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1.
J Am Med Dir Assoc ; : 105254, 2024 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-39255950

RESUMO

OBJECTIVES: To assess the staffing patterns of direct care nursing staff by shift in nursing homes (NHs), assisted living communities (ALCs), and their corresponding memory care units (MCUs). DESIGN: Observational study of the 2021 Ohio Biennial Survey of Long-Term Care Facilities and the Payroll-Based Journal data for December 2021. SETTING AND PARTICIPANTS: NHs (n = 678) and ALCs (n = 542) that reported staffing by shift in Ohio. METHODS: Resident-to-staff ratios in Ohio were calculated from staffing data. The proportion of daily nursing staff assigned to each shift was based on staffing data from the Biennial Survey for NHs and ALCs. Outcomes were calculated for aides and licensed nursing staff. RESULTS: Ohio's NHs and ALCs had lower resident-to-staff ratios on the day shift. Lower resident-to-staff ratios mean there were more staff per resident (ie, better staffed). For both types of staff and all shifts, overall resident-to-staff ratios were lower in NHs than ALCs. However, resident-to-staff ratios for ALC MCUs were on par with NH MCUs. This was consistent with ALC and NH MCUs staffing in a more similar manner. Across all settings, the day shift had the most staff members present, while a number of ALCs had no licensed nurses on duty during the overnight shift. CONCLUSIONS AND IMPLICATIONS: NHs and ALCs have different staffing patterns due to differences in resident needs. However, as ALCs provide for more residents that need NH level of care, ALCs may require additional staffing, especially on the overnight shift where some ALCs have no licensed nurses on duty. The evidence here can be used for decision making about future staffing policies, whether facility-wide policies that encompass MCUs or state-wide policies, so that care delivery aligns with care needs.

2.
J Am Med Dir Assoc ; 22(10): 2074-2078, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34237257

RESUMO

Person-centered care (PCC) in nursing homes is an elusive organizational goal that has attracted the attention of pay-for-performance (P4P) programs. P4P programs are used to incentivize providers to improve the quality of care delivered. However, P4P programs have both overarching policy initiatives (big "P") that must incorporate an implementation framework that is adaptable in practice (little "p"). The purpose of this paper is to apply six key factors that are central to P4P design in long-term care settings: financial incentives, measurement, stakeholder involvement and alignment, feasibility, education and awareness, and reporting and transparency as a framework for a case study of a P4P initiative conducted in Ohio between 2015 and 2019. Notably, the case study is focused on PCC and how the Ohio Department of Medicaid selected the Preferences for Everyday Living Inventory (PELI) for nursing home providers to use with all of their residents. Although inclusion of the PELI met some of the key factors, such as measurement, its implementation did not meet other key factors, such as reporting and transparency. Based on lessons learned from the Ohio P4P, recommendations are presented for use of the PELI as both a process and outcome measure in future P4P initiatives.


Assuntos
Casas de Saúde , Reembolso de Incentivo , Humanos , Assistência de Longa Duração , Ohio , Assistência Centrada no Paciente , Estados Unidos
3.
Artif Cells Nanomed Biotechnol ; 47(1): 132-143, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30663430

RESUMO

Glioblastoma is a heterogeneous disease with multiple genotypic origins. Despite treatment protocols such as surgery, radiotherapy and chemotherapy, the prognosis for patients remains poor. This study investigates the cytotoxic and radiation dose-enhancing and radiosensitizing ability of five rare earth oxide nanoparticles, in two different immortalized mammalian cell lines; U-87 MG and Mo59K. Significant cytotoxicity was observed in U-87 MG cells when exposed to Nd2O3 and La2O3. Autophagy was also detected in cells after incubation with Nd2O3. Radiosensitization was observed in U-87 MG when incubated with Gd2O3, CeO2-Gd and Nd2O3:Si. Importantly, these elements did not cause any intrinsic toxicity in the absence of irradiation and so could be considered biocompatible. The Gd2O3 and CeO2-Gd nanoparticles were also seen to generate ROS in U-87 MG cells after irradiation. Furthermore, the Mo59K and U-87 MG cells responded very differently to exposure to the rare earth nanoparticles. This may indicate the importance of the genotype of cells in the successful use of rare earth oxides for treatment.


Assuntos
Glioblastoma/patologia , Nanopartículas Metálicas/química , Metais Terras Raras/química , Metais Terras Raras/farmacologia , Radiossensibilizantes/química , Radiossensibilizantes/farmacologia , Autofagia/efeitos dos fármacos , Autofagia/efeitos da radiação , Neoplasias Encefálicas/patologia , Divisão Celular/efeitos dos fármacos , Divisão Celular/efeitos da radiação , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Proliferação de Células/efeitos da radiação , Relação Dose-Resposta a Droga , Humanos , Espécies Reativas de Oxigênio/metabolismo
4.
Provider ; 43(1): 32-4, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29601695

RESUMO

Nursing center academy prepares leaders for new regulatory requirements and performance-based health care.


Assuntos
Academias e Institutos , Liderança , Assistência de Longa Duração , Enfermeiros Administradores , Equipe de Assistência ao Paciente/organização & administração , California , Humanos
5.
J Am Med Dir Assoc ; 15(9): 671-80, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24721341

RESUMO

BACKGROUND: Increasingly, nursing home (NH) providers are adopting a person-centered care (PCC) philosophy; yet, they currently lack methods to measure their progress toward this goal. Few PCC tools meet criteria for ease of use and feasibility in NHs. The purpose of this article is to report on the development of the concept and measurement of preference congruence among NH residents (phase 1), its refinement into a set of quality indicators by Advancing Excellence in America's Nursing Homes (phase 2), and its pilot evaluation in a sample of 12 early adopting NHs prior to national rollout (phase 3). The recommended toolkit for providers to use to measure PCC consists of (1) interview materials for 16 personal care and activity preferences from Minimum Data Set 3.0, plus follow-up questions that ask residents how satisfied they are with fulfillment of important preferences; and (2) an easy to use Excel spreadsheet that calculates graphic displays of quality measures of preference congruence and care conference attendance for an individual, household or NH. Twelve NHs interviewed residents (N = 146) using the toolkit; 10 also completed a follow-up survey and 9 took part in an interview evaluating their experience. RESULTS: NH staff gave strong positive ratings to the toolkit. All would recommend it to other NHs. Staff reported that the toolkit helped them identify opportunities to improve PCC (100%), and found that the Excel tool was comprehensive (100%), easy to use (90%), and provided high quality information (100%). Providers anticipated using the toolkit to strengthen staff training as well as to enhance care planning, programming and quality improvement. CONCLUSIONS: The no-cost PCC toolkit provides a new means to measure the quality of PCC delivery. As of February 2014, over 700 nursing homes have selected the Advancing Excellence in America's Nursing Homes PCC goal as a focus for quality improvement. The toolkit enables providers to incorporate quality improvement by moving beyond anecdote, and advancing more systematically toward honoring resident preferences.


Assuntos
Casas de Saúde/normas , Assistência Centrada no Paciente/normas , Qualidade da Assistência à Saúde , Idoso , Humanos , Entrevistas como Assunto , Projetos Piloto , Desenvolvimento de Programas , Indicadores de Qualidade em Assistência à Saúde , Inquéritos e Questionários , Estados Unidos
6.
Gerontologist ; 54 Suppl 1: S17-24, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24443602

RESUMO

PURPOSE OF THE STUDY: Descriptions of culture change adoption are often complex and varied, creating a challenge for those seeking guidance about which of the many components of culture change to adopt and in what order and combination. DESIGN AND METHODS: To begin to address this question, members of The Research Initiative Valuing Eldercare (THRIVE) developed and distributed an online survey to 327 known culture change adopters. Of these, 164 (50%) completed the survey. Data were analyzed to identify adopted components, co-occurrence of adopted components, and differences in these across various types of nursing home models (i.e., traditional unit, household, and small house). RESULTS: Our findings support unique co-occurrence of components across nursing home models. Results also show that homes with more traditional environments have been able to implement certain culture change components without large capital investments required by renovations. IMPLICATIONS: The adoption patterns suggest that the co-occurrence of components should be considered when pursuing organizational transformations to support culture change.


Assuntos
Difusão de Inovações , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Cultura Organizacional , Assistência Centrada no Paciente , Idoso , Idoso de 80 Anos ou mais , Evolução Cultural , Pesquisas sobre Atenção à Saúde , Humanos , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde
7.
Gerontologist ; 54 Suppl 1: S35-45, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24443604

RESUMO

PURPOSE OF THE STUDY: Culture change models are intended to improve the quality of life for nursing home residents, but the impact of these models on quality of care is unknown. We evaluated the impact of the implementation of nursing home culture change on the quality of care, as measured by staffing, health-related survey deficiencies, and Minimum Data Set (MDS) quality indicators. DESIGN AND METHODS: From the Pioneer Network, we have data on whether facilities were identified by experts as "culture change" providers in 2004 and 2009. Using administrative data, we employed a panel-based regression approach in which we compared pre-post quality outcomes in facilities adopting culture change between 2004 and 2009 against pre-post quality outcomes for a propensity score-matched comparison group of nonadopters. RESULTS: Nursing homes that were identified as culture change adopters exhibited a 14.6% decrease in health-related survey deficiency citations relative to comparable nonadopting homes, while experiencing no significant change in nurse staffing or various MDS quality indicators. IMPLICATIONS: This research represents the first large-scale longitudinal evaluation of the association of culture change and nursing home quality of care. Based on the survey deficiency results, nursing homes that were identified as culture change adopters were associated with better care although the surveyors were not blind to the nursing home's culture change efforts. This finding suggests culture change may have the potential to improve MDS-based quality outcomes, but this has not yet been observed.


Assuntos
Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Inovação Organizacional , Assistência Centrada no Paciente/métodos , Qualidade da Assistência à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Inquéritos Epidemiológicos , Humanos , Masculino , Cultura Organizacional
8.
Gerontologist ; 54 Suppl 1: S65-75, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24443608

RESUMO

PURPOSE OF THE STUDY: A key directive of the Affordable Care Act of 2010 is to transform both institutional and community-based long-term care into a more person-centered system. In the nursing home industry, the culture change movement is central to this shift in philosophy. If policymakers are to further encourage implementation of culture change, they need to better understand the factors associated with implementation. DESIGN AND METHODS: Using logistic regression (N = 16,835), we examined the extent to which resident, facility, and state characteristics relate to a nursing home being identified by experts as having implemented culture change over the period 2004 through 2011. RESULTS: At baseline, the 291 facilities that were later identified by experts to have implemented culture change were more often nonprofit-owned, larger in size, and had fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. States experienced greater culture change implementation when they paid a higher Medicaid per diem. IMPLICATIONS: To date, nursing home culture change has been implemented differentially by higher resource facilities, and nursing homes have been responsive to state policy factors when implementing culture change.


Assuntos
Implementação de Plano de Saúde/métodos , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Assistência Centrada no Paciente , Qualidade da Assistência à Saúde/organização & administração , Evolução Cultural , Grupos Diagnósticos Relacionados , Difusão de Inovações , Humanos , Assistência de Longa Duração/organização & administração , Inovação Organizacional , Organizações sem Fins Lucrativos , Propriedade , Setor Público , Características de Residência , Governo Estadual , Estados Unidos
9.
Health Serv Res ; 48(6 Pt 2): 2157-80, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24138774

RESUMO

OBJECTIVE: To use the experience from a health services research evaluation to provide guidance in team development for mixed methods research. METHODS: The Research Initiative Valuing Eldercare (THRIVE) team was organized by the Robert Wood Johnson Foundation to evaluate The Green House nursing home culture change program. This article describes the development of the research team and provides insights into how funders might engage with mixed methods research teams to maximize the value of the team. RESULTS: Like many mixed methods collaborations, the THRIVE team consisted of researchers from diverse disciplines, embracing diverse methodologies, and operating under a framework of nonhierarchical, shared leadership that required new collaborations, engagement, and commitment in the context of finite resources. Strategies to overcome these potential obstacles and achieve success included implementation of a Coordinating Center, dedicated time for planning and collaborating across researchers and methodologies, funded support for in-person meetings, and creative optimization of resources. CONCLUSIONS: Challenges are inevitably present in the formation and operation of effective mixed methods research teams. However, funders and research teams can implement strategies to promote success.


Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Relações Interprofissionais , Projetos de Pesquisa , Idoso , Comportamento Cooperativo , Instituição de Longa Permanência para Idosos/organização & administração , Humanos , Liderança , Casas de Saúde/organização & administração , Cultura Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Integração de Sistemas
11.
Provider ; 34(8): 18-20, 22-3, 26 passim, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18778008
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