Impact of Urinary Incontinence Related to Overactive Bladder on Long-Term Care Residents and Facilities: A Perspective From Directors of Nursing.

The current study assessed the impact of urinary incontinence (UI) on residents, staff, care processes, and quality measures in long-term care (LTC) settings. A 70-question quantitative online survey was sent to directors of nursing (DONs) who had worked for ≥1 year in a ≥100-bed facility (≥80% LTC beds). Of the 62% of residents with UI, 40% were always incontinent, and 81% used incontinence products for UI. Overall, 59% of DONs reported that UI management contributes to certified nursing assistant turnover. Approximately 36% of resident falls occurred while trying to get to the bathroom. LTC quality measures reported as significantly impacted by UI included urinary tract infection and falls with major injury. Only 14% of residents with UI were treated with medication. Most (75%) DONs were unaware of any link between anticholinergic medications and risk of cognitive side effects. These results highlight the need for improved UI treatment, awareness, and management in this population. [Journal of Gerontological Nursing, 48(7), 38-46.].

Population Health Service Organizations: Managed Care Gets a New 4-Wheel Drive Vehicle To Navigate the Value-based Terrain.

Population health service organizations (PHSOs) are supplanting management service organizations that gained popularity in the '90s. PHSOs are emerging as the organizations within health systems that can improve the clinical and financial outcomes of the populations the health systems serve.

Telemedicine Seems To Work But Payment Creates a Disconnect.

The cost savings go to payers, but providers often wind up footing the bill. Value-based care could solve the problem.

Why Different Health Systems Treat The Same Kind of Patient Differently.

ACOs may be the answer to striking the right balance between utilization and clinical outcomes, but separate Part D coverage throws a wrench into the works.

Improving the management of disruptive behavior and reducing antipsychotic medications in nursing facility residents.

OBJECTIVE: The objective of this work is to improve the management of disruptive behavior in the nursing facility setting through an interdisciplinary team (IDT) approach to reduce the use of antipsychotic medications in accordance with the Centers for Medicare & Medicaid Services initiative. DATA SOURCES, EXTRACTION, AND SYNTHESIS: The process began with a search and review of more than 100 peer-reviewed articles, government, and association resources that focused on the management of disruptive behavior in older adults. While data were limited to the past 10 years, the vast majority of data reviewed were within the past 5 years. This information was reviewed and discussed by all of the coauthors who meet in person at the American Society of Consultant Pharmacists as a work group. This group was tasked with identifying strategies through an IDT to improve the management of disruptive behavior and reduce the use of antipsychotic medications in nursing facility residents. In addition, significant follow-up work was accomplished following the live working session. CONCLUSION: Through an IDT, strategies can be implemented for long-term care residents to prevent and better manage disruptive behavior. These strategies can result in the reduction of the use of antipsychotic medications. The field of long-term care would benefit from further research to identify additional nonpharmacologic and pharmacologic treatments for managing disruptive behavior.

Impact of health care reform on reproductive service providers.

The Affordable Care Act affects access to reproductive services in many ways. Beginning in 2014 many individuals will purchase health insurance through the State Insurance Exchanges being drawn to this market by the affordable coverage made even more so by premium subsidies available to lower income individuals. The plans being offered through these exchanges must provide coverage that meets the benefits as defined under the Essential Health Benefits. However, it still remains unclear how Essential Health Benefits will be described and specifically what, if any, reproductive services will be included. Beyond the exchanges low income individuals will have access to the expansion in Medicaid occurring in many states starting also in 2014. Each state Medicaid program is responsible for describing their extent of coverage for reproductive services. Already in place affecting many younger individuals in need of reproductive services is the Dependent 26 provision, which provides coverage to dependents up to the age of 26 under a guardian's insurance. These provisions of the Affordable Care Act may increase access to reproductive services for many individuals previously uninsured or underinsured.

Improving dementia care: the role of screening and detection of cognitive impairment.

The value of screening for cognitive impairment, including dementia and Alzheimer's disease, has been debated for decades. Recent research on causes of and treatments for cognitive impairment has converged to challenge previous thinking about screening for cognitive impairment. Consequently, changes have occurred in health care policies and priorities, including the establishment of the annual wellness visit, which requires detection of any cognitive impairment for Medicare enrollees. In response to these changes, the Alzheimer's Foundation of America and the Alzheimer's Drug Discovery Foundation convened a workgroup to review evidence for screening implementation and to evaluate the implications of routine dementia detection for health care redesign. The primary domains reviewed were consideration of the benefits, harms, and impact of cognitive screening on health care quality. In conference, the workgroup developed 10 recommendations for realizing the national policy goals of early detection as the first step in improving clinical care and ensuring proactive, patient-centered management of dementia.