scholarly journals Evaluation of Risk-Adjusted Home Time After Acute Myocardial Infarction as a Novel Hospital-Level Performance Metric for Medicare Beneficiaries

Circulation ◽  
2020 ◽  
Vol 142 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Ambarish Pandey ◽  
Neil Keshvani ◽  
Mary S. Vaughan-Sarrazin ◽  
Yubo Gao ◽  
Saket Girotra
Keyword(s):  
Mortality Rate ◽  
Skilled Nursing Facility ◽  
Hospital Performance ◽  
Hospital Level ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Performance Metric ◽  
Level Performance ◽  
Medicare Claims Data

Background: The utility of 30-day risk-standardized readmission rate (RSRR) as a hospital performance metric has been a matter of debate. Home time is a patient-centered outcome measure that accounts for rehospitalization, mortality, and postdischarge care. We aim to characterize risk-adjusted 30-day home time in patients with acute myocardial infarction (AMI) as a hospital-level performance metric and to evaluate associations with 30-day RSRR, 30-day risk-standardized mortality rate (RSMR), and 1-year RSMR. Methods: The study included 984 612 patients with AMI hospitalization across 2379 hospitals between 2009 and 2015 derived from 100% Medicare claims data. Home time was defined as the number of days alive and spent outside of a hospital, skilled nursing facility, or intermediate-/long-term acute care facility 30 days after discharge. Correlations between hospital-level risk-adjusted 30-day home time and 30-day RSRR, 30-day RSMR, and 1-year RSMR were estimated with the Pearson correlation. Reclassification in hospital performance using 30-day home time versus 30-day RSRR and 30-day RSMR was also evaluated. Results: Median hospital-level risk-adjusted 30-day home time was 24.0 days (range, 15.3–29.0 days). Hospitals with higher home time were more commonly academic centers, had available cardiac surgery and rehabilitation services, and had higher AMI volume and percutaneous coronary intervention use during the AMI hospitalization. Of the mean 30-day home time days lost, 58% were to intermediate-/long-term care or skilled nursing facility stays (4.7 days), 30% to death (2.5 days), and 12% to readmission (1.0 days). Hospital-level risk-adjusted 30-day home time was inversely correlated with 30-day RSMR ( r =−0.22, P <0.0001) and 30-day RSRR (r =−0.25, P <0.0001). Patients admitted to hospitals with higher risk-adjusted 30-day home time had lower 30-day readmission (quartile 1 versus 4, 21% versus 17%), 30-day mortality rate (5% versus 3%), and 1-year mortality rate (18% versus 12%). Furthermore, 30-day home time reclassified hospital performance status in ≈30% of hospitals versus 30-day RSRR and 30-day RSMR. Conclusions: Thirty-day home time for patients with AMI can be assessed as a hospital-level performance metric with the use of Medicare claims data. It varies across hospitals, is associated with postdischarge readmission and mortality outcomes, and meaningfully reclassifies hospital performance compared with the 30-day RSRR and 30-day RSMR metrics.

scholarly journals Inpatient hospital performance is associated with post-discharge sepsis mortality

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Nicholas M. Mohr ◽  
Alexis M. Zebrowski ◽  
David F. Gaieski ◽  
David G. Buckler ◽  
Brendan G. Carr
Keyword(s):  
Skilled Nursing Facility ◽  
Hospital Performance ◽  
Hospital Inpatient ◽  
Inpatient Mortality ◽  
Sepsis Mortality ◽  
Post Discharge ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Inpatient Hospital ◽  
Sepsis Risk

Abstract Background Post-discharge deaths are common in patients hospitalized for sepsis, but the drivers of post-discharge deaths are unclear. The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes. Methods Retrospective cohort study of age-qualifying Medicare beneficiaries with sepsis hospitalization between January 2013 and December 2014. Hospital survivors were followed for 180-days post-discharge, and mortality, readmissions, and new admission to skilled nursing facility were measured. Inpatient hospital-specific sepsis risk-adjusted mortality ratio (observed: expected) was the primary exposure. Results A total of 830,721 patients in the cohort were hospitalized for sepsis, with inpatient mortality of 20% and 90-day mortality of 48%. Higher hospital-specific sepsis risk-adjusted mortality was associated with increased 90-day post-discharge mortality (aOR 1.03 per each 0.1 increase in hospital inpatient O:E ratio, 95% CI 1.03–1.04). Higher inpatient risk adjusted mortality was also associated with increased probability of being discharged to a nursing facility (aOR 1.03, 95% CI 1.02–1.03) and 90-day readmissions (aOR 1.03, 95% CI 1.02–1.03). Conclusions Hospitals with the highest risk-adjusted sepsis inpatient mortality also have higher post-discharge mortality and increased readmissions, suggesting that post-discharge complications are a modifiable risk that may be affected during inpatient care. Future work will seek to elucidate inpatient and healthcare practices that can reduce sepsis post-discharge complications.

scholarly journals HIV as a chronic disease: Implications for long-term care at an AIDS-dedicated skilled nursing facility

2000 ◽  
Vol 77 (2) ◽  
pp. 187-203 ◽  
Author(s):  
Peter A. Selwyn ◽  
Joseph L. Goulet ◽  
Susan Molde ◽  
Janet Constantino ◽  
Kristopher P. Fennie ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Long Term Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing

scholarly journals Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020

2020 ◽  
Vol 69 (13) ◽  
pp. 377-381 ◽  
Author(s):  
Anne Kimball ◽  
Kelly M. Hatfield ◽  
Melissa Arons ◽  
Allison James ◽  
Joanne Taylor ◽  
...  
Keyword(s):  
Long Term Care ◽  
Skilled Nursing Facility ◽  
King County ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing

scholarly journals Profound Autonomic Instability Complicated by Multiple Episodes of Cardiac Asystole and Refractory Bradycardia in a Patient with Anti-NMDA Encephalitis

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Stephanie R. Mehr ◽  
Roy C. Neeley ◽  
Melissa Wiley ◽  
Avinash B. Kumar
Keyword(s):  
Skilled Nursing Facility ◽  
Autoimmune Encephalitis ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Adults And Children ◽  
Central Hypoventilation ◽  
Children First

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) is autoimmune encephalitis primarily affecting young adults and children. First described about a decade ago, it frequently manifests as a syndrome that includes progressive behavioral changes, psychosis, central hypoventilation, seizures, and autonomic instability. Although cardiac arrhythmias often accompany anti-NMDARE, the need for long-term electrophysiological support is rare. We describe the case of NMDARE whose ICU course was complicated by progressively worsening episodes of tachyarrhythmia-bradyarrhythmia and episodes of asystole from which she was successfully resuscitated. Her life-threatening episodes of autonomic instability were successfully controlled only after the placement of a permanent pacemaker during her ICU stay. She made a clinical recovery and was discharged to a skilled nursing facility after a protracted hospital course.

The recreation therapist versus the certified activity director: Which professional receives fewer deficiencies in long-term care facilities?

2010 ◽  
Vol 9 (1) ◽  
pp. 9-14
Author(s):  
Timothy J. Legg, PhD, CNHA, GNP-BC, FACHCA ◽  
Sharon A. Nazarchuk, PhD, MHA, RN ◽  
Deborah Adelman, PhD, RN, CNS
Keyword(s):  
Long Term Care ◽  
Skilled Nursing Facility ◽  
Therapeutic Recreation ◽  
Professional Group ◽  
Recreation Therapy ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Care Facilities

The literature reports no studies that sought to determine which professional group (certified therapeutic recreation therapist versus certified activity director) achieves fewer survey deficiencies in the skilled nursing facility. This article will examine the scant and dated literature that is available to demonstrate which of these activity professionals has superior outcomes specific to the OBRA ’87 requirements. The article concludes with an articulation of the need for the discipline of recreation therapy to involve itself in outcomes research specific to which of the two disciplines better achieves the objectives of OBRA ’87.

Factors Associated with Short- Versus Long-Term Skilled Nursing Facility

1990 ◽  
Vol 38 (10) ◽  
pp. 1139-1144 ◽  
Author(s):  
Susan K. Bonar ◽  
Mary E. Tinetti ◽  
Mark Speechley ◽  
Leo M. Cooney
Keyword(s):  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Factors Associated

Recovery of Functional Mobility with a Long-Term Nursing Facility Patient Utilizing the Fascial Distortion Model: A Case Study

2021 ◽  
Vol 31 (3) ◽  
pp. 23-26
Author(s):  
Thomas Kincheloe ◽  
Christina Cherry ◽  
Francis Yoo
Keyword(s):  
Musculoskeletal Pain ◽  
Skilled Nursing Facility ◽  
Functional Mobility ◽  
Geriatric Population ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Distortion Model ◽  
Physical Gestures

Abstract Functional immobility has demonstrated a higher risk of all-cause mortality in geriatric population. It is noted that musculoskeletal pain is one major factor involved with geriatric functional immobility. The fascial distortion model (FDM) utilizes pathognomonic physical gestures to diagnose and treat musculoskeletal pain. In this case study, a long-term nursing facility patient with significantly prolonged wheelchair-to-bed transfer presented with several upper and lower extremity fascial distortions. After FDM treatment, the patient demonstrated a moderate return of functional mobility. This case presents the utility of FDM treatment in cases of decreased functional mobility due to musculoskeletal pain as well as treatment for patients in skilled nursing facility settings.

scholarly journals Regional Emergence of Candida auris in Chicago and Lessons Learned From Intensive Follow-up at 1 Ventilator-Capable Skilled Nursing Facility

2020 ◽  
Vol 71 (11) ◽  
pp. e718-e725 ◽  
Author(s):  
Massimo Pacilli ◽  
Janna L Kerins ◽  
Whitney J Clegg ◽  
Kelly A Walblay ◽  
Hira Adil ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Lessons Learned ◽  
Candida Auris ◽  
Public Health Response ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
High Acuity

Abstract Background Since the identification of the first 2 Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity, long-term healthcare facilities and present a case study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF-A). Methods We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris and infection-control (IC) assessments and provided ongoing support for IC improvements in Illinois acute- and long-term care facilities during August 2016–December 2018. During 2018, we initiated a focused effort at vSNF-A and conducted 7 C. auris PPSs; during 4 PPSs, we also performed CPO screening and environmental sampling. Results During August 2016–December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified the highest prevalence of C. auris colonization in vSNF settings (prevalence, 23–71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF-A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items. Conclusions High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control the spread of C. auris and CPOs.

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