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Objectives: We examined which resident-level clinical factors influence the provision of a recent medical care visit in nursing homes (NHs).Design: Multi-site cross-sectional.Setting and Participants: We extracted data on 3,556 NH residents from 18 NH facilities in Ontario, Canada, who received at minimum, an admission and first-quarterly assessment with the Resident Assessment Instrument Minimum Data Set (MDS) 2.0 between November 1, 2009, and October 31, 2017.Methods: We conducted a secondary analysis of routinely collected MDS 2.0 data. The provision of a recent medical care visit by a physician (or authorized clinician) was assessed in the 14-day period preceding a resident's first-quarterly MDS 2.0 assessment. We utilized best-subset multivariable logistic regression to model the adjusted associations between resident-level clinical factors and a recent medical care visit.Results: Two thousand eight hundred fifty nine (80.4%) NH residents had one or more medical care visits prior to their first-quarterly MDS 2.0 assessment. Six clinically relevant factors were identified to be associated with recent medical care visits in the final model: exhibiting wandering behaviours (OR = 1.34, 95% CI 1.09 - 1.63), presence of a pressure ulcer (OR = 1.37, 95% CI 1.05 - 1.78), a urinary tract infection (UTI) (OR = 1.52, 95% CI 1.06 - 2.18), end-stage disease (OR = 9.70, 95% CI 1.32 - 71.02), new medication use (OR = 1.31, 95% CI 1.09 - 1.57), and analgesic use (OR = 1.24, 95% CI 1.03 - 1.49).Conclusions and Implications: Our findings suggest that resident-level clinical factors drive the provision of medical care visits following NH admission. Clinical factors associated with medical care visits align with the minimum competencies expected of physicians in NH practice, including managing safety risks, infections, medications, and death. Ensuring that NH physicians have opportunities to acquire and strengthen these competencies may be transformative to meet the ongoing needs of NH residents. [ABSTRACT FROM AUTHOR]

Objectives To identify characteristics and outcomes of elderly patients admitted to a slow stream, low-intensity, and long-duration inpatient rehabilitation (SSR) program after an acute hospitalization because they were unable to tolerate traditional inpatient rehabilitation. Design Single group pre-post study with assessments conducted on admission and discharge. Setting Baycrest's 30-bed SSR Unit in Toronto, Ontario, Canada. Participants A total of 104 patients older than 60 years admitted between September 2011 and December 2012. Measurements Admission assessments included demographic data, Functional Independence Measure (FIM), and ability to ambulate. Discharge outcomes included change in motor and total FIM scores from admission to discharge, discharge residential status, and length of stay. Results Mean age was 81.6 ± 8.4 years and 68.3% were women. Mean changes in motor and total FIM were 21.0 ± 12.2 ( P < .001) and 22.6 ± 14.0 ( P < .001), respectively. On admission, only 30.8% of patients were ambulatory even with mobility assistive devices, while on discharge, 68.3% of patients were ambulatory; 61.5% of patients returned to their preadmission living arrangement; 8.6% went from their own home to a retirement or relative's home. Only 16.3% were discharged to long-term nursing home care and 13.4% were transferred to an acute hospital. Mean length of SSR stay was 82.5 ± 26.4 days. Conclusion SSR programs can benefit elderly patients at risk for institutionalization after acute hospitalization by improving their functioning and mobility, and allowing them to return to the community. [ABSTRACT FROM AUTHOR]

To characterize the practice profile of nursing home (NH) physicians in Ontario, Canada. Population-based cross-sectional study. A total of 1527 most responsible physicians (MRPs) across 626 NHs in Ontario, Canada, for the calendar year, 2017. We examined physician services within all publicly regulated and funded NH facilities. Descriptive summaries were generated to characterize MRPs and their practice patterns by the physician's primary practice location, the NH facility size, and the proportion of physician billings that occurred within NHs. Community sizes were classified into quintiles based on population size and assigned as urban or rural. The number of ministry-designated NH beds were assessed by quintiles to examine physician services by facility size. We also assessed the proportion of physician billings within NHs by quintiles. MRPs tended to be older, male, and practice family medicine. The majority of MRPs practiced in communities with populations exceeding 100,000 residents, although physicians with greater NH billings tended to practice in rural locations. The mean number of NH residents that a physician was MRP for was positively associated with the community size. Physicians provided care for more NH residents than they were assigned most responsible. Fifty-one percent of physicians were MRP for 90% of all NH residents. Our work provides an exemplar for characterizing physician commitment in NHs, using 2 approaches, according to the NH specialist model. We demonstrated the medical practice characteristics, locations, and billing patterns of physicians within Ontario NHs. Future work can investigate the association between physician commitment and the quality of care provided to NH residents. A greater understanding of physician commitment may lead to the development of quality metrics based on physician practice patterns. [ABSTRACT FROM AUTHOR]