Association between discontinuity in clinicians and outcomes of nursing home residents.

Little is known about the impact of clinician discontinuity on quality of care for nursing home residents. We examined the association between clinician discontinuity and outcomes of residents with long-term care stays up to 3 years using claims for a national 20% sample of Medicare fee-for-service beneficiaries from 2014 through 2019. We used an event study analysis that accounted for staggered treatment timing.

Impact of Extreme Weather Events on Health Outcomes of Nursing Home Residents Receiving Post-Acute Care and Long-Term Care: A Scoping Review.

Objectives: To systematically examine the evidence of the association between extreme weather events (EWEs) and adverse health outcomes among short-stay patients undergoing post-acute care (PAC) and long-stay residents in nursing homes (NHs).

Design: This is a scoping review. The findings were reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews checklist.

Clinicians Who Practice Primarily in Nursing Homes and the Quality of End-of-Life Care Among Residents.

Importance: Clinician specialization in the care of nursing home (NH) residents or patients in skilled nursing facilities (SNFs) has become increasingly common. It is not known whether clinicians focused on NH care, often referred to as SNFists (ie, physicians, nurse practitioners, and physician assistants concentrating their practice in the NH or SNF setting), are associated with a reduced likelihood of burdensome transitions in the last 90 days of life for residents, which are a marker of poor-quality end-of-life (EOL) care.

Objective: To quantify the association between receipt of care from an SNFist and quality of EOL care for NH residents.

Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies.

Importance: Private equity firms and publicly traded companies have been acquiring US hospice agencies; an estimated 16% of US hospice agencies are owned by private equity (PE) firms or publicly traded companies (PTC).

Objective: To examine the association of PE and PTC acquisitions of hospices with Medicare patients' site of care and clinical diagnoses.

Design, Setting, And Participants: This cohort study of US hospice agencies used a novel national database of acquisitions merged with the Medicare Post-Acute Care and Hospice Public Use File for 2013 to 2020.

Physician Turnover in the United States.

Background: Medical groups, health systems, and professional associations are concerned about potential increases in physician turnover, which may affect patient access and quality of care.

Objective: To examine whether turnover has changed over time and whether it is higher for certain types of physicians or practice settings.

Design: The authors developed a novel method using 100% of traditional Medicare billing to create national estimates of turnover.

Perspectives of Physicians with Experience in Nursing Home Care on Telehealth Use During the COVID-19 Public Health Emergency.

Background: Despite expanded access to telehealth services for Medicare beneficiaries in nursing homes (NHs) during the COVID-19 public health emergency, information on physicians' perspectives on the feasibility and challenges of telehealth provision for NH residents is lacking.

Objective: To examine physicians' perspectives on the appropriateness and challenges of providing telehealth in NHs.

Participants: Medical directors or attending physicians in NHs.

The Role Of Real Estate Investment Trusts In Staffing US Nursing Homes.

In 2021 real estate investment trusts (REITs) held investments in 1,806 US nursing homes. REITs are for-profit public or private corporations that invest in income-producing properties. We created a novel database of REIT investments in US nursing homes, merged it with Medicare cost report data (2013-19), and used a difference-in-differences approach within an event study framework to compare staffing before and after a nursing home received REIT investment with staffing in for-profit nursing homes that did not receive REIT investment.

The Association of Teamlets and Teams with Physician Burnout and Patient Outcomes.

Background: Primary care "teamlets" in which a staff member and physician consistently work together might provide a simple, cost-effective way to improve care, with or without insertion within a team.

Objective: To determine the prevalence and performance of teamlets and teams.

Design: Cross-sectional observational study linking survey responses to Medicare claims.

Implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and outcomes of bariatric surgery.

Introduction: This study evaluates the performance of bariatric surgery prior to and after the implementation of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

Methods: The eras prior to (2007-2015) and after (2016-2018) the transition to MBSAQIP were compared for patients, operations and outcomes using adjusted logistic regression estimates.

Results: Thirty-day surgical (6%vs.

US Generalist Physicians and Groups That Focused Practice in a Single Care Setting: 2014-2017.

Background: Some generalist physicians whose training prepared them for primary care practice increasingly practice in a facility (eg, hospitals, nursing homes); however, whether this trend was accompanied by a complimentary rise in generalist physicians who focused their practice on office-based care is unknown.

Objectives: Our objective in this study was to examine trends in the prevalence of generalist physicians and physician groups that practice in a single setting.

Research Design: This was a retrospective cross-sectional study of generalist physicians trained in family medicine, internal medicine, or geriatrics.

Practice Trends and Characteristics of US Hospitalists From 2012 to 2018.

This cohort study uses Medicare data to assess trends and characteristics among hospitalists who shift practice to settings outside of the hospital.

Association of Private Equity Investment in US Nursing Homes With the Quality and Cost of Care for Long-Stay Residents.

Importance: Private equity firms have been acquiring US nursing homes; an estimated 5% of US nursing homes are owned by private equity firms.

Objective: To examine the association of private equity acquisition of nursing homes with the quality and cost of care for long-stay residents.

Design Setting And Participants: In this cohort study of 302 private equity nursing homes with 9632 residents and 9562 other for-profit homes with 249 771 residents, a novel national database of private equity nursing home acquisitions was merged with Medicare claims and Minimum Data Set assessments for the period from 2012 to 2018.

Physician prices and low-value services: evidence from general internal medicine.

Objectives: To assess the cross-sectional relationship between prices paid to physicians by commercial insurers and the provision of low-value services.

Study Design: Observational study design using Health Care Cost Institute claims representing 3 large national commercial insurers.

Methods: The main outcome was count of 19 potential low-value services in 2014.

Defining the Role and Value of Physicians Who Primarily Practice in Nursing Homes: Perspectives of Nursing Home Physicians.

Objective: To identify the perceptions of physicians with expertise in nursing home care on the value of physicians who primarily practice in nursing homes, often referred to as "SNFists," with the goal of enriching our understanding of specialization in nursing home care.

Design: Qualitative analysis of semistructured interviews.

Setting And Participants: Virtual interviews conducted January 18-29, 2021.

Association between city-wide lockdown and COVID-19 hospitalization rates in multigenerational households in New York City.

Background: City-wide lockdowns and school closures have demonstrably impacted COVID-19 transmission. However, simulation studies have suggested an increased risk of COVID-19 related morbidity for older individuals inoculated by house-bound children. This study examines whether the March 2020 lockdown in New York City (NYC) was associated with higher COVID-19 hospitalization rates in neighborhoods with larger proportions of multigenerational households.

Association Between Patient Diversity in Hospitals and Racial/Ethnic Differences in Patient Length of Stay.

Background: Hospitals serving a disproportionate share of racial/ethnic minorities have been shown to have poorer quality outcomes. It is unknown whether efficiencies in inpatient care, measured by length of stay (LOS), differ based on the proportion patients served by a hospital who are minorities.

Objective: To examine the association between the racial/ethnic diversity of a hospital's patients and disparities in LOS.

Association Between Racial Disparities in Hospital Length of Stay and the Hospital Readmission Reduction Program.

Background: On average Black patients have longer LOS than comparable White patients. Longer hospital length of stay (LOS) may be associated with higher readmission risk. However, evidence suggests that the Hospital Readmission Reduction Program (HRRP) reduced overall racial differences in 30-day adjusted readmission risk.

Trends in Medical and Surgical Admission Length of Stay by Race/Ethnicity and Socioeconomic Status: A Time Series Analysis.

Background: Length of stay (LOS), a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES) and longer LOS is associated with adverse health outcomes. Historically, projects to improve LOS efficiency have yielded LOS reductions by 0.3 to 0.

Do Skilled Nursing Facilities That Provide More Rehabilitation Therapy Have Lower Rehospitalization Rates?

This study examines whether skilled nursing facilities (SNFs) that consistently provided more rehabilitation therapy than other SNFs had lower 30-day rehospitalization rates. A cross-sectional analysis of 11 866 SNFs in the United States compared 30-day rehospitalization rates of SNFs that consistently provided more rehabilitation therapy to other SNFs using linear regression models. High-billing SNFs were defined as the 10% of SNFs with the highest proportions of Medicare fee-for-service claims that just surpassed the therapy minute threshold for the highest payment category.

Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations.

This case series examines the increase in acquisitions of hospice agencies by private equity firms and publicly traded corporations from 2011 to 2019.

End user information needs for a SMART on FHIR-based automated transfer form to support the care of nursing home patients during emergency department visits.

Nursing home (NH) patients are extensive users of emergency department (ED) services. Problematically, poor information sharing and incomplete access to information complicates the delivery of care in EDs for NH patients. Paper-based transfer forms can support information sharing, but have significant limitations.

Organizational characteristics and perceptions of clinical event notification services in healthcare settings: a study of health information exchange.

Objective: Event notification systems are an approach to health information exchange (HIE) that notifies end-users of patient interactions with the healthcare system through real-time automated alerts. We examined associations between organizational capabilities and perceptions of event notification system use.

Materials And Methods: We surveyed representatives ( = 196) from healthcare organizations ( = 96) that subscribed to 1 of 3 Health Information Organizations' event notification services in New York City (response rate = 27%).