Multi-Site Study of Provider Self-Efficacy and Beliefs in Explaining Judgments About Need and Responsibility for Advance Care Planning.
advance care planning; nurses; social workers; factorial survey; self-efficacy; decision-making; skilled nursing facilities; beliefs
BACKGROUND AND OBJECTIVES: We examined the impact of advance care planning (ACP) self-efficacy and beliefs in explaining skilled nursing facility (SNF) provider judgments about resident need and provider responsibility for initiating ACP conversations. RESEARCH DESIGN AND METHODS: This observational multi-site study of 348 registered nurses, licensed practical nurses, and social workers within 29 SNFs used an anonymous survey in which providers judged vignettes with assigned situational features of a typical SNF resident. Mixed modeling was used to analyze the vignette responses. RESULTS: Providers who had more negative beliefs about ACP were less likely to judge residents in need of ACP and less likely to feel responsible for ensuring ACP took place. Self-efficacy did not have a significant impact on judgments of need, but did significantly increase judgments of responsibility for ensuring ACP conversations. Providers with the highest levels of ACP self-efficacy were most likely to feel responsible for ensuring ACP conversations. In an exploratory analysis, these relationships remained the same whether responding to high or low risk residents (i.e., based on risk of hospitalization, type of diagnosis, functional status, and rate of declining health). DISCUSSION AND IMPLICATIONS: Both negative beliefs about ACP and self-efficacy in one's ability to conduct ACP discussions were associated with professional judgments regarding ACP. The findings illustrate the importance of addressing negative beliefs about ACP and increasing provider ACP self-efficacy through education and policies that empower nurses and social workers.
Baughman KR; Ludwick R; Jarjoura D; Yeager M; Kropp D
The American Journal Of Hospice & Palliative Care
2020
2020-12-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1177/1049909120979977" target="_blank" rel="noreferrer noopener">10.1177/1049909120979977</a>
Heart Failure in Post-Acute and Long-Term Care: Evidence and Strategies to Improve Transitions, Clinical Care, and Quality of Life
2013 accf/aha guideline; association; cognitive impairment; discharge education; Emergency department; Geriatrics & Gerontology; Heart failure; hospitalized-patients; older patients; palliative care; post-acute care; scientific statement; skilled nursing facilities; task-force; transitional care
Heart failure (HF) is highly prevalent among older patients in skilled nursing facilities (SNFs). HF outcomes for SNF patients suffer because of many factors, including staff training, lack of physician availability, and failure to implement evidence-based care. AMDA - The Society for Post-Acute and Long-Term Care Medicine has recently updated the Clinical Practice Guidelines for Heart Failure Management in SNFs. This review supplements the Guidelines with a robust focus on best practices for transitional care, symptom management, treatment and monitoring, and palliative care in patients with HF. (C) 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
Nazir A; Smucker W D
Journal of the American Medical Directors Association
2015
2015-10
Journal Article
<a href="http://doi.org/10.1016/j.jamda.2015.05.006" target="_blank" rel="noreferrer noopener">10.1016/j.jamda.2015.05.006</a>
Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States: Insights From the Nationwide Readmissions Database.
*aortic stenosis; *costs and cost analysis; *length of stay; *Patient Readmission/economics; *readmission; *rehospitalization; *transcatheter aortic valve implantation; *transcatheter aortic valve replacement; 80 and over; Aged; Aortic Valve Stenosis/diagnosis/economics/*surgery; Comorbidity; Databases; Factual; Female; Hospital Costs; Humans; Length of Stay; Male; Patient Discharge; Postoperative Complications/etiology; Risk Factors; Skilled Nursing Facilities; Time Factors; Transcatheter Aortic Valve Replacement/*adverse effects/economics; Treatment Outcome; United States
BACKGROUND: Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. METHODS AND RESULTS: Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay \textgreater5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), \textgreater4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. CONCLUSIONS: Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, TAVR access site, and post-procedure complications. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs.
Kolte Dhaval; Khera Sahil; Sardar M Rizwan; Gheewala Neil; Gupta Tanush; Chatterjee Saurav; Goldsweig Andrew; Aronow Wilbert S; Fonarow Gregg C; Bhatt Deepak L; Greenbaum Adam B; Gordon Paul C; Sharaf Barry; Abbott J Dawn
Circulation. Cardiovascular interventions
2017
2017-01
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/10.1161/CIRCINTERVENTIONS.116.004472" target="_blank" rel="noreferrer noopener">10.1161/CIRCINTERVENTIONS.116.004472</a>
Transfer of DNR orders to the ED from extended care facilities.
*Advance Directives; *Critical Illness; *Health Services for the Aged; *Skilled Nursing Facilities; 80 and over; 80 and Over; Advance Directives; Aged; Coding – Administration; Coding – Standards; Critical Illness; Do-not-resuscitate; Emergency Medical Services – Administration; Emergency Medical Services/*organization & administration; Emergency Service; EMS; Extended care facilities; Female; Forms and Records Control/*organization & administration/standards; Health Services for the Aged; Hospital; Human; Humans; Length of Stay; Male; Medical Records – Statistics and Numerical Data; Medical Records/*statistics & numerical data; Middle Age; Middle Aged; Ohio; Outcome Assessment; Outcome Assessment (Health Care); Patient Advocacy; Physicians; Prospective Studies; Resuscitation Orders; Skilled Nursing Facilities
PURPOSE/OBJECTIVE: With an elderly and chronically ill patient population visiting the emergency department, it is important to know patients' wishes regarding care preferences and advanced directives. Ohio law states DNR orders must be transported with the patient when they leave an extended care facility (ECF). We reviewed the charts of ECF patients to evaluate which patients presenting to the ED had their DNR status recognized by the physician and DNR orders that were made during their hospital stay. METHODS: We prospectively enrolled patients presenting from ECFs to the ED, blinding the treating team to the purpose. We did a chart review for the presence of a DNR form, demographic data and acknowledgement of the DNR forms. RESULTS: Fifty patients were enrolled in this study. The mean age was 77.6years and 56% were female. Twenty-eight percent had a DNR order transported to the ED, but 68% had a DNR preference noted in their ECF notes. Registration only noted an advanced directive on 32% of patients (p=0.09). Eighteen percent had a DNR noted by the ED physician (p=0.42). Sixteen percent of patients had a DNR order written by an ED physician while 28% had a DNR order written by a non-ED physician during their inpatient evaluation. Thirty percent had a palliative care consult while in the hospital, but there was no significant association between DNR from the ECF and these consults. CONCLUSIONS: Hospital staff did a poor job of noting DNR preferences and ECFs were inconsistent with sending Ohio DNR forms.
McQuown Colleen M; Frey Jennifer A; Amireh Ahmad; Chaudhary Ali
The American journal of emergency medicine
2017
2017-07
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/10.1016/j.ajem.2017.02.007" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2017.02.007</a>