To adapt the Assessing Care of Vulnerable Elders project nursing home (NH) specific quality indicators (QIs), for use with routinely collected data, and to evaluate which clinical conditions and types of care were inadequately measured using these data sources.
This study found that a high percentage of nursing home residents hospitalized for hip fracture and stroke (80% and 64% respectively) used Medicare-paid skilled nursing facilities, yet had outcomes similar to those who did not use such care.
Twice-daily feeding assistance promotes food and fluid intake and weight gain in nursing home residents at risk for weight loss. Delivery of snacks between meals requires less staff time than at mealtime and thus may be more practical to implement.
Finds that questions addressing the effect of pain on day-to-day functions are an important addition to standardized pain assessments in nursing homes, particularly for persons who report intermediate levels of pain severity.
Nurse aide agency staff of less than 14 full-time equivalents per 100 beds has little influence on quality in nursing homes, whereas nurse aide agency staff of more than 25 full-time equivalents per 100 beds has a substantial influence on quality.
Finds variability in advance directive documentation for nursing home patients on transfer to the emergency department, and finds that emergency clinicians experience substantial difficulty in reliably obtaining information about advance directives.