Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments
Advance directives; African Americans; CONFIDENCE intervals; Gerontology And Geriatrics; Judgments; Nurses; Nursing; Quality of care; Quality of life; Race; Racism; Research design; Residential segregation; Rural areas; Rural education; Rural urban differences; Segregation; Social science research; Social workers; Urban education
Background and Objectives Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. We examined the professional judgments of SNF providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed and feelings of responsibility for ensuring ACP discussions Research Design and Methods Nurses and social workers (n = 350) within 29 urban SNFs completed surveys and rated vignettes describing eight typical SNF residents. Linear mixed modeling was used to examine factors that impacted ratings of need for ACP and responsibility for ensuring ACP. Results Neither the race of the provider, resident, nor the interaction of the two were associated with either outcome variable. In contrast, providers rated (on a 9-point scale) residents at high risk for hospitalization as more in need of ACP (estimate = 0.86, confidence interval [CI] 0.65, 1.07) and felt more responsible for ensuring ACP (estimate = 0.60, CI 0.42, 0.78) Discussion and Implications Research on ACP is continuing to evolve and these results show the primacy of disease trajectory variables on providers' judgments about ACP. Differences between providers indicate a need for stronger policies and education. Further, research comparing rural, suburban, and urban SNFs is needed to explore possible forms of structural racism such as residential and SNF segregation.
Baughman Kristin R; Ludwick PhD R N-B C C N S F A A N Ruth; Jarjoura PhD David; Kropp BS Denise; Shenoy BS Vimal
The Gerontologist
2019
2019-04
<a href="http://doi.org/10.1093/geront/gnx129" target="_blank" rel="noreferrer noopener">10.1093/geront/gnx129</a>
A foreigner in my own country: forgetting the heterogeneity of our national community.
Ohio; United States; Ethics; Rural Areas; Medical; Research by Discipline; Rural Health Services – Ethical Issues
Aultman JM
American Journal of Bioethics
2006
2006-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/15265160500506787" target="_blank" rel="noreferrer noopener">10.1080/15265160500506787</a>
The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey.
*Antibiotics; *Antimicrobial stewardship; *Infections; *Surgery; Academic Medical Centers; Anti-Infective Agents/*therapeutic use; Antibiotic Prophylaxis; Antiinfective Agents – Therapeutic Use; Antimicrobial Stewardship/*methods; Audit; Communicable Diseases; Community; Cross Sectional Studies; Cross-Sectional Studies; Culture; Data Analysis Software; Descriptive Statistics; Education; Female; Global Health/trends; Hospitals; Human; Humans; Infection – Prevention and Control; Infection Control – Methods; International Agencies; Intraabdominal Infections/*drug therapy; Male; Medical Organizations; Medical Practice; Microbiology; Multidisciplinary Care Team; Operative; Policy Making; Postoperative Complications/*drug therapy; Preoperative Care; Resource Allocation; Rural Areas; Specialization; Surgery; Surgical Wound Infection – Therapy; Surveys and Questionnaires; Urban Areas
BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p \textless 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.
Sartelli Massimo; Labricciosa Francesco M; Barbadoro Pamela; Pagani Leonardo; Ansaloni Luca; Brink Adrian J; Carlet Jean; Khanna Ashish; Chichom-Mefire Alain; Coccolini Federico; Di Saverio Salomone; May Addison K; Viale Pierluigi; Watkins Richard R; Scudeller Luigia; Abbo Lilian M; Abu-Zidan Fikri M; Adesunkanmi Abdulrashid K; Al-Dahir Sara; Al-Hasan Majdi N; Alis Halil; Alves Carlos; Araujo da Silva Andre R; Augustin Goran; Bala Miklosh; Barie Philip S; Beltran Marcelo A; Bhangu Aneel; Bouchra Belefquih; Brecher Stephen M; Cainzos Miguel A; Camacho-Ortiz Adrian; Catani Marco; Chandy Sujith J; Jusoh Asri Che; Cherry-Bukowiec Jill R; Chiara Osvaldo; Colak Elif; Cornely Oliver A; Cui Yunfeng; Demetrashvili Zaza; De Simone Belinda; De Waele Jan J; Dhingra Sameer; Di Marzo Francesco; Dogjani Agron; Dorj Gereltuya; Dortet Laurent; Duane Therese M; Elmangory Mutasim M; Enani Mushira A; Ferrada Paula; Esteban Foianini J; Gachabayov Mahir; Gandhi Chinmay; Ghnnam Wagih Mommtaz; Giamarellou Helen; Gkiokas Georgios; Gomi Harumi; Goranovic Tatjana; Griffiths Ewen A; Guerra Gronerth Rosio I; Haidamus Monteiro Julio C; Hardcastle Timothy C; Hecker Andreas; Hodonou Adrien M; Ioannidis Orestis; Isik Arda; Iskandar Katia A; Kafil Hossein S; Kanj Souha S; Kaplan Lewis J; Kapoor Garima; Karamarkovic Aleksandar R; Kenig Jakub; Kerschaever Ivan; Khamis Faryal; Khokha Vladimir; Kiguba Ronald; Kim Hong B; Ko Wen-Chien; Koike Kaoru; Kozlovska Iryna; Kumar Anand; Lagunes Leonel; Latifi Rifat; Lee Jae G; Lee Young R; Leppaniemi Ari; Li Yousheng; Liang Stephen Y; Lowman Warren; Machain Gustavo M; Maegele Marc; Major Piotr; Malama Sydney; Manzano-Nunez Ramiro; Marinis Athanasios; Martinez Casas Isidro; Marwah Sanjay; Maseda Emilio; McFarlane Michael E; Memish Ziad; Mertz Dominik; Mesina Cristian; Mishra Shyam K; Moore Ernest E; Munyika Akutu; Mylonakis Eleftherios; Napolitano Lena; Negoi Ionut; Nestorovic Milica D; Nicolau David P; Omari AbdelKarim H; Ordonez Carlos A; Paiva Jose-Artur; Pant Narayan D; Parreira Jose G; Pedziwiatr Michal; Pereira Bruno M; Ponce-de-Leon Alfredo; Poulakou Garyphallia; Preller Jacobus; Pulcini Celine; Pupelis Guntars; Quiodettis Martha; Rawson Timothy M; Reis Tarcisio; Rems Miran; Rizoli Sandro; Roberts Jason; Pereira Nuno Rocha; Rodriguez-Bano Jesus; Sakakushev Boris; Sanders James; Santos Natalia; Sato Norio; Sawyer Robert G; Scarpelini Sandro; Scoccia Loredana; Shafiq Nusrat; Shelat Vishalkumar; Sifri Costi D; Siribumrungwong Boonying; Soreide Kjetil; Soto Rodolfo; de Souza Hamilton P; Talving Peep; Trung Ngo Tat; Tessier Jeffrey M; Tumbarello Mario; Ulrych Jan; Uranues Selman; van Goor Harry; Vereczkei Andras; Wagenlehner Florian; Xiao Yonghong; Yuan Kuo-Ching; Wechsler-Fordos Agnes; Zahar Jean-Ralph; Zakrison Tanya L; Zuckerbraun Brian; Zuidema Wietse P; Catena Fausto
World journal of emergency surgery : WJES
2017
2017
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1186/s13017-017-0145-2" target="_blank" rel="noreferrer noopener">10.1186/s13017-017-0145-2</a>
The Relationship Between Organizational Characteristics and Advance Care Planning Practices.
Administrative Personnel; Adult; advance care planning; Advance Care Planning; Advance Care Planning/*organization & administration/standards; area agency on aging; Attitude of Health Personnel; care management; Case Management; Case Managers; Chi Square Test; Clinical Protocols/standards; community-based long-term care; Confidence Intervals; Cross Sectional Studies; Cross-Sectional Studies; Data Analysis Software; Descriptive Research; Descriptive Statistics; Female; Funding Source; Government Agencies; Human; Humans; Inservice Training/organization & administration; Interviews; Logistic Regression; Long Term Care; Male; Medicaid; Medicaid/statistics & numerical data; Middle Age; Middle Aged; Midwestern United States; Multivariate Analysis; nurses; Odds Ratio; Ohio; organizational characteristics; Organizational Culture; Practice Guidelines as Topic; Questionnaires; Registered Nurses; Rural Areas; social workers; Social Workers; Surveys; T-Tests; Telephone; United States; Urban Areas
Organizational characteristics may impede the uniform adoption of advance care planning (ACP) best practices. We conducted telephone interviews with site directors of a Midwestern state's Medicaid waiver program administered by the Area Agencies on Aging and surveyed the 433 care managers (registered nurses and social workers) employed within these 9 agencies. Care managers at 2 agencies reported more frequent ACP discussions and higher levels of confidence. Both sites had ACP training programs, follow-up protocols, and informational packets available for consumers that were not consistently available at the other agencies. The findings point to the need for consistent educational programs and policies on ACP and more in depth examination of the values, beliefs, and resources that account for organizational differences in ACP.
Baughman Kristin R; Ludwick Ruth; Palmisano Barbara; Hazelett Susan; Sanders Margaret
The American journal of hospice & palliative care
2015
2015-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1049909114530039" target="_blank" rel="noreferrer noopener">10.1177/1049909114530039</a>