An Interdisciplinary Videoconference to Improve Transitions of Care and Reduce Readmission, Cost, and Post-Acute Length of Stay in a Teaching and Community Hospital.

Objectives: Coordination of care across health care settings is needed to ensure safe patient transfers. We examined the effects of the ECHO-Care Transitions program (ECHO-CT) on readmissions, skilled nursing facility (SNF) length of stay (LOS), and costs.

Design: This is a prospective cohort study evaluating the ECHO-CT program.

Home-delivered meals for people with dementia: Which model delays nursing home placement? - Protocol for a feasibility pilot.

Background: Home-delivered meals promote food security, socialization, and independence among homebound older adults. However, it is unclear which of the two predominant modes of meal delivery, daily-delivered vs. drop-shipped, frozen meals, promotes community living for homebound older adults with dementia.

The Benefits of Culture Change in Nursing Homes-Obtaining Nationally Representative Evidence.

Objective: Despite face validity and regulatory support, empirical evidence of the benefit of culture change practices in nursing homes (NHs) has been inconclusive. We used rigorous methods and large resident-level cohorts to determine whether NH increases in culture change practice adoption in the domains of environment, staff empowerment, and resident-centered care are associated with improved resident-level quality outcomes.

Design: We linked national panel 2009-2011 and 2016-2017 survey data to Minimum Data Set assessment data to test the impact of increases in each of the culture change domains on resident quality outcomes.

Using Healthcare Data in Embedded Pragmatic Clinical Trials among People Living with Dementia and Their Caregivers: State of the Art.

Embedded pragmatic clinical trials (ePCTs) are embedded in healthcare systems as well as their data environments. For people living with dementia (PLWD), settings of care can be different from the general population and involve additional people whose information is also important. The ePCT designs have the opportunity to leverage data that becomes available through the normal delivery of care.

Ethical and Regulatory Issues for Embedded Pragmatic Trials Involving People Living with Dementia.

Embedded pragmatic clinical trials (ePCTs) present an opportunity to improve care for people living with dementia (PLWD) and their care partners, but they also generate a complex constellation of ethical and regulatory challenges. These challenges begin with participant identification. Interventions may be delivered in ways that make it difficult to identify who is a human subject and therefore who needs ethical and regulatory protections.

The Changing Adoption of Culture Change Practices in U.S. Nursing Homes.

Background And Objectives: The study aimed to: (i) describe whether culture change (CC) practice implementation related to physical environment, resident-centered care, and staff empowerment increased within the same nursing homes (NHs) over time; and (ii) identify factors associated with observed increases.

Research Design And Methods: This was a nationally representative panel study of 1,584 U.S.

Nursing Home Culture Change Practices and Survey Deficiencies: A National Longitudinal Panel Study.

Background And Objectives: Nursing home (NH) adoption of culture change practices has substantially increased in recent decades. We examined how increasing adoption of culture change practices affected the prevalence of health, severe health, and quality of life (QoL) deficiencies.

Research Design And Methods: Novel data on culture change practice adoption from a nationally representative NH panel (N = 1,585) surveyed in 2009/2010 and 2016/2017 were used to calculate change in practice adoption scores in 3 culture change domains (resident-centered care, staff empowerment, physical environment).

Leadership, Staff Empowerment, and the Retention of Nursing Assistants: Findings From a Survey of U.S. Nursing Homes.

Objectives: We examined the relationship between nursing assistant (NA) retention and a measure capturing nursing home leadership and staff empowerment.

Design: Cross-sectional study using nationally representative survey data.

Setting And Participants: Data from the Nursing Home Culture Change 2016-2017 Survey with nursing home administrator respondents (N = 1386) were merged with facility-level indicators.

End-of-Life Culture Change Practices in U.S. Nursing Homes in 2016/2017.

Context: The nursing home (NH) culture change (CC) movement, which emphasizes person-centered care, is particularly relevant to meeting the unique needs of residents near the end of life.

Objectives: We aimed to evaluate the NH-reported adoption of person-centered end-of-life culture change (EOL-CC) practices and identify NH characteristics associated with greater adoption.

Methods: We used NH and state policy data for 1358 NHs completing a nationally representative 2016/17 NH Culture Change Survey.

The Prevalence of Culture Change Practice in US Nursing Homes: Findings From a 2016/2017 Nationwide Survey.

Background And Objectives: Given the dynamic nursing home (NH) industry and evolving regulatory environment, depiction of contemporary NH culture-change (person/resident-centered) care practice is of interest. Thus, we aimed to portray the 2016/2017 prevalence of NH culture change-related processes and structures and to identify factors associated with greater practice prevalence.

Research Design And Methods: We administered a nationwide survey to 2142 NH Administrators at NHs previously responding to a 2009/2010 survey.

Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team.

Objective: To examine the association between reliance on VA outpatient care and hospital admissions among Medicare-eligible Veterans enrolled in the Homeless Patient Aligned Care Team (H-PACT).

Data Sources/study Setting: Registry of H-PACT enrollees linked to VA and Medicare utilization data for 2013.

Study Design: After assigning Veterans to two groups according to whether they received >90 percent of outpatient care in VA (higher reliance) or <90 percent of outpatient care in VA (lower reliance), generalized linear models with inverse probability of treatment weights were used to estimate the association of reliance with Medicare and VA-financed hospital admissions.

Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015.

Importance: End-of-life care costs are high and decedents often experience poor quality of care. Numerous factors influence changes in site of death, health care transitions, and burdensome patterns of care.

Objective: To describe changes in site of death and patterns of care among Medicare decedents.

Untapped Potential: Using the HRS-Medicare-Linked Files to Study the Changing Nursing Home Population.

Background: Nursing home (NH) care in the United States now includes many short-term admissions to skilled nursing facilities (SNFs) for postacute care.

Objective: To demonstrate the potential of the Health and Retirement Study (HRS) linked to administrative data to study this group.

Research Design: Descriptive retrospective panel study.

Palliative Care Consults in U.S. Nursing Homes: Not Just for the Dying.

Background: Little is known about nursing home (NH) residents who receive palliative care (PC) consults in the United States.

Objective: Separately by short versus long (≥90 days) stays, to describe NH residents with PC consults compared to a prevalent NH sample.

Design: Descriptive longitudinal study.

Specialty Palliative Care Consultations for Nursing Home Residents With Dementia.

Context: U.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice.

Palliative Care Consultations in Nursing Homes and End-of-Life Hospitalizations.

Context: Although specialty palliative care in hospital and outpatient settings is associated with lower acute care use, its impact in U.S. nursing homes (NHs) is unknown.

Palliative Care Consultations in Nursing Homes and Reductions in Acute Care Use and Potentially Burdensome End-of-Life Transitions.

Objectives: To evaluate how receipt and timing of nursing home (NH) palliative care consultations (primarily by nurse practitioners with palliative care expertise) are associated with end-of-life care transitions and acute care use DESIGN: Propensity score-matched retrospective cohort study.

Setting: Forty-six NHs in two states.

Participants: Nursing home residents who died from 2006 to 2010 stratified according to days between initial consultation and death (≤7, 8-30, 31-60, 61-180).

Physicians in nursing homes: effectiveness of physician accountability and communication.

Objectives: The objective of this study was to develop a measure of the perceptions of nursing home (NH) directors of nursing (DONs) on the adequacy of physician care and to examine its variation as well as its construct validity.

Design: A nationwide cross-sectional study with primary data collection.

Setting: A total of 2043 NHs surveyed between August 2009 and April 2011.

End-of-Life Care in Nursing Homes with Greater versus Less Palliative Care Knowledge and Practice.

Background: Many older adults in nursing homes (NHs) lack palliative care (PC) access; but little is known about whether access to PC knowledge and practice (beyond hospice) impacts residents' care.

Objective: The study objective was to evaluate how differing levels of NH PC knowledge and practice are associated with residents' end-of-life health care use.

Methods: In 2009/10 we surveyed a stratified random sample of U.

Sensitivity and specificity of the Minimum Data Set 3.0 discharge data relative to Medicare claims.

Objective: The objective of this study was to determine whether the Minimum Data Set (MDS) 3.0 discharge record accurately identifies hospitalizations and deaths of nursing home residents.

Design: We merged date of death from Medicare enrollment data and hospital inpatient claims with MDS discharge records to check whether the same information can be verified from both the sources.

Does the introduction of nursing home culture change practices improve quality?

Objectives: To understand whether nursing home (NH) introduction of culture change practices is associated with improved quality.

Design: NH-level panel study using multivariate fixed-effects statistical modeling to estimate the effect of culture change introduction on quality outcomes.

Setting: Eight hundred twenty-four U.