scholarly journals A Randomized Trial of Heart Failure Disease Management in Skilled Nursing Facilities: Design and Rationale

2013 ◽  
Vol 14 (9) ◽  
pp. 710.e5-710.e11 ◽  
Author(s):  
Rebecca S. Boxer ◽  
Mary A. Dolansky ◽  
Christine A. Bodnar ◽  
Mendel E. Singer ◽  
Jeffery M. Albert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Disease Management ◽  
Randomized Trial ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Facilities Design ◽  
Heart Failure Disease Management

Improving Heart Failure Disease Management in Skilled Nursing Facilities

2013 ◽  
Vol 22 (4) ◽  
pp. 432-447 ◽  
Author(s):  
Mary A. Dolansky ◽  
Jeanne A. Hitch ◽  
Ileana L. Piña ◽  
Rebecca S. Boxer
Keyword(s):  
Heart Failure ◽  
Disease Management ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Heart Failure Disease Management

scholarly journals A randomized trial of heart failure disease management in skilled nursing facilities (SNF Connect): Lessons learned

2017 ◽  
Vol 14 (3) ◽  
pp. 308-313 ◽  
Author(s):  
Andrea Daddato ◽  
Heidi L Wald ◽  
Carolyn Horney ◽  
Diane L Fairclough ◽  
Erin C Leister ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Disease Management ◽  
Lessons Learned ◽  
Skilled Nursing Facilities ◽  
Patient Recruitment ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Recruitment Challenges ◽  
Heart Failure Disease Management

Background/Aims: Conducting clinical trials in skilled nursing facilities is particularly challenging. This manuscript describes facility and patient recruitment challenges and solutions for clinical research in skilled nursing facilities. Methods: Lessons learned from the SNF Connect Trial, a randomized trial of a heart failure disease management versus usual care for patients with heart failure receiving post-acute care in skilled nursing facilities, are discussed. Description of the trial design and barriers to facility and patient recruitment along with regulatory issues are presented. Results: The recruitment of Denver-metro skilled nursing facilities was facilitated by key stakeholders of the skilled nursing facilities community. However, there were still a number of barriers to facility recruitment including leadership turnover, varying policies regarding research, fear of litigation and of an increased workload. Engagement of facilities was facilitated by their strong interest in reducing hospital readmissions, marketing potential to hospitals, and heart failure management education for their staff. Recruitment of patients proved difficult and there were few facilitators. Identified patient recruitment challenges included patients being unaware of their heart failure diagnosis, patients overwhelmed with their illness and care, and frequently there was no available proxy for cognitively impaired patients. Flexibility in changing the recruitment approach and targeting skilled nursing facilities with higher rates of admissions helped to overcome some barriers. Conclusion: Recruitment of skilled nursing facilities and patients in skilled nursing facilities for clinical trials is challenging. Strategies to attract both facilities and patients are warranted. These include aligning study goals with facility incentives and flexible recruitment protocols to work with patients in “transition crisis.”

scholarly journals 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization

2018 ◽  
Vol 2 (S1) ◽  
pp. 87-87
Author(s):  
Himali Weerahandi ◽  
Li Li ◽  
Jeph Herrin ◽  
Kumar Dharmarajan ◽  
Lucy Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Hazard Rate ◽  
Skilled Nursing Facilities ◽  
Unplanned Readmission ◽  
Time Interval ◽  
Fee For Service ◽  
Nursing Facilities ◽  
Heart Failure Hospitalization ◽  
Skilled Nursing

OBJECTIVES/SPECIFIC AIMS: Determine timing of risk of readmissions within 30 days among patients first discharged to a skilled nursing facilities (SNF) after heart failure hospitalization and subsequently discharged home. METHODS/STUDY POPULATION: This was a retrospective cohort study of patients with SNF stays of 30 days or less following discharge from a heart failure hospitalization. Patients were followed for 30 days following discharge from SNF. We categorized patients based on SNF length of stay (LOS): 1–6 days, 7–13 days, 14–30 days. We then fit a piecewise exponential Bayesian model with the outcome as time to readmission after discharge from SNF for each group. Our event of interest was unplanned readmission; death and planned readmissions were considered as competing risks. Our model examined 2 different time intervals following discharge from SNF: 0–3 days post SNF discharge and 4–30 days post SNF discharge. We reported the hazard rate (credible interval) of readmission for each time interval. We examined all Medicare fee-for-service (FFS) patients 65 and older admitted from July 2012 to June 2015 with a principal discharge diagnosis of HF, based on methods adopted by the Centers for Medicare and Medicaid Services (CMS) for hospital quality measurement. RESULTS/ANTICIPATED RESULTS: Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home [median age, 84 years (IQR; 78–89); female, 61.0%]; 13,257 (19.2%) were discharged with home care, 54,328 (80.4%) without. Median length of SNF admission was 17 days (IQR; 11–22). In total, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge; median time to readmission was 9 days (IQR; 3–18). The hazard rate of readmission for each group was significantly increased on days 0–3 after discharge from SNF compared with days 4–30 after discharge from SNF. In addition, the hazard rate of readmission during the first 0–3 days after discharge from SNF decreased as the LOS in SNF increased. DISCUSSION/SIGNIFICANCE OF IMPACT: The hazard rate of readmission after SNF discharge following heart failure hospitalization is highest during the first 6 days home. Length of stay at SNF also has an effect on risk of readmission immediately after discharge from SNF; patients with a longer length of stay in SNF were less likely to be readmitted in the first 3 days after discharge from SNF.

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