Factors Associated with Undiagnosed Anemia in Older Patients Admitted to Skilled Nursing Facilities

2011 ◽  
Vol 12 (3) ◽  
pp. B11-B12
Author(s):  
D.V. Espino ◽  
D.V. Espino ◽  
H. Faldu ◽  
Y.P. Ye ◽  
M.R. Finley
Keyword(s):  
Older Patients ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Factors Associated

Extended Use of Urinary Catheters in Older Surgical Patients: A Patient Safety Problem?

2008 ◽  
Vol 29 (2) ◽  
pp. 116-124 ◽  
Author(s):  
Heidi L. Wald ◽  
Anne M. Epstein ◽  
Tiffany A. Radcliff ◽  
Andrew M. Kramer
Keyword(s):  
Orthopedic Surgery ◽  
Older Patients ◽  
Urinary Catheter ◽  
Gastrointestinal Surgery ◽  
Patient Characteristics ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Urinary Catheters ◽  
Skilled Nursing ◽  
Indwelling Urinary Catheter

Objectives.To explore the relationship between the extended postoperative use of indwelling urinary catheters and outcomes for older patients who have undergone cardiac, vascular, gastrointestinal, or orthopedic surgery in skilled nursing facilities and to describe patient and hospital characteristics associated with the extended use of indwelling urinary catheters.Design.Retrospective cohort study.Setting.US acute care hospitals and skilled nursing facilities.Patients.A total of 170,791 Medicare patients aged 65 years or more who were admitted to skilled nursing facilities after discharge from a hospital with a primary diagnosis code indicating major cardiac, vascular, orthopedic, or gastrointestinal surgery in 2001.Main Outcome Measures.Patient-specific 30-day rate of rehospitalization for urinary tract infection (UTI) and 30-day mortality rate, as well as the risk of having an indwelling urinary catheter at the time of admission to a skilled nursing facility.Results.A total of 39,282 (23.0%) of the postoperative patients discharged to skilled nursing facilities had indwelling urinary catheters. After adjusting for patient characteristics, the patients with catheters had greater odds of rehospitalization for UTI and death within 30 days than patients who did not have catheters. The adjusted odds ratios (aORs) for UTI ranged from 1.34 for patients who underwent gastrointestinal surgery (P <.001) to 1.85 for patients who underwent cardiac surgery (P <.001); the aORs for death ranged from 1.25 for cardiac surgery (P = .01) to 1.48 for orthopedic surgery (P = .002) and for gastrointestinal surgery (P < .001). After controlling for patient characteristics, hospitalization in the northeastern or southern regions of the United States was associated with a lower likelihood of having an indwelling urinary catheter, compared with hospitalization in the western region (P = .002 vs P = .03).Conclusions.Extended postoperative use of indwelling urinary catheters is associated with poor outcomes for older patients. The likelihood of having an indwelling urinary catheter at the time of discharge after major surgery is strongly associated with a hospital's geographic region, which reflects a variation in practice that deserves further study.

scholarly journals Covid-19 in Hospitalized Patients Admitted from Skilled Nursing Facilities: Factors Associated with Mortality

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 941-941
Author(s):  
Rongfang Zhan ◽  
Cheng Yin ◽  
Liam O'Neill
Keyword(s):  
Logistic Regression ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Nursing Home Residents ◽  
Binary Logistic Regression ◽  
Hospitalized Patients ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Factors Associated

Abstract Background Nursing home residents were impacted disproportionately by the coronavirus because of their vulnerabilities. Although many studies concentrated on risk factors associated with mortality of hospitalized patients, there were limited studies epitomizing them from skilled nursing facilities to hospitals. The study aims to identify inpatients’ characteristics on demographics, hospital admission types, insurance types, and chronic diseases associated with mortality among our cohort patients in Texas. Methods Individuals above 50 years, diagnosed with Covid-19, and admitted from skilled nursing facilities were included in the retrospective cohort study. Pearson’s Chi-Square and Mann-Whitney tests were applied to measure four major perspectives between survivors and non-survivors. Then, a binary logistic regression was employed to determine the association between independent variables and mortality. Results A total of 218 patients were included in the study, of which 54 (24.8%) died during hospitalization. According to the univariate analysis, expired patients were more likely to be emergency admission (p = 0.001), elective admission (p = 0.02), Medicaid as primary payment (p = 0.034), heart disease (p = 0.027), CKD (p = 0.03), and hypertension (p = 0.002). The binary logistic regression revealed that hypertension (OR = 3.176, 95% CI: 1.200-8.409, p = 0.02) and Medicaid (OR = 2.637, 95% CI: 1.287-5.405, p = 0.008) as primary payment had significantly high odds of mortality. Conclusion Hypertension and Medicaid as primary payment are the strongest predictive factors associated with mortality and suggest that hospitals in Texas distribute critical care and resources while prevent and treat them to increase survival rates.

scholarly journals Factors Associated With Candida auris Colonization and Transmission in Skilled Nursing Facilities With Ventilator Units, New York, 2016–2018

2020 ◽  
Author(s):  
John Rossow ◽  
Belinda Ostrowsky ◽  
Eleanor Adams ◽  
Jane Greenko ◽  
Robert McDonald ◽  
...  
Keyword(s):  
New York ◽  
New York State ◽  
Control Measures ◽  
Skilled Nursing Facilities ◽  
Care Hospital ◽  
Nursing Facilities ◽  
Candida Auris ◽  
Skilled Nursing ◽  
Infected People ◽  
Factors Associated

Abstract Background Candida auris is an emerging, multidrug-resistant yeast that spreads in healthcare settings. People colonized with C. auris can transmit this pathogen and are at risk for invasive infections. New York State (NYS) has the largest US burden (&gt;500 colonized and infected people); many colonized individuals are mechanically ventilated or have tracheostomy, and are residents of ventilator-capable skilled nursing facilities (vSNF). We evaluated the factors associated with C. auris colonization among vSNF residents to inform prevention interventions. Methods During 2016–2018, the NYS Department of Health conducted point prevalence surveys (PPS) to detect C. auris colonization among residents of vSNFs. In a case-control investigation, we defined a case as C. auris colonization in a resident, and identified up to 4 residents with negative swabs during the same PPS as controls. We abstracted data from medical records on patient facility transfers, antimicrobial use, and medical history. Results We included 60 cases and 218 controls identified from 6 vSNFs. After controlling for potential confounders, the following characteristics were associated with C. auris colonization: being on a ventilator (adjusted odds ratio [aOR], 5.9; 95% confidence interval [CI], 2.3–15.4), receiving carbapenem antibiotics in the prior 90 days (aOR, 3.5; 95% CI, 1.6–7.6), having ≥1 acute care hospital visit in the prior 6 months (aOR, 4.2; 95% CI, 1.9–9.6), and receiving systemic fluconazole in the prior 90 days (aOR, 6.0; 95% CI, 1.6–22.6). Conclusions Targeted screening of patients in vSNFs with the above risk factors for C. auris can help identify colonized patients and facilitate the implementation of infection control measures. Antimicrobial stewardship may be an important factor in the prevention of C. auris colonization.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

2021 ◽  
Author(s):  
Rachel A Prusynski ◽  
Allison M Gustavson ◽  
Siddhi R Shrivastav ◽  
Tracy M Mroz
Keyword(s):  
United States ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Hospital Readmissions ◽  
The United States ◽  
Skilled Nursing Facilities ◽  
Functional Improvement ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

scholarly journals Carbapenemase-Producing, Carbapenem-Resistant Acinetobacter baumannii: Summary of CDC Consultations, 2017–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s151-s152
Author(s):  
Lauren Epstein ◽  
Alicia Shugart ◽  
David Ham ◽  
Snigdha Vallabhaneni ◽  
Richard Brooks ◽  
...  
Keyword(s):  
Public Health ◽  
Acinetobacter Baumannii ◽  
Median Number ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Number Of Patients ◽  
Single Facility

Background: Carbapenemase-producing carbapenem-resistant Acinetobacter baumannii (CP-CRAB) are a public health threat due to potential for widespread dissemination and limited treatment options. We describe CDC consultations for CP-CRAB to better understand transmission and identify prevention opportunities. Methods: We defined CP-CRAB as CRAB isolates with a molecular test detecting KPC, NDM, VIM, or IMP carbapenemases or a plasmid-mediated oxacillinase (OXA-23, OXA-24/40, OXA-48, OXA-58, OXA-235/237). We reviewed the CDC database of CP-CRAB consultations with health departments from January 1, 2017, through June 1, 2019. Consultations were grouped into 3 categories: multifacility clusters, single-facility clusters, and single cases. We reviewed the size, setting, environmental culturing results, and identified infection control gaps for each consultation. Results: We identified 29 consultations involving 294 patients across 19 states. Among 9 multifacility clusters, the median number of patients was 12 (range, 2–87) and the median number of facilities was 2 (range, 2–6). Among 9 single-facility clusters, the median number of patients was 5 (range, 2–50). The most common carbapenemase was OXA-23 (Table 1). Moreover, 16 consultations involved short-stay acute-care hospitals, and 6 clusters involved ICUs and/or burn units. Also, 8 consultations involved skilled nursing facilities. Environmental sampling was performed in 3 consultations; CP-CRAB was recovered from surfaces of portable, shared equipment (3 consultations), inside patient rooms (3 consultations) and nursing stations (2 consultations). Lapses in environmental cleaning and interfacility communication were common across consultations. Among 11 consultations for single CP-CRAB cases, contact screening was performed in 7 consultations and no additional CP-CRAB was identified. All 4 patients with NDM-producing CRAB reported recent international travel. Conclusions: Consultations for clusters of oxacillinase-producing CP-CRAB were most often requested in hospitals and skilled nursing facilities. Healthcare facilities and public health authorities should be vigilant for possible spread of CP-CRAB via shared equipment and the potential for CP-CRAB spread to connected healthcare facilities.Funding: NoneDisclosures: None

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