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Nursing home performance in a trial to reduce hospitalizations: Implications for future trials.

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Title: Nursing home performance in a trial to reduce hospitalizations: Implications for future trials.
Authors: Ouslander, Joseph G. (AUTHOR), Reyes, Bernardo (AUTHOR), Yang, Zhiyou (AUTHOR), Engstrom, Gabriella (AUTHOR), Tappen, Ruth (AUTHOR), Newman, David (AUTHOR), Huckfeldt, Peter J. (AUTHOR)
Source: Journal of the American Geriatrics Society. Aug2021, Vol. 69 Issue 8, p2316-2326. 11p.
Subjects: Evaluation of medical care, Medical quality control, Hospital emergency services, Patient readmissions, Nursing care facilities, Hospital admission & discharge, Human services programs, Hospital care, Quality assurance, Descriptive statistics, Root cause analysis, Working hours, Secondary analysis, Alternative education
Abstract: Background: Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care. Design: Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers. Participants: Seventy‐one NHs that completed the 12‐month trial Intervention: Implementation included distance‐learning strategies, involvement of a champion, regular submission of data on hospitalizations and root cause analyses of transfers, and training, feedback and support. Measurements: Primary outcomes included all‐cause and potentially avoidable hospitalizations and emergency department (ED) visits per 1000 NH resident days, and the percentage of residents readmitted in 30‐days. We compared multiple other variables that could influence effective program implementation in NHs in the highest versus lowest quartile of changes in the primary outcomes. Results: The 18 high‐performing NHs had significant reductions in hospitalization and ED visits, whereas the 18 NHs in the low‐performing group had increases. The difference in changes in each outcome varied between a reduction of 0.75 and 2.30 events relative to a NH with a census of 100; the absolute difference in 30‐day readmissions was 19%. None of the variables we examined reached significance after adjustment for multiple comparisons between the groups. There was no consistent pattern of differences in nonprofit status, nursing staffing, and quality ratings. Conclusion: Our experience and reviews of other NH trials suggest that key factors contributing to successful implementation QI programs in NHs remain unclear. To improve NH care, implementation trials should account for intervention fidelity and factors that have not been examined in detail, such as degree and nature of leadership support, financial and regulatory incentives, quality measures, resident and family perspectives, and the availability of onsite high‐quality medical care and support of the medical director. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Nursing home performance in a trial to reduce hospitalizations: Implications for future trials.
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  Data: <searchLink fieldCode="AR" term="%22Ouslander%2C+Joseph+G%2E%22">Ouslander, Joseph G.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Reyes%2C+Bernardo%22">Reyes, Bernardo</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Yang%2C+Zhiyou%22">Yang, Zhiyou</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Engstrom%2C+Gabriella%22">Engstrom, Gabriella</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tappen%2C+Ruth%22">Tappen, Ruth</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Newman%2C+David%22">Newman, David</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Huckfeldt%2C+Peter+J%2E%22">Huckfeldt, Peter J.</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+the+American+Geriatrics+Society%22">Journal of the American Geriatrics Society</searchLink>. Aug2021, Vol. 69 Issue 8, p2316-2326. 11p.
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  Data: <searchLink fieldCode="DE" term="%22Evaluation+of+medical+care%22">Evaluation of medical care</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+quality+control%22">Medical quality control</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+emergency+services%22">Hospital emergency services</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+readmissions%22">Patient readmissions</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+care+facilities%22">Nursing care facilities</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+admission+%26+discharge%22">Hospital admission & discharge</searchLink><br /><searchLink fieldCode="DE" term="%22Human+services+programs%22">Human services programs</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+care%22">Hospital care</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+assurance%22">Quality assurance</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Root+cause+analysis%22">Root cause analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Working+hours%22">Working hours</searchLink><br /><searchLink fieldCode="DE" term="%22Secondary+analysis%22">Secondary analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Alternative+education%22">Alternative education</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care. Design: Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers. Participants: Seventy‐one NHs that completed the 12‐month trial Intervention: Implementation included distance‐learning strategies, involvement of a champion, regular submission of data on hospitalizations and root cause analyses of transfers, and training, feedback and support. Measurements: Primary outcomes included all‐cause and potentially avoidable hospitalizations and emergency department (ED) visits per 1000 NH resident days, and the percentage of residents readmitted in 30‐days. We compared multiple other variables that could influence effective program implementation in NHs in the highest versus lowest quartile of changes in the primary outcomes. Results: The 18 high‐performing NHs had significant reductions in hospitalization and ED visits, whereas the 18 NHs in the low‐performing group had increases. The difference in changes in each outcome varied between a reduction of 0.75 and 2.30 events relative to a NH with a census of 100; the absolute difference in 30‐day readmissions was 19%. None of the variables we examined reached significance after adjustment for multiple comparisons between the groups. There was no consistent pattern of differences in nonprofit status, nursing staffing, and quality ratings. Conclusion: Our experience and reviews of other NH trials suggest that key factors contributing to successful implementation QI programs in NHs remain unclear. To improve NH care, implementation trials should account for intervention fidelity and factors that have not been examined in detail, such as degree and nature of leadership support, financial and regulatory incentives, quality measures, resident and family perspectives, and the availability of onsite high‐quality medical care and support of the medical director. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=151931879
RecordInfo BibRecord:
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      – Type: doi
        Value: 10.1111/jgs.17231
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 2316
    Subjects:
      – SubjectFull: Evaluation of medical care
        Type: general
      – SubjectFull: Medical quality control
        Type: general
      – SubjectFull: Hospital emergency services
        Type: general
      – SubjectFull: Patient readmissions
        Type: general
      – SubjectFull: Nursing care facilities
        Type: general
      – SubjectFull: Hospital admission & discharge
        Type: general
      – SubjectFull: Human services programs
        Type: general
      – SubjectFull: Hospital care
        Type: general
      – SubjectFull: Quality assurance
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Root cause analysis
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      – SubjectFull: Working hours
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      – SubjectFull: Secondary analysis
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      – SubjectFull: Alternative education
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      – TitleFull: Nursing home performance in a trial to reduce hospitalizations: Implications for future trials.
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              Text: Aug2021
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              Y: 2021
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