Dataset Information

Quality Innovation Networks Share Varied Resources for Nursing Homes on Mostly User-Friendly Websites.

ABSTRACT:

Background/objective

Quality innovation networks' (QINs') support of nursing homes (NHs) is a national strategy to systematically improve the quality of care experienced by residents. QINs have been tasked with providing NHs with information, resources, tools, and training to assist in developing best practices and to support quality improvement efforts in infection prevention (including joining the National Healthcare Safety Network [NHSN]), avoid unnecessary hospitalizations, and increase use of hospice and palliative care. Our objective was to examine QIN online resources provided to NHs to support best practices and improvement efforts.

Design

An environmental scan was conducted.

Setting/measurement

Each QIN website was evaluated on (1) usability, (2) accessibility and prominence, (3) website design, (4) availability of training materials, (5) recency of update, (6) identification of key personnel, and (8) quality focus areas (ie, infection prevention, NHSN, antibiotic stewardship, reducing unnecessary or avoidable hospitalizations, and palliative and hospice care).

Results

QIN websites varied dramatically in design and resources offered to NHs as well as in the content and ease of finding information. Antibiotic stewardship and NHSN resources were widely available. Information (ie, fact sheets) on reducing avoidable hospitalizations was commonly available, while resources, such as tool kits, webinars, training, and contact information for personnel on reducing avoidable hospitalizations, were available to 23 states. Infection prevention resources were varied and limited to 34 states. Both palliative care and hospice resources were available through only a few QINs (13 states and 20 states, respectively).

Conclusions

Given that much of the information, tool kits, and resources are standardized and in the public domain, centralized resources with tailored or specialized links to unique local resources, like in-person trainings and state-specific contact information, could be more beneficial for NHs. J Am Geriatr Soc 67:2376-2381, 2019.

SUBMITTER: Quigley DD

PROVIDER: S-EPMC8173537 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Objective: Determine the accuracy of nursing home self-reported antipsychotic prescribing before and after implementation of a Medicare campaign to reduce use.Methods: Quasi-experimental study comparing trends in self-reported antipsychotic prescribing relative to claims-based prescribing. Setting is a nationwide sample of 11,912 facilities, 2011-2013. Participants are long-stay nursing home residents (n = 586,281) with prescribing data in Medicare Minimum Data Set 3.0 and Medicare Part D claims database. Verified with a pharmacy dispensing database. Main outcomes are the discrepancies in quarterly prevalence of antipsychotic prescribing between nursing home self-reports and claims data and the characteristics of facilities and residents where discrepancies were identified.Results: Nursing homes underreport their antipsychotic prescribing levels, on average, by 1 percentage point per quarter relative to Medicare Part D claims (0.013, 95% confidence interval (CI), 0.012-0.015; p<.001). After the Medicare campaign, the underreporting gap increased by another half a percentage point (0.004, 95% CI .003-.005; p = .012). Nursing home residents with dementia, Alzheimer's disease or bipolar disorders were at the highest risk for underreported antipsychotic prescribing before the campaign (Adjusted Odds ratio (AOR) 1.385, 95% CI: 1.330-1.444; AOR 1.234, 95% CI: 1.172-1.300; AOR 1.574, 95% CI: 1.444-1.716, respectively) and afterwards. After the launch of the Medicare campaign, underreported antipsychotic prescribing occurred most in for-profit nursing homes (AOR 1.088, 95% CI: 1.005-1.178) and facilities in the US South (AOR 1.262, 95% CI: 1.145-1.391). Agreement was high between claims and dispensing data (99.7%).Conclusion: Nursing homes did not identify up to 6,000 residents per calendar quarter as having received antipsychotics despite these prescriptions being paid by Medicare and dispensed by a pharmacy. Nursing home rates of antipsychotic prescribing from self-reported data may be biased.