Development of a Risk Tool to Support Discussions of Care for Older Adults Admitted to the ICU With Pneumonia.

Background: Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience.

Objective: To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course.

Design: Retrospective Electronic Health Record (EHR) review.

What happens to orders written for older primary care patients?

Background And Objectives: Data are limited on order completion errors in primary care. The objective of this study was to determine the incidence and nature of order completion errors among community-dwelling older adults.

Methods: This prospective, cross-sectional exploratory study was conducted at a suburban family medicine clinical teaching site.

Improving quality of NSAID prescribing by internal medicine trainees with an educational intervention.

Background: Prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) for older adults is a safety concern. Education innovations in postgraduate training designed to improve patient safety should comply with the Accreditation Council for Graduate Medical Education (ACGME).

Purpose: The objective is to evaluate a seven-component education program for internal medicine trainees designed to change prescribing practices while addressing ACGME competencies.

Health care provider evaluation of a substitutive model of hospital at home.

Objective: To evaluate Hospital at Home (HaH), a substitute for inpatient care, from the perspectives of participating providers.

Research Design: Multivariate general estimating equations regression analyses of a patient-specific survey of providers delivering HaH care in a prospective, nonrandomized clinical trial.

Subjects: Eleven physicians and 26 nurses employed in 3 Medicare-Advantage plans and 1 Veterans Administration medical center.

Comparison of functional outcomes associated with hospital at home care and traditional acute hospital care.

Objectives: To compare differences in the functional outcomes experienced by patients cared for in Hospital at Home (HaH) and traditional acute hospital care.

Design: Survey questionnaire of participants in a prospective nonrandomized clinical trial.

Setting: Three Medicare managed care health systems and a Veterans Affairs Medical Center.

Substitutive Hospital at Home for older persons: effects on costs.

Objective: To compare the cost of substitutive Hospital at Home care versus traditional inpatient care for older patients with community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, exacerbation of congestive heart failure, or cellulitis.

Study Design: Prospective nonrandomized clinical trial involving 455 community-dwelling older patients in 3 Medicare managed care health systems and at a Department of Veterans Affairs medical center.

Methods: Costs were analyzed across all patients, within each of the separate health systems, and by condition.

Effects of multidisciplinary Internet-based program on management of heart failure.

OBJECTIVES: To develop and test the effectiveness of an Internet-based self management program by multidisciplinary health care professionals for patients with heart failure (HF). METHODS: The comprehensive educational material for HF was created and posted on a website. A computer with Internet connection and computer training were provided first.

Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care.

Objectives: To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care.

Design: Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model.

Setting: Three Medicare managed care health systems and a Veterans Affairs Medical Center.

Assessment of safety attitudes in a skilled nursing facility.

Safety has not been well studied in the long-term care setting. This pilot study assesses staff attitudes regarding safety culture at one 250-bed skilled nursing facility. A valid and reliable Safety Attitudes Questionnaire (SAQ) was administered once to a sample of 51 employees.

Satisfaction with hospital at home care.

Objectives: To examine differences in satisfaction with acute care between patients who received treatment in a physician-led substitutive Hospital at Home program and those who received usual acute hospital care.

Design: Survey questionnaire of participants in prospective, nonrandomized clinical trial.

Setting: Three Medicare-managed care health systems and a Department of Veterans Affairs Medical Center.

Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients.

Background: Acutely ill older persons often experience adverse events when cared for in the acute care hospital.

Objective: To assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient's home in a hospital at home.

Design: Prospective quasi-experiment.

A comprehensive collaborative patient safety residency curriculum to address the ACGME core competencies.

Context: Patient safety currently receives only scant attention in most residency curricula. Safety is a subject that transcends the US Accreditation Council for Graduate Medical Education's 6 core competencies.

Objective: To design and implement a new patient safety curriculum in collaboration with the Schools of Nursing and Pharmacy, in such a way as to address all 6 competencies.

A multifactorial intervention to reduce prevalence of delirium and shorten hospital length of stay.

Objectives: To improve outcomes for cognitively impaired and delirious older adults.

Design: Pretest, posttest.

Setting: A university-affiliated hospital.

Correlates of behavioral disturbances and pattern of psychotropic medication use in five skilled nursing facilities.

There are several treatment options for behavioral disturbances (BDs) in dementia. However, the choice of a specific psychotropic agent is directed by personal preferences and local community practice patterns. We examined the relationship between common clusters of BDs and the use of different classes of psychotropic agents in our community.

Pneumonia versus aspiration pneumonitis in nursing home residents: diagnosis and management.

Objectives: To determine the frequency of aspiration pneumonitis in nursing home residents with an initial diagnosis of pneumonia and to compare the clinical characteristics, management, and outcome of aspiration pneumonitis with those of pneumonia.

Design: Retrospective chart review.

Setting: Hospital geriatric unit for nursing home residents.

Efficacy and safety of gatifloxacin in elderly outpatients with community-acquired pneumonia.

To evaluate the safety and efficacy of gatifloxacin in adults <65, 65 to 79, or > or =80 years old with community-acquired pneumonia, adult male and female outpatients from general community-based practices were enrolled in an open-label, multicenter, noncomparative study. Gatifloxacin 400 mg once daily was administered for seven to 14 days. Medical history, physical examination, signs and symptoms of infection, Gram stain and culture if specimen available, clinical response, and safety were determined.