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Nursing Home Transfers for Behavioral Concerns: Findings from the OPTIMISTIC Demonstration Project.
- Source :
-
Journal of the American Geriatrics Society [J Am Geriatr Soc] 2021 Feb; Vol. 69 (2), pp. 415-423. Date of Electronic Publication: 2020 Nov 20. - Publication Year :
- 2021
-
Abstract
- Objectives: To characterize pretransfer on-site nursing home (NH) management, transfer disposition, and hospital discharge diagnoses of long-stay residents transferred for behavioral concerns.<br />Design: This was a secondary data analysis of the Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care project, in which clinical staff employed in the NH setting conducted medical, transitional, and palliative care quality improvement initiatives and gathered data related to resident transfers to the emergency department/hospital setting. R software and Microsoft Excel were used to characterize a subset of transfers prompted by behavioral concerns.<br />Setting: NHs in central Indiana were utilized (N = 19).<br />Participants: This study included long-stay NH residents with behavioral concerns prompting transfer for acute emergency department/hospital evaluation (N = 355 transfers).<br />Measurements: The measures used in this study were symptoms prompting transfer, resident demographics and baseline characteristics (Minimum Data Set 3.0 variables including scores for the Cognitive Function Scale, ADL Functional Status, behavioral symptoms directed toward others, and preexisting psychiatric diagnoses), on-site management (e.g., medical evaluation in person or by phone, testing, and interventions), avoidability rating, transfer disposition (inpatient vs emergency department only), and hospital discharge diagnoses.<br />Results: Over half of the transfers, 56%, had a medical evaluation before transfer, and diagnostic testing was conducted before 31% of transfers. After transfer, 80% were admitted. The most common hospital discharge diagnoses were dementia-related behaviors (27%) and altered mental status (27%), followed by a number of medical diagnoses.<br />Conclusion: Most transfers for behavioral concerns merited hospital admission, and medical discharge diagnoses were common. There remain significant opportunities to improve pretransfer management of NH transfers for behavioral concerns.<br /> (© 2020 The American Geriatrics Society.)
- Subjects :
- Aged
Ambulatory Care methods
Ambulatory Care statistics & numerical data
Comorbidity
Emergency Service, Hospital statistics & numerical data
Female
Hospitalization statistics & numerical data
Humans
Male
Mental Disorders epidemiology
Mental Disorders psychology
Mental Disorders therapy
Patient Transfer methods
Quality of Health Care standards
United States epidemiology
Dementia epidemiology
Dementia psychology
Dementia therapy
Medical Overuse prevention & control
Medical Overuse statistics & numerical data
Nursing Homes statistics & numerical data
Problem Behavior psychology
Psychomotor Agitation etiology
Psychomotor Agitation therapy
Skilled Nursing Facilities statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1532-5415
- Volume :
- 69
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of the American Geriatrics Society
- Publication Type :
- Academic Journal
- Accession number :
- 33216954
- Full Text :
- https://doi.org/10.1111/jgs.16920