Impact of a multidisciplinary intervention on antibiotic use for nursing home-acquired pneumonia.

Background: Academic detailing in nursing homes (NHs) has been shown to improve drug use patterns and adherence to guidelines.

Objective: The purpose of this study was to evaluate the impact of a multidisciplinary intervention that included academic detailing on adherence to national nursing home-acquired pneumonia (NHAP) guidelines related to use of antibiotics.

Methods: This quasi-experimental study evaluated the effects of a 2-year multifaceted and multidisciplinary intervention targeting implementation of national evidence-based guidelines for NHAP.

Regional variation in mortality and subsequent hospitalization of nursing residents with heart failure.

Objective: Do demographics, clinical characteristics, care structures, mortality, and rehospitalization differ by region among a national sample of nursing home (NH) residents with heart failure (HF)?

Methods: Retrospective observational study of NH residents with HF by ICD-9 CM codes or Minimum Data Set (MDS) diagnosis, using the Linked Nursing Home/Skilled Nursing Facility Stay File, containing MDS, hospitalization, and mortality data for all residents in a 10% random sample of NHs (n = 1840) during 2003-2004. Facility characteristics, demographics, functional characteristics, comorbidity, and outcomes were described by geographic region. Baseline characteristics and care structures for subjects who experienced a subsequent HF hospitalization or death were compared with those who did not, using unadjusted odds ratios and chi-square tests or Fisher's exact tests for categorical, and t tests or Wilcoxon Rank Sum tests for continuous variables.

A multifaceted intervention to implement guidelines did not affect hospitalization rates for nursing home-acquired pneumonia.

Objective: Determine whether a comprehensive approach to implementing national consensus guidelines for nursing home-acquired pneumonia (NHAP) affected hospitalization rates.

Design: Quasi-experimental, mixed-methods, multifaceted, unblinded intervention trial.

Setting: Sixteen nursing homes (NHs) from 1 corporation: 8 in metropolitan Denver, CO; 8 in Kansas and Missouri during 3 influenza seasons, October to April 2004 to 2007.

Impact of NHAP guideline implementation intervention on staff and resident vaccination rates.

Objectives: Determine whether a comprehensive approach to implementing national consensus guidelines for nursing home acquired pneumonia (NHAP), including influenza and pneumococcal vaccination, improves resident subject and staff vaccination rates.

Methods: Quasi-experimental, mixed-methods multifaceted intervention trial conducted at 16 nursing homes (NHs) from 1 corporation (8 in metropolitan Denver, Colorado; 8 in Kansas and Missouri) during 3 influenza seasons, October to April 2004 to 2007. Residents with 2 or more signs and symptoms of systemic lower respiratory tract infection (LRTI) and NH staff and physicians were eligible.

Associations among nurse and certified nursing assistant hours per resident per day and adherence to guidelines for treating nursing home-acquired pneumonia.

Background: Nursing home (NH)-acquired pneumonia (NHAP) causes excessive mortality, hospitalization, and functional decline, partly because many NH residents do not receive appropriate care. Care structures like nurse/resident staffing ratios can impede or abet quality care. This study examines the relationship between nurse/resident staffing ratios, turnover, and adherence to evidence-based guidelines for treating NHAP.

Predictors of rehospitalization and death after a severe exacerbation of COPD.

Background: Patients who survive a severe exacerbation of COPD are at high risk of rehospitalization for COPD and death. The objective of this study was to determine predictors of these events in a large cohort of Veterans Affairs (VA) patients.

Methods: We identified 51,353 patients who were discharged after an exacerbation of COPD in the VA health-care system from 1999 to 2003, and determined the rates of rehospitalization for COPD and death from all causes.

Factors influencing models of end-of-life care in nursing homes: results of a survey of nursing home administrators.

Approximately 20% of deaths in the United States occur in nursing homes. Dying nursing home residents have unique care needs, which historically have been inadequately addressed. The goal of this study was to determine what factors influence nursing home administrators' choice of model for end-of-life care in their facilities.

Site of death in the hospital versus nursing home of Medicare skilled nursing facility residents admitted under Medicare's Part A Benefit.

Objectives: To determine factors that predict site of death (hospital vs nursing home (NH)), related costs, and geographic variation in site of death of NH residents admitted under the Medicare Part A Benefit.

Design: Retrospective cohort study.

Setting: NHs located in the United States (N=13,146).

Quantifying posthospital care transitions in older patients.

Background: Older patients frequently receive care in multiple settings. However, there has been a paucity of studies that quantify the number of care transitions or that attempt to explain utilization patterns over a given time period. Furthermore, no studies have examined transitions based on method of payment.