Asymptomatic Spread of COVID-19 in 97 Patients at a Skilled Nursing Facility.
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SUBMITTER: Goldberg SA
PROVIDER: S-EPMC7256505 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesTo derive a risk prediction score for potential adverse outcomes in older adults transitioning to a skilled nursing facility (SNF) from the hospital.DesignRetrospective analysis.SettingMedicare Current Beneficiary Survey (2003-11).ParticipantsPreviously community-dwelling Medicare beneficiaries who were hospitalized and discharged to SNF for postacute care (N=2,043).MeasurementsRisk factors included demographic characteristics, comorbidities, health status, hospital length of stay, prior SNF stays, SNF size and ownership, treatments received, physical function, and active signs or symptoms at time of SNF admission. The primary outcome was a composite of undesirable outcomes from the patient perspective, including hospital readmission during the SNF stay, long SNF stay (≥100 days), and death during the SNF stay.ResultsOf the 2,043 previously community-dwelling beneficiaries hospitalized and discharged to a SNF for post-acute care, 589 (28.8%) experienced one of the three outcomes, with readmission (19.4%) most common, followed by mortality (10.5%) and long SNF stay (3.5%). A risk score including 5 factors (Barthel Index, Charlson-Deyo comorbidity score, hospital length of stay, heart failure diagnosis, presence of an indwelling catheter) demonstrated very good discrimination (C-statistic=0.75), accuracy (Brier score=0.17), and calibration for observed and expected events.ConclusionOlder adults frequently experience potentially adverse outcomes in transitions to a SNF from the hospital; this novel score could be used to better match resources with patient risk.
| S-EPMC5992035 | biostudies-literature
Project description: Not available
| S-EPMC8447421 | biostudies-literature
Project description:Failure to reconcile medications across transitions in care is an important source of harm to patients. Little is known about medication discrepancies upon admission to skilled nursing facilities (SNFs).To describe the prevalence of, type of medications involved in, and sources of medication discrepancies upon admission to the SNF setting.Cross-sectional study.Patients admitted to SNF for subacute care.Number of medication discrepancies, defined as unexplained differences among documented medication regimens, including the hospital discharge summary, patient care referral form and SNF admission orders.Of 2,319 medications reviewed on admission, 495 (21.3%) had a medication discrepancy. At least one medication discrepancy was identified in 142 of 199 (71.4%) SNF admissions. The discharge summary and the patient care referral form did not match in 104 of 199 (52.3%) SNF admissions. Disagreement between the discharge summary and the patient care referral form accounted for 62.0% (n = 307) of all medication discrepancies. Cardiovascular agents, opioid analgesics, neuropsychiatric agents, hypoglycemics, antibiotics, and anticoagulants accounted for over 50% of all discrepant medications.Medication discrepancies occurred in almost three out of four SNF admissions and accounted for one in five medications prescribed on admission. The discharge summary and the patient care referral forms from the discharging institution are often in disagreement. Our study findings underscore the importance of current efforts to improve the quality of inter-institutional communication.
| S-EPMC2669872 | biostudies-other
Project description:BACKGROUND:Older adults that transfer from skilled nursing facilities (SNF) to home have significant risk for poor outcomes. Transitional care of SNF patients (i.e., time-limited services to ensure coordination and continuity of care) is poorly understood. OBJECTIVE:To determine the feasibility and relevance of the Connect-Home transitional care intervention, and to compare preparedness for discharge between comparison and intervention dyads. DESIGN:A non-randomized, historically controlled design-enrolling dyads of SNF patients and their family caregivers. SETTING:Three SNFs in the Southeastern United States. PARTICIPANTS:Intervention dyads received Connect-Home; comparison dyads received usual discharge planning. Of 173 recruited dyads, 145 transferred to home, and 133 completed surveys within 3 days of discharge. INTERVENTION:The Connect-Home intervention consisted of tools and training for existing SNF staff to deliver transitional care of patient and caregiver dyads. MEASUREMENTS:Feasibility was assessed with a chart review. Relevance was assessed with a survey of staff experiences using the intervention. Preparedness for discharge, the primary outcome, was assessed with Care-Transitions Measure-15 (CTM-15). RESULTS:The intervention was feasible and relevant to SNF staff (i.e., 96.9% of staff recommended intervention use in the future). Intervention dyads, compared to comparison dyads, were more prepared for discharge (CTM-15 score 74.7 vs 65.3, mean ratio 1.16, 95% CI: 1.08, 1.24). CONCLUSION:Connect-Home is a promising transitional care intervention for older patients discharged from SNF care. The next step will be to test the intervention using a cluster randomized trial, with patient outcomes including re-hospitalization.
| S-EPMC5666578 | biostudies-literature
Project description:BackgroundAmong patients in skilled nursing facilities for post-acute care, increased registered nurse, total licensed staff, and nurse assistant staffing is associated with a decreased rate of hospital transfer for selected diagnoses. However, the cost-effectiveness of increasing staffing to recommended levels is unknown.MethodsUsing a Markov cohort simulation, we estimated the incremental cost-effectiveness of recommended staffing versus median staffing in patients admitted to skilled nursing facilities for post-acute care. The outcomes of interest were life expectancy, quality-adjusted life expectancy, and incremental cost-effectiveness.ResultsThe incremental cost-effectiveness of recommended staffing versus median staffing was $321,000 per discounted quality-adjusted life year gained. One-way sensitivity analyses demonstrated that the cost-effectiveness ratio was most sensitive to the likelihood of acute hospitalization from the nursing home. The cost-effectiveness ratio was also sensitive to the rapidity with which patients in the recommended staffing scenario recovered health-related quality of life as compared to the median staffing scenario. The cost-effectiveness ratio was not sensitive to other parameters.ConclusionAdopting recommended nurse staffing for short-stay nursing home patients cannot be justified on the basis of decreased hospital transfer rates alone, except in facilities with high baseline hospital transfer rates. Increasing nurse staffing would be justified if health-related quality of life of nursing home patients improved substantially from greater nurse and nurse assistant presence.
| S-EPMC1145183 | biostudies-literature
Project description:To analyze the effect of states' Medicaid bed-hold policies on the 30-day rehospitalization of Medicare postacute skilled nursing facility (SNF) residents.Minimum data set assessments were merged with Medicare claims and eligibility files for all first-time SNF admissions (N = 3,322,088) over the period 2000 through 2005; states' Medicaid bed-hold policies were obtained via survey.Regression specification incorporating facility fixed effects to examine changes in Medicaid bed-hold policies on the likelihood of a 30-day SNF rehospitalization.Using a continuous measure of bed-hold generosity, state Medicaid bed-hold was positively related to Medicare SNF rehospitalization. Specifically, the introduction of a bed-hold policy with average generosity increases Medicare rehospitalizations by 1.8 percent, representing roughly 12,000 SNF rehospitalizations at a cost to Medicare of approximately U.S.$100 million over our study period.Although facilities do not receive a Medicaid bed-hold payment for Medicare SNF stays, we found that the adoption of more generous policies led to greater SNF rehospitalizations. This type of spillover is largely ignored in current discussions of Medicare payment reforms such as bundled payment. Neither Medicare nor Medicaid has an incentive to internalize the risks and benefits of its actions as they affect the other.
| S-EPMC3029851 | biostudies-literature
Project description:BACKGROUND AND PURPOSE:Inability to obtain sufficient gains in function during a skilled nursing facility (SNF) stay impacts patients' functional trajectories and susceptibility to adverse events. The purpose of this study was to identify predictors of functional change in patients temporarily residing in an SNF following hospitalization. METHODS:One hundred forty patients admitted to a single SNF from the hospital who had both evaluation and discharge measures of physical function documented were included. Data from the Minimum Data Set 3.0 and electronic medical record were extracted to record clinical and demographic characteristics. The Short Physical Performance Battery (SPPB) was administered by rehabilitation therapists at evaluation and discharge. The SPPB consists of balance tests, gait speed, and a timed 5-time sit-to-stand test. RESULTS AND DISCUSSION:The Patient Health Questionnaire (PHQ-9) Screening Tool for Depression was the only significant predictor of change in gait speed over an SNF stay. Eighty-seven percent of patients achieved a clinically meaningful change in the SPPB of 1 point or greater from evaluation to discharge, with 78% demonstrating a clinically meaningful change of 0.1 m/s or greater on gait speed. However, 69% of patients demonstrated SPPB scores of 6 points or less and 57% ambulated less than 0.65 m/s at the time of discharge from the SNF, which indicates severe disability. CONCLUSIONS:Poor physical function following an SNF stay places older adult at significant risk for adverse events including rehospitalization, future disability, and institutionalization. Understanding the predictors of functional change from evaluation to discharge may direct efforts toward developing innovative and effective interventions to improve function trajectories for older adults following an acute hospitalization.
| S-EPMC5740023 | biostudies-literature
Project description:ObjectiveTo describe the frequency and timing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody detection in a convenience sample of skilled nursing facility (SNF) residents with and without confirmed SARS-CoV-2 infection.DesignRetrospective analysis of SNF electronic health records.SettingQualitative SARS-CoV-2 antibody test results were available from 81 SNFs in 16 states.ParticipantsSix hundred and sixty nine SNF residents who underwent both polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2.MeasurementsPresence of SARS-CoV-2 antibodies following the first positive PCR test for confirmed cases, or first PCR test for non-cases.ResultsAmong 397 residents with PCR-confirmed infection, antibodies were detected in 4 of 7 (57.1%) tested within 7-14 days of their first positive PCR test; in 44 of 47 (93.6%) tested within 15-30 days; in 182 of 219 (83.1%) tested within 31-60 days; and in 110 of 124 (88.7%) tested after 60 days. Among 272 PCR negative residents, antibodies were detected in 2 of 9 (22.2%) tested within 7-14 days of their first PCR test; in 41 of 81 (50.6%) tested within 15-30 days; in 65 of 148 (43.9%) tested within 31-60 days; and in 9 of 34 (26.5%) tested after 60 days. No significant differences in baseline resident characteristics or symptoms were observed between those with versus without antibodies.ConclusionsThese findings suggest that vulnerable older adults can mount an antibody response to SARS-CoV-2, and that antibodies are most likely to be detected within 15-30 days of diagnosis. That antibodies were detected in a large proportion of residents with no confirmed SARS-CoV-2 infection highlights the complexity of identifying who is infected in real time. Frequent surveillance and diagnostic testing based on low thresholds of clinical suspicion for symptoms and/or exposure will remain critical to inform strategies designed to mitigate outbreaks in SNFs while community SARS-CoV-2 prevalence remains high.
| S-EPMC8013911 | biostudies-literature
Project description:BackgroundThere is a need to adopt evidence-based approaches to discharge planning in the skilled nursing facility (SNF) short stay population.PurposeThis article describes implementation of the Reengineered Discharge (RED) process in SNFs and makes recommendations for its future implementation.MethodsThe methods included a pre- and postanalysis of an 18-month RED implementation with a contemporaneous comparison of 4 Midwestern SNFs randomly assigned to 2 different RED implementation strategies. The Standard facilities received less implementation than Enhanced facilities.ResultsStandard SNFs made more improvements and were more satisfied with the improved process than Enhanced SNFs. Field notes revealed that corporate willingness to make process changes impacted the Standard group's capacity for change; both groups were heavily influenced by external forces, and turnover was an impediment to RED implementation.ConclusionThis research revealed that discharge processes are similar across settings and that evidence-based programs such as RED can be adapted to the SNF setting.
| S-EPMC7008493 | biostudies-literature
Project description:ObjectiveThis research aimed to understand the experiences of patients transitioning from hospitals to skilled nursing facilities (SNFs) by eliciting views from patients and hospital and skilled nursing facility staff.DesignWe conducted semi-structured interviews with hospital and skilled nursing facility staff and skilled nursing facility patients and their family members in an attempt to understand transitions between hospital and SNF. These interviews focused on all aspects of the discharge planning and nursing facility placement processes including who is involved, how decisions are made, patients' experiences, hospital-SNF communication, and the presence of programs to improve the transition process.ParticipantsParticipants were 138 staff in 16 hospitals and 25 SNFs in 8 markets across the country, and 98 newly admitted, previously community-dwelling SNF patients and/or their family members in five of those markets.ApproachInterviews were qualitatively analyzed to identify overarching themes.Key resultsPatients reported they felt rushed in making their SNF decisions, did not feel they were appropriately prepared for the hospital-SNF transition or educated about their post-acute needs, and experienced transitions that felt chaotic, with complications they associated with timing and medications. Hospital and SNF staff expressed similar opinions, stating that transitions were rushed, there were problems with the timing of the discharge, with information transfer and medication reconciliation, and that patients were not appropriately prepared for the transition. Staff at some facilities reported programs designed to address these problems, but the efficacy of these programs is unknown.ConclusionsResults indicate problematic transitions stemming from insufficient care coordination and failure to appropriately prepare patients and their family members. Previous research suggests that problematic or hurried transitions from hospital to SNF are associated with medication errors and unnecessary rehospitalizations. Interventions to improve transitions from hospital to SNF that include a focus on patients and families are needed.
| S-EPMC6318170 | biostudies-literature