Browsing by Subject "transfers"

Now showing 1 - 3 of 3
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    The Complexity of Determining Whether a Nursing Home Transfer Is Avoidable at Time of Transfer
    (Wiley, 2018-05) Unroe, Kathleen T.; Carnahan, Jennifer L.; Hickman, Susan E.; Sachs, Greg A.; Hass, Zachary; Arling, Greg; Medicine, School of Medicine
    Objectives To describe the relationship between nursing facility resident risk conditions and signs and symptoms at time of acute transfer and diagnosis of conditions associated with potentially avoidable acute transfers (pneumonia, urinary tract infection, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) or asthma, dehydration, pressure sores). Design As part of a demonstration project to reduce potentially avoidable hospital transfers, Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project clinical staff collected data on residents who transferred to the emergency department (ED) or hospital. Cross‐tabulations were used to identify associations between risk conditions or symptoms and hospital diagnoses or death. Mixed‐effects logistic regression models were used to describe the significance of risk conditions, signs, or symptoms as predictors of potentially avoidable hospital diagnoses or death. Setting Indiana nursing facilities (N=19). Participants Long‐stay nursing facility residents (N=1,174), who experienced 1,931 acute transfers from November 2014 to July 2016. Measurements Participant symptoms, transfers, risk factors, and hospital diagnoses. Results We found that 44% of acute transfers were associated with 1 of 6 potentially avoidable diagnoses. Symptoms before transfer did not discriminate well among hospital diagnoses. Symptoms mapped into multiple diagnoses and most hospital diagnoses had multiple associated symptoms. For example, more than two‐thirds of acute transfers of residents with a history of CHF and COPD were for reasons other than exacerbations of those two conditions. Conclusion Although it is widely recognized that many transfers of nursing facility residents are potentially avoidable, determining “avoidability” at time of transfer is complex. Symptoms and risk conditions were only weakly predictive of hospital diagnoses.
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    COVID-19 in Older Adults: Transfers Between Nursing Homes and Hospitals
    (ACEP, 2020) Levine, Stacie; Bonner, Alice; Perry, Adam; Melady, Donald; Unroe, Kathleen T.; Medicine, School of Medicine
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    Long-Stay Nursing Facility Resident Transfers: Who Gets Admitted to the Hospital?
    (AGS, 2020-09) Unroe, Kathleen T.; Caterino, Jeffrey M.; Stump, Timothy E.; Tu, Wanzhu; Carnahan, Jennifer L.; Vest, Joshua R.; Sachs, Greg A.; Hickman, Susan E.; Medicine, School of Medicine
    BACKGROUND/OBJECTIVES The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project is a successful, multicomponent demonstration project to reduce potentially avoidable hospitalizations of long-stay nursing facility residents. To continue to reduce hospital transfers, a more detailed understanding of these transfer events is needed. The purpose of this study was to describe differences in transfer events that result in treatment in the hospital versus emergency department (ED) only. DESIGN OPTIMISTIC project nurses collected data on residents who transferred. Transfer events that resulted in treatment in ED versus hospitalization were compared using t-tests and chi-square tests. A generalized estimating equations regression model was used to assess the associations between hospital admission and transfer characteristics. PARTICIPANTS A total of 867 long-stay nursing facility residents enrolled in OPTIMISTIC, January 2015 to June 2016. MEASUREMENTS Resident and transfer characteristics from Minimum Data Set and project REDCap (Research Electronic Data Capture) database, including demographics, cognitive status, comorbidities, symptoms at time of transfer, and diagnoses. RESULTS The most common symptoms associated with treatment in the ED only were falls, trauma, or fracture (38% vs 10% admitted). Residents with cognitive impairment were more likely to be admitted to the hospital (odds ratio (OR) = 1.47; 95% confidence interval (CI) = 1.09–1.98; P = .011). Residents with respiratory complaints were more likely to be admitted (OR = 2.098; 95% CI = 1.198–3.675; P = .009); residents with hematological/bleeding (nongastrointestinal) (OR = 0.23; 95% CI = 0.107–0.494; P = .0002), pain (OR = 0.421; 95% CI = 0.254–0.698; P = .0008), or fall/trauma/fracture (OR = 0.181; 95% CI = 0.12–0.272; P < .001) were less likely to be admitted to the hospital. CONCLUSION Some presenting symptoms and other characteristics are more associated with ED only treatment versus hospitalization. A knowledge of who is likely to receive ED only care could prompt adoption of targeted resources and protocols to further reduce these types of transfer events. Opportunity may exist in the ED as well to reduce hospitalizations and increase discharges back to the facility.