COVID-19 Recommendations for Assisted Living: Implications for the Future

Similar to nursing homes, COVID-19 has challenged assisted living (AL), given its congregate nature and vulnerable residents. However, COVID-19 recommendations have not consistently recognized differences between nursing homes and AL, and in so doing present implications for the future of AL. This project examined COVID-19 recommendations from six key organizations and compared them across nursing homes and AL. Differences include recommending more flexible visitation and group activities for AL, while similarities suggest that AL may best integrate health care into offered services (e.g., work with consulting clinicians who know residents and the AL community). Primary points to be discussed are that COVID-19 may accelerate the closer coordination of social work and medical care into AL, because recommendations suggest AL would benefit from the services and expertise of nurses, social workers, and physicians. There seems to be an unmet need to mitigate loneliness in AL, which warrants specific attention moving forward.

Health Care Professionals’ Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis

Incentive-based pay-for-performance (P4P) models have been introduced during the last 2 decades as a mechanism to improve the delivery of evidence-based care that ensures clinical quality and improves health outcomes. There is mixed evidence that P4P has a positive effect on health outcomes and researchers cite lack of engagement from health care professionals as a limiting factor. This qualitative metasynthesis of existing qualitative research was conducted to integrate health care professionals’ perceptions of P4P in clinical practice. Four themes emerged during the research process: positive perceptions of the value of performance measurement and associated financial incentives; negative perceptions of the performance measurement and associated financial incentives; perceptions of how P4P programs influence the quality/appropriateness of care; and perceptions of the influence of P4P program on professional roles and workplace dynamics. Identifying factors that influence health care professionals’ perceptions about this type of value-based payment model will guide future research.

Decrease in (Major) Amputations in Diabetics: A Secondary Data Analysis by AOK Rheinland/Hamburg

Aim. In two German regions with 11.1 million inhabitants, 6 networks for specialized treatment of DFS were implemented until 2008. Data provided for accounting purposes was analysed in order to determine changes in the rate of diabetics requiring amputations in the years before and after the implementation.Method. Data covering 2.9 million people insured by the largest insurance company between 2007 and 2013 was analysed by the use of log-linear Poisson regression adjusted for age, gender and region.Results. The rate of diabetics needing major amputations fell significantly by 9.5% per year (p<0.0001) from 217 to 126 of 100,000 patients per year. The rate of diabetics needing amputations of any kind fell from 504 to 419 of 100,000 patients per year (p=0.0038).Discussion. The networks integrate health care providers in an organised system of shared care. They educate members of the medical community and the general public. At the same time, a more general disease management program for people with diabetes was implemented, which may also have contributed to this decrease. At the end of the observation period, the rate of diabetics requiring amputations was still high. For this reason, further expansion of organised specialized care is urgently needed.

Evaluation of Perinatal Care Management Programs: An Integrated Review

Nursing care management has become a popular method to integrate health care systems with goals of decreasing costs and improving quality. As high-risk pregnancies and newborn intensive care unit (NBICU) costs generate some of the highest costs in health care, care management has been a strategy introduced in perinatal medicine to accomplish the same goals. Consistent with other areas of nursing, perinatal care management currently has no agreed upon model of practice or method of evaluating how and whether the goals have been achieved. The purpose of this project was to evaluate various perinatal care management programs found in the literature. Electronic and manual searches of current data were performed locating 31 relevant articles. From these articles, nine met the inclusion criteria and were reviewed. While some care management programs were able to decrease costs and improve outcomes, other programs did not. There are possibly two reasons for the varied results in the literature. The first is that there are differences in program designs, decreasing the likelihood of identifying specific interventions that can make a difference. Second, thus far researchers have used ineffective study designs in evaluating care management programs. More research needs to be completed before a conclusion can be drawn whether perinatal care management can decrease costs while improving quality.