Poster Abstracts / JAMDA 14 (2013) B3eB26
Cardiac Rehabilitation Program in a Skilled Nursing Facility
Quality Improvement Methods: Long term care facilities have implemented a medical group who focus on long term care medicine and use a model to provide intensive acute care to reduce hospitalization rates. The setting includes six long term care facilities which also provide skilled nursing care. Data was collected from admissions for the months January-June 2012 of each facility. Interventions include increased average availability of a medical provider ranging from 2-5 times per week as well as phone call coverage 24 hours/day. This level of care was implemented to try to improve quality of acute care changes in the long term care environment to reduce hospitalizations. Conclusion: Providers who practice primarily in long term care medicine and who provide intensive weekly rounds and coverage can lower hospitalization rates. Lowered hospitalization rates can lower national health care costs as well as ﬁnancial penalties to hospitals for elevated readmission rates. Author Disclosures: Vanessa Sturgill Fant, MD has stated there are no ﬁnancial disclosures to be made that are pertinent to this abstract.
Presenting Author: Arvind Modawal, MB BCH, MD, MPH, IPC: The Hospitalist Company Author(s): Arvind Modawal, MB BCH, MD, MPH
Deﬁning, Measuring and Improving Person Centered Care in Nursing Homes
discussions or focus groups. Evaluation: A primary measure of change is the proportion of residents receiving antipsychotic medications at 6 months and at 12 months when compared to the beginning of the program. Additionally, we are utilizing a pre-post survey to assess selfefﬁcacy for managing behavior problems and knowledge of conditions that contribute to BPSD. Conclusion: Behavioral case-conference is a means to enhance knowledge and skills for the identiﬁcation and management of BPSD and to encourage adoption of a patient-centered approach to care. Although, it is not a comprehensive approach to managing antipsychotic use, we anticipate improved implementation of nonpharmacologic techniques and a reduced need for antipsychotic drugs. Author Disclosures: All authors have stated there are no ﬁnancial disclosures to be made that are pertinent to this abstract.
Background: The majority of Cardiac Rehabilitation (CR) programs are hospital or outpatient-based, it is a new growth area for SNF. Meta-analysis found CR reduced recurrent myocardial infarction by 17% at 12 months and mortality by 47% at 2 years (Clark 2005). Objective/Aim: AIMS: The new CR program is a partnership at Oak Hills Nursing and Rehabilitation utilizes the services of the Oak Hills Nursing and Rehabilitation staff with integrated EMR, Medical Director providing onsite physician supervision and Paragon Rehabilitation providing Rehab services to improve care of patients with stable cardiac conditions. Quality Improvement Methods: Setting: 75 bed skilled nursing facility in Cincinnati, OH. Core Components: A CR program is deﬁned as a physiciansupervised program that provides the following in both inpatient residents and in outpatient: Patient assessment; lipid management; hypertension management; smoking cessation; diabetes management; nutritional counseling; weight management; physical activity counseling; psychosocial management; and exercise training. Cardiac therapy may include: Flexibility exercises; breathing exercise; Aerobic exercise; ADLs; strength training; balance exercises; gait training to promote independence; and walking programs. Participants eligible for program: Medically stable or can be stabilized. They include the following: Stable myocardial infarctions; coronary artery bypass graft surgery (CABG); angioplasty; post cardiac transplant surgery; stable CHF; and cardiac risk factors with comorbidity. Participants with unstable medical condition are excluded from the program: Unstable angina - i.e. - refractory to pharmacological management; acute congestive heart failure; uncontrolled dysrhythmias ; resting BP’s >200/100 mm Hg; moderate to severe aortic stenosis; third degree AV block; acute pericarditis; acutely treated for recent embolic events; resting ST segment depression greater than 3-4 mm; uncontrolled Diabetes Mellitus; moderate to severe cardiomyopathies; and orthopedic problems which preclude them from exercise. Conclusion: CR program can be successful in improving quality of life, increasing independence for participants and ﬁnancially beneﬁcial for the facility, physician and mid-level providers and therapy company. Author Disclosures: Arvind Modawal, MB BCH, MD, MPH has stated there are no ﬁnancial disclosures to be made that are pertinent to this abstract. Dedicated Providers of Long Term Care Medicine Can Lower Rates of Admissions to the Hospital Presenting Author: Vanessa Sturgill Fant, MD, Mid-Atlantic Eldercare Author(s): Vanessa Sturgill Fant, MD
Background: New guidelines implemented by CMS in October 2012 place a ﬁnancial penalty on hospitals for 30 day readmission rates.
Objective/Aim: To incorporate a provider system into the long term care environment to lower rates of admissions to the hospital setting.
Presenting Author: Howard B. Degenholtz, PhD, University of Pittsburgh Health Policy and Management Author(s): Howard B. Degenholtz, PhD
Background: Person Centered Care (PCC) is a philosophy, embraced most popularly by the culture change movement that attempts to shift the focus of caregivers to the resident as a whole person. The goal is to address the individual’s needs, goals and preferences in a way that respects their identity and autonomy. While resident decision making and autonomy have long been part of the regulatory and clinical framework for nursing homes, the concept and embrace of PCC as a way to organize the daily lives of residents is relatively new. Objective/Aim: The Advancing Excellence Campaign, in 2012, has adopted PCC as a goal area, and convened a working group to develop an approach for participating nursing homes to adopt PCC practices as part of their broader quality improvement activities. The working group has developed an Enhanced Resident Interview for PCC and associated tools for implementing the new interview. Quality Improvement Methods: After a review of the peer review and grey literature, the working group decided to focus on resident quality of life (QOL) as the primary outcome of PCC. In addition, the working group felt that PCC needed to be a routine part of resident assessment and care planning. Therefore, the group developed an approach which ‘enhances’ the sections of the Minimum Data Set 3.0 (MDS) that capture resident preferences for daily living and activities. For each of the 16 items in Section F of the MDS, the enhanced interview measures how often the resident’s preferences are met. A set of open-ended probes can be used to learn resident’s preferences for each activity or preference area. A simple red-yellow-green algorithm was developed to triage the 16 questions by comparing the standard MDS assessment item that rates the importance of each issue and the enhanced items that rate frequency. For example, if a resident indicates than an issue is important but does not occur, this will be coded as ‘red’. For individual care planning, staff is directed to focus on the red zone issues. At the facility level, it is straightforward to track the proportion of residents with one or more issues in the red zone. A Root Cause Analysis tool was developed to help facilities identify barriers to meeting residents’ preferences. The Advancing Excellence Campaign will make the tools available to participating facilities as well as a spreadsheet that automatically calculates red-yellow-green and facilitates uploading the data for benchmarking purposes. Conclusion: The Advancing Excellence Campaign is an important forum for bringing together experts in long term care to develop state of the art tools for quality improvement. The Enhanced Resident Interview for PCC is an example of the ways that the Campaign is helping the industry improve quality. Author Disclosures: Howard B. Degenholtz, PhD has stated there are no ﬁnancial disclosures to be made that are pertinent to this abstract.