Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-25T17:40:26.481Z Has data issue: false hasContentIssue false
  • English
  • Français

A Survey of Nursing Home Organizational Characteristics Associated with Potentially Avoidable Hospital Transfers and Care Quality in One Large British Columbia Health Region

Published online by Cambridge University Press:  08 December 2011

Margaret J. McGregor ,
Jennifer Baumbusch ,
Riyad B. Abu-Laban ,
Kimberlyn M. McGrail ,
Dug Andrusiek ,
Judith Globerman ,
Shannon Berg ,
Michelle B. Cox ,
Kia Salomons  and
Jan Volker
...Show all authors
Margaret J. McGregor*
Affiliation:
Department of Family Practice, University of British Columbia (UBC) Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation UBC Centre for Health Services and Policy Research
Jennifer Baumbusch
Affiliation:
UBC School of Nursing
Riyad B. Abu-Laban
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation UBC Division of Emergency Medicine
Kimberlyn M. McGrail
Affiliation:
UBC Centre for Health Services and Policy Research
Dug Andrusiek
Affiliation:
British Columbia Ambulance Service Medical Programs
Judith Globerman
Affiliation:
Dr. Irving & Phyliss Snider Campus for Jewish Seniors
Shannon Berg
Affiliation:
UBC Centre for Health Services and Policy Research
Michelle B. Cox
Affiliation:
Department of Family Practice, University of British Columbia (UBC)
Kia Salomons
Affiliation:
Department of Family Practice, University of British Columbia (UBC)
Jan Volker
Affiliation:
Department of Family Practice, University of British Columbia (UBC)
Lisa Ronald
Affiliation:
Department of Family Practice, University of British Columbia (UBC) Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation
*
*Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Margaret J. McGregor, M.D., MHSc Department of Family Practice University of British Columbia Room 713, 828 West 10th Avenue Vancouver, BC V5Z 1L8([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with better care quality. Accordingly, we conducted a cross-sectional survey of nursing home directors of care in Vancouver Coastal Health, a large health region in British Columbia. The survey addressed staffing levels and organization, physician access, end-of-life care, and factors influencing facility-to-hospital transfers. Many of the modifiable organizational characteristics associated in the literature with potentially avoidable hospital transfers and better care quality are present in nursing homes in British Columbia. However, their presence is not universal, and some features, especially the organization of physician care and end-of-life planning and services, are particularly lacking.

Résumé

L’hospitalisation des résidents en maisons de soins infirmiers peut être futile aussi bien que coûteux, et il y a maintenant des preuves qui indiquent que le traitement des résidents des maisons de soins infirmiers en place donne de meilleurs résultats pour certaines conditions. Nous avons examiné les caractéristiques organisationnelles des installations que des récherches précédentes ont montré sont associées à des transferts de l’hôpital potentiellement évitables et avec une meilleure qualité de soins. En conséquence, nous avons mené une enquête transversale de l’administration des maisons de soins infirmiers dans Vancouver Coastal Health, une grande région sanitaire en la Colombie-Britannique. Le sondage portait sur les niveaux de dotation de personnel et l’organisation, l’accès aux médecins, les soins au fin de vie, et les facteurs influençant transferts de l’installation à l’hôpital. Un bon nombre des caractéristiques organisationnels modifiables, associés dans la littérature avec les transferts hospitaliers potentiellement évitables, et de meilleure qualité de soins, sont présents dans les maisons de soins infirmiers en la Colombie-Britannique. Cependant, leur présence n’est pas universelle, et certaines fonctionnalités sont particulièrement en défaut, en particulier l’organisation des soins médicaux et le planification et les services pour la fin de vie.

Keywords

vieillissementmaison de soins infirmierssoins résidentiels de longue duréetransfert à hôpitalsoins de qualitédotation en personnelfin de vieagingnursing homeresidential long-term carehospital transfercare qualitystaffingend-of-life
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 30 , Issue 4 , December 2011 , pp. 551 - 561
Copyright
Copyright © Canadian Association on Gerontology 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Reference List

Ackermann, R.J., & Kemle, K.A. (1998). The effect of a physician assistant on the hospitalization of nursing home residents. Journal of the American Geriatrics Society, 46(5), 610–614.CrossRefGoogle ScholarPubMed
Allman, R.M., Laprade, C.A., Noel, L.B., Walker, J.M., Moorer, C.A., Dear, M.R., et al. . (1986). Pressure sores among hospitalized patients. Annals of Internal Medicine, 105(3), 337–342.CrossRefGoogle ScholarPubMed
Barry, T.T., Brannon, D., & Mor, V. (2005). Nurse aide empowerment strategies and staff stability: effects on nursing home resident outcomes. The Gerontologist, 45(3), 309–317.CrossRefGoogle ScholarPubMed
Bates-Jensen, B.M., Schnelle, J.F., Alessi, C.A., Al-Samarrai, N.R., & Levy-Storms, L. (2004). The effects of staffing on in-bed times of nursing home residents. Journal of the American Geriatric Society, 52(6), 931–938.CrossRefGoogle ScholarPubMed
Bergman, H., & Clarfield, A.M. (1991). Appropriateness of patient transfer from a nursing home to an acute-care hospital: A study of emergency room visits and hospital admissions. Journal of the American Geriatrics Society, 39(12), 1164–1168.CrossRefGoogle Scholar
Bottrell, M.M., O’Sullivan, J.F., Robbins, M.A., Mitty, E.L., & Mezey, M.D. (2001). Transferring dying nursing home residents to the hospital: DON perspectives on the nurse’s role in transfer decisions. Geriatric Nursing, 22(6), 313–317.CrossRefGoogle Scholar
Bourbonniere, M., Feng, Z., Intrator, O., Angelelli, J., Mor, V., & Zinn, J.S. (2006). The use of contract licensed nursing staff in U.S. nursing homes. Medical Care Research and Review, 63(1), 88–109.CrossRefGoogle ScholarPubMed
Brooks, S., Warshaw, G., Hasse, L., & Kues, J.R. (1994). The physician decision-making process in transferring nursing home patients to the hospital. Archives of Internal Medicine, 154(8), 902–908.CrossRefGoogle ScholarPubMed
Buchanan, J.L., Murkofsky, R.L., O’Malley, A.J., Karon, S.L., Zimmerman, D., Caudry, D.J., et al. . (2006). Nursing home capabilities and decisions to hospitalize: A survey of medical directors and directors of nursing. Journal of the American Geriatrics Society, 54(3), 458–465.Google ScholarPubMed
Canadian Healthcare Association. (2009). New directions for facility-based long term care. Ottawa, Ontario, Canada: Canadian Healthcare Association. Retrieved July 31, 2010, from http://www.cha.ca/index.php?option=com_content&view=article&id=223&Hemid=101Google Scholar
Canadian Healthcare Association. (2010). Guide to Canadian Healthcare Facilities. Ottawa, Ontario, Canada: Canadian Healthcare Association.Google Scholar
Canadian Union of Public Employees. (2009). Residential long-term care in Canada – Our vision for better senior’s care. Ottawa, Ontario, Canada: Canadian Union of Public Employees.Google Scholar
Carter, K.S. (2009). The best of care: Getting it right for seniors in British Columbia (Part 1). Victoria: BCOmbudsperson, Retrieved July 31, 2010, fromhttp://www.ombudsman.bc.ca/images/resources/reports/Public_Reports/Public_Report_No_46.pdf.Carter,M.W.2003.Google Scholar
Carter, M.W., & Porell, F.W. (2005). Vulnerable populations at risk of potentially avoidable hospitalizations: The case of nursing home residents with Alzheimer’s disease. American Journal of Alzheimer’s Disease and Other Dementias, 20(6), 349–358.CrossRefGoogle ScholarPubMed
Casarett, D., Karlawish, J., Morales, K., Crowley, R., Mirsch, T., & Asch, D.A. (2005). Improving the use of hospice services in nursing homes: A randomized controlled trial. Journal of the American Medical Association, 294(2), 211–217.CrossRefGoogle ScholarPubMed
US Centers for Medicare and Medicaid Services. (2001). Report to Congress: Appropriateness of minimum nurse staffing ratios in nursing homes: Phase II final report. Report No.: 2 of 3. Prepared by Abt Associates Inc. Baltimore: US Center for Medicare and Medicaid Services. Retrieved August 29, 2011 fromhttp://www.allhealth.org/briefingmaterials/abt-nursestaffingratios(12-01)-999.pdfGoogle Scholar
Cohen, M., Tate, J., & Baumbush, J. (2009). An uncertain future for seniors – BC’s restructuring of home and community health care, 2001–2008. Canadian Centre for Policy Alternatives. Vancouver Retrieved August 29, 2011 fromhttp://www.policyalternatives.ca/publications/reports/uncertain-future-seniorsGoogle Scholar
Decker, F.H. (2008). The relationship of nursing staff to the hospitalization of nursing home residents. Research in Nursing and Health, 31(3), 238–251.Google Scholar
Dosa, D. (2005). Should I hospitalize my resident with nursing-home acquired pneumonia? Controversies in Long-term Care, 6(5), 327–333.Google ScholarPubMed
Engle, VF. (1998). Care of the living, care of the dying: Reconceptualizing nursing home care. Journal of the American Geriatric Society, 46(9), 1172–1174.CrossRefGoogle ScholarPubMed
Finucane, P., Wundke, R., Whitehead, C., Williamson, L., & Baggoley, C. (2000). Use of in-patient hospital beds by people living in residential care. Gerontology, 46(3), 133–138.CrossRefGoogle ScholarPubMed
Fried, T.R., Gillick, M.R., & Lipsitz, L.A. (1997). Short-term functional outcomes of long-term care residents with pneumonia treated with and without hospital transfer. Journal of the American Geriatric Society, 45(3), 302–306.CrossRefGoogle ScholarPubMed
Gillick, M.R, Serrell, N.A., & Gillick, L.S. (1982). Adverse consequences of hospitalization in the elderly. Social Science and Medicine, 16(10), 1033–1038.CrossRefGoogle ScholarPubMed
Grabowski, D.C., O’Malley, A.J., & Barhydt, N.R. (2007). The costs and potential savings associated with nursing home hospitalizations. Health Affairs (Millwood), 26(6), 1753–1761.CrossRefGoogle ScholarPubMed
Grabowski, D.C., Stewart, K.A., Broderick, S.M., & Coots, L.A. (2008). Predictors of nursing home hospitalization: A review of the literature. Medical Care Research and Review, 65(1), 3–39.CrossRefGoogle ScholarPubMed
Harrington, C., & Swan, J.H. (2003). Nursing home staffing, turnover, and case mix. Medical Care Research and Review, 60(3), 366–392.CrossRefGoogle ScholarPubMed
Horn, S.D., Buerhaus, P., Bergstrom, N., & Smout, R.J. (2005). RN staffing time and outcomes of long-stay nursing home residents: Pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care. American Journal of Nursing, 105(11), 58–70.CrossRefGoogle ScholarPubMed
Hutt, E., Ecord, M., Eilertsen, T.B., Frederickson, E., & Kramer, A.M. (2002). Precipitants of emergency room visits and acute hospitalization in short-stay Medicare nursing home residents. Journal of the American Geriatrics Society, 50(2), 223–229.CrossRefGoogle ScholarPubMed
Hutt, E, Frederickson, E., Ecord, M., & Kramer, A.M. (2003). Associations among processes and outcomes of care for Medicare nursing home residents with acute heart failure. Journal of the American Medical Directors Association, 4(4), 195–199.CrossRefGoogle ScholarPubMed
Intrator, O., Castle, N.G., & Mor, V. (1999). Facility characteristics associated with hospitalization of nursing home residents: Results of a national study. Medical Care, 37(3), 228–237.CrossRefGoogle ScholarPubMed
Intrator, O., Grabowski, D.C., Zinn, J., Schleinitz, M., Feng, Z., Miller, S., et al. . (2007). Hospitalization of nursing home residents: The effects of states’ Medicaid payment and bed-hold policies. Health Services Research, 42(4), 1651–1671.CrossRefGoogle ScholarPubMed
Intrator, O., Zinn, J., & Mor, V. (2004). Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. Journal of the American Geriatrics Society, 52(10), 1730–1736.CrossRefGoogle ScholarPubMed
Jones, J., Dwyer, P., White, L., & Firman, R. (1997). Patient transfer from nursing home to emergency department: Outcomes and policy implications. Academic Emergency Medicine, 4(9), 908–915.CrossRefGoogle ScholarPubMed
Konetzka, R.T., Spector, W., & Limcangco, M.R. (2008). Reducing hospitalizations from long-term care settings. Medical Care Research and Review, 65(1), 40–66.CrossRefGoogle ScholarPubMed
Lee, S. W., Goh, C., & Chan, Y.H. (2003). Emergency department usage by community step-down facilities – patterns and recommendations. Annals of the Academy of Medicine, Singapore, 32(5), 697–702.Google ScholarPubMed
McGregor, M.J., Pare, D., Wong, A., Cox, M.B., & Brasher, P. (2010). Correlates of a “Do Not Hospitalize” designation in a sample of frail nursing home residents in Vancouver, Canada. Canadian Family Physician, 56(11), 1158–1164.Google Scholar
McGregor, M.J., Tate, R.B., McGrail, K.M., Ronald, L.A., Broemeling, A.M., & Cohen, M. (2006). Care outcomes in long-term care facilities in British Columbia, Canada. Does ownership matter? Medical Care, 44(10), 929–935.CrossRefGoogle ScholarPubMed
Miller, S.C., Gozalo, P., & Mor, V. (2001). Hospice enrollment and hospitalization of dying nursing home patients. American Journal of Medicine, 111(1), 38–44.CrossRefGoogle ScholarPubMed
Molloy, D.W., Guyatt, G.H., Russo, R., Goeree, R., O’Brien, B.J., Bedard, M., et al. . (2000). Systematic implementation of an advance directive program in nursing homes: A randomized controlled trial. Journal of the American Medical Association, 283(11), 1437–1444.CrossRefGoogle ScholarPubMed
Rantz, M.J., Hicks, L., Grando, V., Petroski, G.F., Madsen, R.W., Mehr, D.R., et al. . (2004). Nursing home quality, cost, staffing, and staff mix. The Gerontologist, 44(1), 24–38.CrossRefGoogle ScholarPubMed
Schnelle, J.F., Simmons, S.F., Harrington, C., Cadogan, M., Garcia, E., & Bates-Jensen, M. (2004). Relationship of nursing home staffing to quality of care. Health Services Research, 39(2), 225–250.CrossRefGoogle ScholarPubMed
Sharkey, S. (2008). People caring for people – Impacting the quality of life and care for residents of long-term care homes – A report of the independent review of staffing and care standards for long-term care homes in Ontario. Ontario Governnment. Retrieved August 29, 2011 fromhttp://www.health.gov.on.ca/english/public/pub/ministry_reports/staff_care_standards/staff_care_standards.pdfGoogle Scholar
Spector, W.D., Selden, T.M., & Cohen, J.W. (1998). The impact of ownership type on nursing home outcomes. Health Economics, 7(7), 639–653.Google ScholarPubMed
Travis, S.S., Loving, G., McClanahan, L., & Bernard, M. (2001). Hospitalization patterns and palliation in the last year of life among residents in long-term care. The Gerontologist, 41(2), 153–160.CrossRefGoogle ScholarPubMed
Zimmerman, S., Gruber-Baldini, A.L., Hebel, J.R., Sloane, P.D., & Magaziner, J. (2002). Nursing home facility risk factors for infection and hospitalization: Importance of registered nurse turnover, administration, and social factors. Journal of the American Geriatric Society, 50(12), 1987–1995.CrossRefGoogle ScholarPubMed
Zweig, S.C., Kruse, R.L., Binder, E.F., Szafara, K.L., & Mehr, D.R. (2004). Effect of do-not-resuscitate orders on hospitalization of nursing home residents evaluated for lower respiratory infections. Journal of the American Geriatrics Society, 52(1), 51–58.CrossRefGoogle ScholarPubMed