Perspectives on Deprescribing in long-term care: qualitative findings from nurses, aides, residents, and proxies.

Background: Deprescribing initiatives in the long-term care (LTC) setting are often unsuccessful or not sustained. Prior research has considered how physicians and pharmacists feel about deprescribing, yet little is known about the perspectives of frontline nursing staff and residents. Our aim was to elicit perspectives from LTC nursing staff, patients, and proxies regarding their experiences and preferences for deprescribing in order to inform future deprescribing efforts in LTC.

Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis.

Unlabelled: Decisions on whether to use pharmacologic osteoporosis therapy in skilled nursing facility residents are complex and require shared decision-making. Residents, proxies, and staff desire individualized fracture risk estimates that consider advanced age, dementia, and mobility. They want options for reducing administration burden, monitoring instructions, and periodic reassessment of risk vs.

Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities.

Background And Objectives: Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation.

Research Design And Methods: Descriptive qualitative study using framework analysis applied to open-ended semistructured interviews (n = 28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework.

Lessons learned from frontline skilled nursing facility staff regarding COVID-19 vaccine hesitancy.

Background: Presently a median of 37.5% of the U.S.

Stemming the Tide of COVID-19 Infections in Massachusetts Nursing Homes.

Background/objectives: In April 2020, Massachusetts nursing homes (NHs) became a hotspot for COVID-19 infections and associated deaths. In response, Governor Charles Baker allocated $130 million in additional funding for 2 months contingent on compliance with a new set of care criteria including mandatory testing of all residents and staff, and a 28-point infection control checklist. We aimed to describe the Massachusetts effort and associated outcomes.

Engaging Stakeholders in the Design and Conduct of Embedded Pragmatic Clinical Trials for Alzheimer's Disease and Alzheimer's Disease-Related Dementias.

Embedded pragmatic clinical trials (ePCTs) of nondrug interventions for Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) are conducted in real-world clinical settings and designed to generate an evidence base to inform clinical and policy decisions about care for this vulnerable population. The ePCTs exist within a complex ecosystem of relationships between researchers, payors, policymakers, healthcare systems, direct care staff, advocacy groups, families, caregivers, and people living with dementia (PLWD). Because the rapid increase of the number of Americans with AD/ADRD outpaces curative treatments, there is an urgent need to mobilize the power of these relationships to improve dementia care and address a mounting public health crisis.

Association of a Communication Training Program With Use of Antipsychotics in Nursing Homes.

Importance: Off-label antipsychotic prescribing in nursing homes (NHs) is common and is associated with increased risk of mortality in older adults. Prior large-scale, controlled trials in the NH setting failed to show meaningful reductions in antipsychotic use.

Objective: To quantify the influence of a large-scale communication training program on NH antipsychotic use called OASIS.

The INTERACT Institute: Observations on Dissemination of the INTERACT Quality Improvement Program Using Certified INTERACT Trainers.

Unnecessary hospitalizations of vulnerable nursing home (NH) residents can lead to hospital-acquired conditions, morbidity, mortality, and excess health care expenditures. Previous research has shown that a substantial percentage of these hospitalizations are preventable. Interventions to reduce acute care transfers (INTERACT) is a quality improvement program that has been adopted by many NHs throughout the United States.

The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care.

Interventions to Reduce Acute Care Transfers (INTERACT) is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time.

Avoidability of hospital transfers of nursing home residents: perspectives of frontline staff.

Objectives: To describe nursing home (NH) staff perceptions of avoidability of hospital transfers of NH residents.

Design: Mixed methods qualitative and quantitative analysis of 1,347 quality improvement (QI) review tools completed by staff at 26 NHs and transcripts of conference calls.

Setting: Twenty-six NHs in three states participating in the Interventions to Reduce Acute Care Transfers (INTERACT II) QI project.

Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project.

A substantial proportion of hospitalizations of nursing home (NH) residents may be avoidable. Medicare payment reforms, such as bundled payments for episodes of care and value-based purchasing, will change incentives that favor hospitalization but could result in care quality problems if NHs lack the resources and training to identify and manage acute conditions proactively. Interventions to Reduce Acute Care Transfers (INTERACT) II is a quality improvement intervention that includes a set of tools and strategies designed to assist NH staff in early identification, assessment, communication, and documentation about changes in resident status.