (eg, visiting family members or at a dialysis center). This article describes 82 out-of-facility (community) transfers and compares them to transfers originating within the nursing home (direct transfers). DESIGN: Secondary data analysis with multivariable model for community transfer risk factors. SETTING AND PARTICIPANTS: Eighty-two community transfers and 1362 transfers originating in the nursing home, involving 870 residents enrolled in the OPTIMISTIC demonstration project between January 1, 2015, and June 30, 2016. METHODS: Transfers were compared using data from the Minimum Data Set and root cause analyses performed at time of transfer. Multivariable associations were assessed at the transfer level to define risk factors for community transfers. Project nurses collected data on community transfers to inform a root cause analysis. RESULTS: Residents with community transfers were younger (74.4 years vs 78.2 years), with lower prevalence of cognitive impairment (44.8% vs 70.3%) and higher rates of heart failure (38.7% vs 23.3%) than residents with direct transfers. Community transfers were more likely due to cardiovascular illness (31.2% vs 8.7%), whereas less likely to be for cognitive, behavioral, and psychiatric concerns (11.7% vs 22.7%). Nearly half (46%) of community transfers originated at dialysis centers. Residents transferred outside the nursing home were less likely to have documented limitations to care such as a do not resuscitate code status. Communication during community transfers was identified on root cause analyses as a potential area for improvement. CONCLUSIONS AND IMPLICATIONS: Community transfers were more likely to occur in younger residents with higher rates of cardiovascular disease and lower rates of cognitive impairment. Improved communication between nursing home staff and outside providers as well as more extensive advance care planning for residents with cardiovascular disease may reduce community transfers. Published by Elsevier Inc.
Entities:
Keywords:
Hospital transfers; avoidable hospitalizations; long-term care; nursing home
Authors: Marilyn J Rantz; Lori Popejoy; Amy Vogelsmeier; Colleen Galambos; Greg Alexander; Marcia Flesner; Charles Crecelius; Bin Ge; Gregory Petroski Journal: J Am Med Dir Assoc Date: 2017-07-27 Impact factor: 4.669
Authors: Kathleen T Unroe; Jeffrey M Caterino; Timothy E Stump; Wanzhu Tu; Jennifer L Carnahan; Joshua R Vest; Greg A Sachs; Susan E Hickman Journal: J Am Geriatr Soc Date: 2020-07-06 Impact factor: 5.562