Low Dose Steroid Replacement Therapy Causes Hepatitis B Virus Reactivation in Long-term Health Care Facility Patient
We present a case of HBV reactivation in a post-acute long-term patient on low dose steroid replacement therapy. Low dose steroid replacement therapy is not well described as a cause HBV reactivation. This case illustrates that long-term facility residents are at risk of HBV reactivation with low dose steroid replacement therapy. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Ahmed Eltanbedawi, A.N. Eltanbedawi Tags: Case Report Source Type: research

Perforated Appendicitis in a Nursing Home Resident with Advanced Multiple Sclerosis
Acute appendicitis is the most common surgical emergency and becomes serious when it perforates. The principal presenting complaint of patients with acute appendicitis is abdominal pain. The diagnosis may be missed in patients with neurological disorders- in this case multiple sclerosis (MS) and quadriplegia-who do not complain of pain. There are limited research and practice guidelines for patients with chronic neurodegenerative disorders with acute abdomen. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Paria Pourmalek, X. Shao, P. Pourmalek, N. Taheri Tags: Case Report Source Type: research

Prevention of Rehospitalization in Non-Compliant Patients Utilizing Transitional Care Program (TCM): A Bundle Payment Care Initiative (BPCI Model 3) Case Study
A case of post Skilled Nursing Facility (SNF) rehospitalization prevention using CMEC transitional care protocol in a non-compliant patient. This patient underwent right lower extremity major joint replacement and was participating in BPCI Model 3 program with 90-day episode risk sharing. The SNF assumes risk for all services provided within the episode. This includes services provided directly by the SNF and those delivered by other providers including any Part A and Part B services i.e. physician services, DME, services provided by another PAC provider and related acute readmissions. (Source: Journal of the American Medi...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Chandan Cheema, A. Narwan, R. Brar, C. Cheema Tags: Case Report Source Type: research

Rare Cutaneous Melanoma in a Centenarian
Malignant cutaneous neoplasms with combined phenotypical features of high-grade basal cell carcinoma& malignant melanoma are exceptionally rare. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Saeeda Qadri, S. Qadri, P. Coll Tags: Case Report Source Type: research

Urethral Polyembolokoilamania: An Unusual Cause of Urinary Incontinence and Scrotal Pain
Foreign bodies in the bladder are among the rarest differential diagnoses in the lower urinary tract symptoms and may be missed in initial medical evaluations. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Ashley Sarasan, A. Sarasan, A. Chandra, R. Connolly Tags: Case Report Source Type: research

Wellens' Warning: A Case of Critical Stenosis
Wellens' Syndrome, also known as Coronary T-wave Inversion Syndrome, was identified in the 1980's after a group of patients with unstable angina and characteristic precordial T wave changes on electrocardiogram (ECG) went on to develop large anterior myocardial infarctions. ECG findings are due to critical stenosis in the proximal left anterior descending (LAD) artery. Of patients who present with unstable angina, this ECG pattern is present in 14-18% of cases. Progression from Wellens' Syndrome to anterior myocardial infarction occurs after a mean of 8.5 days and the unique ECG pattern classically presents during chest pa...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Katherine Thyssen, K. Thyssen, D.E. Sanchez Pellecer, M. Mendoza de la Garza, E. Tung, A. Chandra Tags: Case Report Source Type: research

When Back Pain Becomes Ominous: A Case of High Grade Neuroendocrine Carcinoma of Kidney Origin in a Geriatric Patient
Back pain is a common geriatric complaint. 70% of adults in Germany have at least one episode of back pain a year. Consistently back pain ranks in the top 5 disabling disorders in the United states. Multiple providers including chiropractors are often consulted, Unfortunately, back pain can be a herald sign for serious pathology and this is commoner in the elderly. Red flags including onset with minimal injury, unintentional weight loss of at least 10% of body weight in 6 months are pointers to non-benign nature. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Olusola Onoviran, O.F. Onoviran Tags: Case Report Source Type: research

When Back Pain Is Not Benign: A Case of Spinal Osteomyelitis and Diskitis
Back pain is a common complaint in the post acute and long term case setting. The most common causes include musculoskeletal pain and degenerative disease, but back pain may also be secondary to more serious causes, such as malignancy and infection. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Caitlin Jones, C. Jones, T. Rose, J. Thomas Tags: Case Report Source Type: research

A Framework for Imparting Short, Actionable Teaching of Geriatrics Topics Using Audio Podcasts for Housestaff: Preliminary Results
As the US population ages, recognizing and providing care for those with geriatric syndromes will become ever more important. However, with most trainees learning in hospitals, the opportunities for discovering practical ways of implementing geriatric skills —such as assessment of delirium or identifying community services for dementia patients, usually learned in the outpatient setting—are limited. Presently, short-form, easily accessible resources teaching the mechanics of geriatric care are not available. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Karthik Kota, K. Kota, W. Chang, S.M. Handler Tags: Education Source Type: research

Deciphering the Geriatric Rotation Evaluation Showed Negative Attitudes of Post-Acute Care and Long Term Care Curriculum
Medical students and physician trainees ’ attitude toward elderly population have a strong association on influencing a career in geriatrics, but there is paucity of information regarding the attitudes of trainees towards providing care for long term care elderly patients. The negative consequences of poor curriculum or the lack of it m ay contribute to a decreased interest to pursue fellowship in geriatric medicine. Some potential curricular interventions to offset this include an academic focus to improve medical knowledge, with some published literature demonstrating a positive impact of this intervention on attit...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Anas Souqiyyeh, A. Souqiyyeh, L. Kim, R. Factora Tags: Education Source Type: research

Developing and Testing Training to Improve Palliative Care Communication Skills in the Nursing Home
In skilled nursing facilities (SNF), effective communication between interdisciplinary team (IDT) members, patients, residents, and their surrogates is essential to provide high-quality palliative and end of life (EOL) care. However, clinical staff in the SNF setting often lack specialized communication skills training best suited for palliative and EOL care needs. There is a paucity of educational curricula for teaching these skills at SNF's and little data defining their clinical implications. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Danielle De Merieux, L. Posner, J. Reinhardt, E. Weingast, J. Malamy, D. De Merieux, R. Spinner Tags: Education Source Type: research

Development of a Localized Community-Based Integrated Home Care System: Model Swapping through an International Symposium
The population in Taiwan is aging, and it is becoming a significant challenge for us to use limited resources to take care of all the older adults. Many home-bound older adults receive inadequate care, the majority of whom receive their prescription medications only through family members ’ or caregivers’ visits to the physicians on their behalf. These risky and inadequate health care patterns were recognized by National Health Insurance Administration in Taiwan, which initiated a pilot integrated home medical care program last year to enable and reimburse physicians and health c are teams to provide medical ca...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Chunghao Lin, C. Lin, Y. Chen, K. Liao, G. Wang, S. Yu Tags: Education Source Type: research

Futures to CMD: 2017 Survey Results and Personal Reflections
The number of older adults receiving nursing home care is expected to rise from 1.2 million in 2000 to 2.7 million in 2040. To meet this increase, a geriatric-focused physician workforce with expertise in nursing home care is desperately needed. Yet, as of 2001, only 13 percent of graduating internal medicine residents felt prepared to care for this population. The Foundation Futures Program was established in 2001 to inform and educate clinicians regarding the needs of nursing home residents. Since inception, the program has hosted 985 participants, of which 26% remained members of AMDA-The Society for Post-Acute and Long...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Christian Bergman, C. Bergman, C. Ewing, T. Iloabuchi, H. White Tags: Education Source Type: research

Improving Competences in Geriatric Knowledge of 6th Grade Medicine Students from Instituto Tecnol ógico y de Eestudios Superiores de Monterrey (ITESM) Mexico in Medical Assistance for Older Adults who Live at the Nursing Home and Long Term Care (NH/LTC)
The global demographic transition, which Mexico is part of, with a larger number of older adults, families with less young members and the increase of NH/LTC in Mexico, makes it necessary for medicine students to learn about competences and knowledge in medical assistance for older adults who live at NH/LTC. The specific competences in medical assistance for older adult patients have the aim of working together in order to provide a safe and affordable access, with high-quality and focused in medical assistance for the older adults; therefore we carry out an educational program for 6th grade Medicine students at ITESM in m...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Jose Ya ñez, J.A. Yañez Tags: Education Source Type: research

NICHE (Nurses Improving Care for Healthsystem Elders) Program: Long Term Care
We describe the NICHE Long Term Care program that promotes the use of evidence-based clinical interventions and establishes nurses as leaders to bring about changes in the quality of care delivered to older adults in long term and residential care facilities. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Sherry Greenberg, S.A. Greenberg, M. Gilmartin, C. D'Amico, E. Sullivan-Marx Tags: Education Source Type: research

Seeing is Believing: Learners ’ Perceptions of Interdisciplinary Team Roles
ACGME requirements for family medicine (FM) resident training include long-term care (LTC) education over a 24 month period. Many medical student and residents have little to no exposure with LTC patient care. Furthermore, there are many misconceptions and stigmas regarding LTC facilities and little understanding of the unique patient care concept in these diverse settings. LTC facilities provide care through an interdisciplinary team (IDT) base approach that includes the physician/providers, physical therapy and occupational therapy (PT/OT), audiology and speech language therapy, social work (SW) team, and nursing staff. ...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Jennifer Hwang, J. Hwang Tags: Education Source Type: research

A Quality Improvement Initiative to Improve Nurse-Physician Telephone Communication in a Long-term Care Facility
Telephone calls are the primary mode of nurse-physician communication in long term care facilities (LTCF). Staff turnover, lack of standardized protocols, and employee fatigue and multitasking could contribute to gaps in communication, leading to adverse patient outcomes. The literature demonstrates that deployment of standardized communication tools, such as “Situation, Background, Assessment, Recommendation (SBAR)” training for nurses, can facilitate improved nurse-physician communication. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Kahli Zietlow, K. Zietlow, A. Ahmed, N. Sharda, M. Yanamadala, N. Eisenson Tags: Quality Improvement Source Type: research

Battlefield Acupuncture (BFA) For Pain Management in a VA Community Living and Rehabilitation Center
Chronic pain affects at least 116 Million U.S. adults at an estimated cost of $650 billion annually in direct medical treatment and lost productivity. Approximately 25%-50% of community-dwelling older adults and 45%-80% of nursing home residents have substantial pain. Pain management is commonly medication-based and opioids are still widely used to treat pain. Although opioids may have some benefit for acute pain management, habitual use of these drugs for chronic pain carries many risks. In 2010, a Joint Task Force evaluated pain management in the military and veteran ’s health care and found that there is a paucity...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Xiangrong Shao, M. Byers, X. Shao, F. Bozorgi, S. Begum, D. Wertheimer, R. Khalil, P. Poumalek, N. Taheri Tags: Quality Improvement Source Type: research

Better advance care planning in long-term care through starting the conversation
Due to cognitive impairment, multimorbidity, and fewer family connections, nursing home residents are at especially high risk for receiving medical care that is medically inappropriate or inconsistent with their wishes. Therefore, Advance Care Planning (ACP) in this setting is crucial to the provision of patient-centered care. The Transportable Physician Orders for Patient Preferences (TPOPP) form has been developed and implemented in Kansas and Missouri to allow patients to discuss ACP and implement orders to ensure that their wishes are respected across the entirety of the healthcare system. (Source: Journal of the Ameri...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Christina Capps, C. Capps, L. Gillen, D. Hayley, R. Mason Tags: Quality Improvement Source Type: research

Collaboration Between a Post-Acute & Long Term Care Facility and It ’s Family Council in Better Serving It’s Patients, Families, and Staff
The 1987 Nursing Home (NH) Reform Act includes provisions for families of NH residents to hold private family council (FC) meetings within Medicare and Medicaid certified NH facilities. Literature on FCs including literature recommended by a local ombudsman were reviewed. A local PA& LTC Facility and it ’s FC then collaborated on a quality improvement(QI) project to improve its informal FC's process. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Chidinma Aniemeke, C. Aniemeke, G. Macias, L. Murphy, N.K. Patel, M. Rosina Finley Tags: Quality Improvement Source Type: research

Deprescribing: A Team Based Guideline and Implementation Process to Deprescribe in the Nursing Home
Polypharmacy can result in an increased risk of side effects and potential adverse events in long term care (LTC) residents. Recent research has emerged showing the benefits of removing unnecessary medications. New guidelines aim to identify which medications should be removed and the best way to implement a “deprescribing” process. As a performance improvement plan (PIP), we developed a guideline and implementation process to identify and remove unnecessary medications in LTC residents. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Ruth Spinner, R. Spinner, M. Martin, M. Lasker Tags: Quality Improvement Source Type: research

De-Prescribing in the Post-Acute and Long-Term Care Setting: A Quality Improvement Project with Potential to Reduce Adverse Events and Costs
Polypharmacy, the inappropriate and excessive use of medications, is common in the PA/LTC setting. Polypharmacy contributes to adverse drug events (ADEs), manifesting as falls, cognitive decline, syncope, organ dysfunction, besides non-adherence, hospitalization and mortality. Older adults utilize the highest proportion of prescribed medications. De-Prescribing (DeP) refers to the process of safe and appropriate tapering, stopping, or withdrawal of medications deemed unnecessary or inappropriate. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: T.S. Dharmarajan, T.S. Dharmarajan, S. Islam, H. Boja, L. Mamakos, A. Gavilanes, Z. Saadabadi, M. Kanagala, A. Lebelt, P. Murakonda Tags: Quality Improvement Source Type: research

Development and Evaluation of a Clinical Practice Guideline to Improve Antibiotic Stewardship in a Post-Acute/Long-Term Care Setting
Antibiotic stewardship efforts are mandated in post-acute and long-term care (PA-LTC) settings secondary to high rates of inappropriate antibiotic use and antimicrobial resistance. Urinary tract infections (UTI), respiratory tract infections (RTI), and skin and soft tissue infections (SSTI) are among common reasons for inappropriate antibiotic use, with as high as 75% of prescriptions deemed unnecessary. As such, a PA-LTC organization in Maryland has identified the inappropriate use of antibiotics as a problem among its facilities and is seeking to implement best practices. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Nadia Khan, N. Khan, L. Meekins, V. Ohakam Tags: Quality Improvement Source Type: research

Does Bright Light Therapy Improve Quality of Life For Residents in Long Term Care Facilities?
Alzheimer ’s is the number one mental disorder diagnosed in the elderly with over 5.4 million people afflicted in 2016. According to Maplewood's records 43% of patients have dementia, 45% have depression and 21% have both. These two diagnoses have symptoms of sleep disturbances, agitated behavior and sadnes s which can increase the risk for falls. Often medications given to treat depression can lead to somnolence, decreased appetite, constipation, confusion or possible arrhythmia. Circadian rhythms are controlled in the suprachiasmatic nucleus (SCN) located in the hypothalamus by a monosynaptic pathway with the retin...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Leah Ederer, L. Ederer Tags: Quality Improvement Source Type: research

Early Physician's Assessment on Admission in Post-acute Care Facilities Reduce Rehospitalization
Greater than 25% of hospitalized Medicare patients are discharged to post-acute care facilities and yet one third of readmission from post-acute care facilities occur within the first week. Also, previous expert consensus indicates that early assessment on admission by medical staff may avoid unnecessary rehospitalizations. Therefore, timing of medical assessment may play an important role to prevent rehospitalizations and in doing so, prevent drain on resources and improve quality of care. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Hyungseok Oh, H. Oh Tags: Quality Improvement Source Type: research

Fall Prevention in Long Term Care Using Purposeful Hourly Rounding
The elderly population, in particular those who reside in Long Term Care (LTC) facilities are at an increased risk from suffering from falls. Falls can lead to injury, diminished functional ability, loss of independence, even death. A large retirement community in Baltimore, Maryland has identified falls on the LTC floor as a patient safety concern. As the LTC floor phases out using bed alarms they are seeking other methods to monitor for and prevent falls. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Jennifer Linehan, J. Linehan Tags: Quality Improvement Source Type: research

Hidden Gems: Unearthing Happy and Healthy Elders in a Long-Term Care Facility
Person-centered approaches to dementia care can improve quality of life but present significant challenges in implementation. Participation in activities has been shown to help improve engagement, attention, and affect in elders with dementia, as well as reduce agitated behaviors. This quality improvement project introduces a staged framework for dementia care to increase participation in activities among residents with dementia. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Serena Wong, S.P. Wong, A. Cook, G.T. Buhr Tags: Quality Improvement Source Type: research

High Acuity Unit in SNF: Novel Program to Improve Quality of Care for Post-Acute Patients
Over the past several years, the acuity level of patients discharged from the hospital to skilled nursing facilities (SNF) has increased significantly, and the role of the SNF has expanded. Increasingly, SNFs are caring for patients with higher level nursing and rehabilitation needs including tracheostomies, TPN, advanced wound care, high flow oxygen needs, assisted ventilation, IV medications, peripheral nerve blocks, JP drains, LVADS, and life vests. Along with these more clinically challenging patients comes an increased risk of rehospitalization. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Liam Fry, L. Fry, A. Philip, T. Mackenzie, L. Von Der Ahe, E. Doan, F. Ahmed Tags: Quality Improvement Source Type: research

Implementation of an Evidence-Based Inpatient Delirium Prevention Program – Real Life Barriers and Successes
Despite the wealth of evidence to demonstrate the success of comprehensive non-pharmacologic interventions in the prevention of delirium in hospitalized patients, at our hospital these preventative measures are not standard practice. We developed a multidisciplinary delirium project including residents, faculty, nursing, pharmacy and volunteer colleagues. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Lisa Sanders, L.K. Sanders, T. James, B. Pedroja Tags: Quality Improvement Source Type: research

Improving Elder Care in a Community Based Hospital
We present key components of this systematic approach, including assembling a team of leaders and collecting data to identify key problems, re-designing and making small scale changes, monitoring and continually reviewing progress to ensure sustainability. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Neema Sharda, N. Sharda, L. Genao, J. Pavon, H. White, V. Orto, K. Keith, S. Johnson Tags: Quality Improvement Source Type: research

Is It Safe to Discontinue Holding Parameters for Anti-hypertensive Medicines in Nursing Facilities?
Many patients are prescribed anti-hypertensive medications with holding parameters to maintain a goal blood pressure and avoid episodes of hypotension or bradycardia in hospital. However, when these patients are discharged to nursing homes, they are generally medically stable. As the timings for checking vital signs and administering medicines may not coincide at nursing facilities, it becomes challenging for the nursing staff to follow these parameters. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Ramla Sharif, R. Sharif Tags: Quality Improvement Source Type: research

Medical Assistance in Dying in Alberta: Implementation of a Provincial Care Coordination Service for an Unprecedented Clinical Activity
In June 2016 Bill C-14 was enacted by the Federal Government. This bill decriminalized the assistance of suicide, by physicians and nurse practitioners, with very detailed patient eligibility requirements. The Bill, as well, reinforced the freedom of any health care worker to be permitted to be a non-participant. With health care a provincial responsibility in Canada each province was tasked to have a means for patients to access or inquire about Medical Assistance in Dying (MAID) where none existed before. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Jo Heggerud, D. Faulder, J. Heggerud Tags: Quality Improvement Source Type: research

Patient-centered Goals of Care: Using the Chronic Care Management (CCM) Code Towards Cooperative Goal Setting in the Multimorbid Elderly
Patient-centered care contributes to quality healthcare delivery by encouraging health care providers to consider patients ’ needs as articulated by the patients themselves. Due to barriers such as limited time and lack of clinician training, shared decision-making may not take place. It is particularly important in older adults with multiple comorbidities for the clinician and patient to cooperatively determine goals together. In recognition of the importance of care coordination in patients with multiple chronic conditions, Medicare approved payment for non face-to-face care management for selected patients with mu...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Nivedita Gunturi, N. Gunturi, A. Gennari, K. Bartels Tags: Quality Improvement Source Type: research

Post-Acute Care RNs impact on MSSP Skilled Nursing Facilities Length of Stay
Baylor Scott& White Quality Alliance (BSWQA) created a Transition of Care project in the Post-Acute Care area utilizing embedded RN Care Managers in select North Texas skilled nursing facilities (SNFs) with a goal of reducing length of stay (LOS) in the Medicare Shared Savings Program (MSSP) population. In partnership with the SNFs, RN Care Managers advocated for patients and their families to improve the overall patient care experience with enhanced plans of care and discharge planning to accomplish a decreased LOS resulting in financial savings. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Julia Newton, J.A. Newton Tags: Quality Improvement Source Type: research

RAVEN Initiative: Implementation of an Intervention to Reduce Antipsychotic Use in the Nursing Home Setting
Antipsychotic drugs are associated with serious adverse effects including an increased risk of death when used in elderly patients for the treatment of dementia-related behaviors. Despite this risk, antipsychotics remain a commonly prescribed medication in the nursing home (NH) setting. The Department of Health and Human Services (HHS) reports that 22% of nursing home Medicare claims for atypical antipsychotics are not administered in accordance with the Centers for Medicare and Medicaid Services (CMS) standards regarding unnecessary drug use. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Maureen Bieltz, M. Bieltz, S. Lantz, S. Whyte-Nagel, K. Zeigler, K. Tiesi Tags: Quality Improvement Source Type: research

Reducing Falls in the Frail Elderly
Falls in frail elderly have been recognized by Centers for Medicare& Medicaid Services (CMS) as a focus for research to reduce morbidity, mortality, and health care costs in this population. The CDC (2016), estimates the cost of falls and injuries sustained to be $35 billion dollars annually, with approximately one-third of cost from falls sustained in the Long Term Care Facility (LTCF). The number of LTCF residents is predicted to double over the next two decades with the disconcerting reality that falls resulting in serious injury may proportionately increase (CDC, 2014). (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Nora Hockman-McDowell, N.M. Hockman-McDowell, J.W. McDowell Tags: Quality Improvement Source Type: research

Reduction of Off-Label Use of Antipsychotics in a Long Term Care Facility
The Centers for Medicaid and Medicare Services (CMS) sets a goal for nursing homes that residents should not receive an antipsychotic medication unless absolutely necessary. One commonly-cited number is that 15.5% of long-term nursing home residents are prescribed antipsychotics nationally. When needed, the antipsychotic medication should be used at the lowest dose for the shortest amount of time possible. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Christian Burton, C.A. Burton, R. Young, C. Thomas, C. Na, V. Shepard, H. Shen, J. Armstrong, J. Ogar, L. Hadley Tags: Quality Improvement Source Type: research

Reduction of Unnecessary Usage of Antipsychotics, Physical Altercations and Falls in Memory Care Units by Implementing Person Centered Comfort Care
A “Memory Care” Project team came together in October 2014 to review current dementia care practices, identified the gaps and created a structured Memory Care Program. This program impacted 108 of NY city Health+Hospital/Coler Behavioral disturbances among patients with dementia, including agitati on, aggression, and psychosis, form a constellation of symptoms referred to as behavioral and psychological symptoms of dementia (BPSD). These impact heavily on resident’s quality of life, caregiver stress, and management options for the team. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Deepa Vinoo, D. Vinoo, J. Santos, R. Amin Tags: Quality Improvement Source Type: research

Transitions of HOPE: Developing a SNF Collaborative
As the US healthcare transitions to value-based payment models, hospital systems are collaborating with skilled nursing facilities (SNFs) to integrate resources and reduce healthcare spending and hospital re-admission rates. Challenges in forming these collaborations include evaluating quality of SNF care, engaging key personnel across care continuum, aligning incentives, integrating electronic records, and developing shared goals. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Michael Krol, M.L. Krol, H. White, H. Jacobson, J. Bellantoni Tags: Quality Improvement Source Type: research

Use of Robotic Cats to Reduce Falls in Skilled Nursing Facility
Falls are a major source of morbidity for patients in skilled nursing facilities. Each year, a typical nursing home with 100 beds reports 100 to 200 falls, and the average number of fall is 2.6 falls per person per year in SNF. 10-20% of nursing home falls cause serious injuries. As part of a targeted plan to reduce falls, our QAPI committee decided to trial the use of robotic cats - five of them - in our skilled nursing facility to see if using the cats with the residents would result in less overall falls. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Liam Fry, L. Fry, M. Walker, S. Ledesma, K. Gluch, K. Deason Tags: Quality Improvement Source Type: research

V.E.R.C.I. (Veterans Enrolled in Restorative Care plus Intervention) Exercise Project: A Model to Improve Strength, Balance, Mobility, and Decrease Fall Risk in Aging Veterans
Older U.S. Veterans in VA Community Living and Rehabilitation Center (CLC) have disproportionately higher rates of sarcopenia, dynapenia, and higher incidences of frailty which result in loss of functional mobility and increased risks of falls and fall-related injuries than older non-veterans. This project uses a low-impact muscle-strengthening and balance training program to improve functional mobility, gait speed and balance, thereby reducing fall risk to CLC Veterans. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Mary Lewis, J. Giffuni, N. Adu-Sarkodie, M. Lewis, F.L. Fort, F. Bozorgi, X. Shao Tags: Quality Improvement Source Type: research

Why Won ’t Antibiotics Be Used? Developing Tools for Education and Communication Concerning Suspected UTI in Long Term Care (LTC). A Project of the Colorado Long Term Care Research Partnership
Preventing infections and reducing antibiotics use in long term care facilities is a public health issue. Urinary tract infections (UTIs) are often misdiagnosed and over treated with antibiotics. Expectations of patients and families can play a role in antibiotic overuse. Denver-area LTC stakeholders identified that friction between clinicians and families requesting antibiotics for presumed UTIs reflected an important concern, which could result in dissatisfaction in care and contribute to antibiotic overuse. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Jo Trojanowski, Leslie Eber, J. Trojanowski, L.B. Eber, C. Drake, R.S. Boxer, H.L. Wald Tags: Quality Improvement Source Type: research

A Comparison of Rural and Urban Veterans Health Administration's Home Based Primary Care
In the over 40 years since VA Home Base Primary Care Programs (HBPC) were created, the program has expanded to nearly 400 sites serving both urban and rural populations. Our objectives are to compare the current state characteristics, structure, practice and team functioning of VA HBPC in rural and urban settings, including primary care provider models, team attributes, services delivered, work environment and perceived team effectiveness. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Suzanne Gillespie, S. Gillespie, J. Karuza, T. Olsan, X. Cai, O. Intrator, J. Li, S. Gao, J. Szydlowski, H. Temkin-Greener, B. Kinosian, T. Edes Tags: Research Source Type: research

A Study of Remote Medication Management Using Veterans Affairs Clinical Video Telehealth Services
Community Based Outpatient Clinics (CBOCs) are centers that allow primary care to be delivered to veterans that are a long distance from a main Veterans Affairs (VA) campus. However, these CBOCs often do not have physicians who are trained in geriatric principles. In Pittsburgh, a clinical video telehealth (CVT) dementia consult service based in the Pittsburgh VA allows for remote care of dementia patients, particularly in the optimization of medications. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Woody Chang, W. Chang, M. Homer, M. Rossi Tags: Research Source Type: research

Current Prescribing Patterns for Urinary Tract Infections at a Skilled Nursing/Long Term Care Facility (SN/LTCF)
In September 2014, the White House developed a “National Strategy for Combating Antibiotic-Resistant Bacteria” that included enhancing antimicrobial stewardship in SN/LTCFs. Urinary tract infections (UTIs) are one of the most frequently diagnosed infections in SN/LTCFs, with the treatment of asymptomatic bacteriuria (ASB) a leading cause of antibiotic misuse. Despite the FDA’s recommendation not to use flouroquinolones (FQs) for uncomplicated UTIs, this class is still commonly prescribed in SNF/LTC. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Christine Kloby, C. Kloby, M. Katz, R. McKenzie Tags: Research Source Type: research

Effect of Urinalysis with Reflex Testing on Urine Culture Testing and Treatment
Though it is a well-known fact that older patients —particularly women, and particularly in nursing homes—can have bacterial colonization of their uroepithelial tract, an oft-used reflex when a patient has any change in condition—fever, mental status change, and even urinary symptoms—is to get a urinalysis and culture. Both are often ordered simultaneously in order to practice conservatively, but this can lead to issues if a culture comes back with ambiguous results (under 100,000 colony forming units, or a non-standard organism). (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Karthik Kota, K. Kota, J. Hwang, J. Naumovski Tags: Research Source Type: research

Effects of a Story-sharing Intervention on Depression and Well-being in Older Adults Transitioning to Long-term Care
The purpose of this randomized control trial (RCT) was to investigate the effects of a story-sharing intervention on older adults transitioning to long-term care (LTC). The specific aims were (1) to determine the effects of story sharing on the health transition outcomes of depression and well-being of adults transitioning to LTC; and (2) to determine if the sociodemographic characteristics (age, gender, ethnicity, marital status, level of education (LOE), months living at LTC facility, choice to move, and health problem(s) that may have resulted in the move) predict depression and/or well-being. (Source: Journal of the Am...
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Gail Sullivan, G.J. Sullivan Tags: Research Source Type: research

Health Outcomes from Assisted Living Facilities: a Cohort Study of a Primary Care Practice
The population of older US adults residing in assisted living facilities (ALFs) is growing, yet health data on this population is relatively sparse. We aimed to describe health outcomes of ALF residents in the greater Rochester, Minnesota area compared to age and sex matched community dwelling elders. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Mairead Bartley, M. Bartley, S. Quigg, A. Chandra, P.Y. Takahashi Tags: Research Source Type: research

High BMI and Functional Dependence in Nursing Facilities: What We Need to Know
There is paucity of research on the effects of obesity and its related comorbidities on the care of long-term Care (LTC) residents living in nursing facilities. There is a strong association between higher body mass index (BMI) and greater utilization of health care resources for hospitalized and community dwelling patients. Research has shown that even a modest 5-10% weight loss can decrease obesity related- comorbidity. A research study in LTC setting can address such disparities in care associated with obesity. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Maryam Hasan, M. Hasan, M. McNabney, M. Bellantoni, E. Oh, F. Sheikh Tags: Research Source Type: research

Impaired Awareness and Its Relationship with Neuropsychiatric Symptoms in People with Korsakoff Syndrome and other Alcohol-Related Cognitive Disorders Living in Specialized Long-Term Care Facilities
Impaired awareness is a common feature in Korsakoff syndrome (KS), but it has hardly been studied. Without accurate awareness, KS patients may reluctant to accept care, and it may have adverse effects such as provoking challenging neuropsychiatric symptoms (NPS) and caregiver distress. The purpose of this study was to investigate the levels of impaired awareness in multiple functional domains, and to examine its relationships with NPS, and caregiver distress in people with KS residing in specialized long-term care facilities (LTCFs). (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 22, 2018 Category: Health Management Authors: Ineke Gerridzen, I. Gerridzen, K. Joling, M. Depla, R. Veenhuizen, C. Hertogh, E. Verschuur Tags: Research Source Type: research