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Minimum Data Set (minimum + data_set)
Kinds of Minimum Data Set Selected AbstractsThe Effect of State Medicaid Case-Mix Payment on Nursing Home Resident AcuityHEALTH SERVICES RESEARCH, Issue 4p1 2006Zhanlian Feng Objective. To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Data Sources. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. Study Design. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. Data Collection/Extraction Methods. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Principal Findings. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. Conclusions. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents. [source] Does Prospective Payment Really Contain Nursing Home Costs?HEALTH SERVICES RESEARCH, Issue 2 2002Li-Wu Chen Objective. To examine whether nursing homes would behave more efficiently, without compromising their quality of care, under prospective payment. Data Sources. Four data sets for 1994: the Skilled Nursing Facility Minimum Data Set, the Online Survey Certification and Reporting System file, the Area Resource File, and the Hospital Wage Indices File. A national sample of 4,635 nursing homes is included in the analysis. Study Design. Using a modified hybrid functional form to estimate nursing home costs, we distinguish our study from previous research by controlling for quality differences (related to both care and life) and addressing the issues of output and quality endogeneity, as well as using more recent national data. Factor analysis was used to operationalize quality variables. To address the endogeneity problems, instrumental measures were created for nursing home output and quality variables. Principal Findings. Nursing homes in states using prospective payment systems do not have lower costs than their counterpart facilities under retrospective cost-based payment systems, after quality differences among facilities are controlled for and the endogeneity problem of quality variables is addressed. Conclusions. The effects of prospective payment on nursing home cost reduction may be through quality cuts, rather than cost efficiency. If nursing home payments under prospective payment systems are not adjusted for quality, nursing homes may respond by cutting their quality levels, rather than controlling costs. Future outcomes research may provide useful insights into the adjustment of quality in the design of prospective payment for nursing home care. [source] The impact of personal characteristics on engagement in nursing home residents with dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2009Jiska Cohen-Mansfield Abstract Objective To examine the impact of personal attributes on engagement in persons with dementia. Methods Participants were 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia. Cognitive functioning was assessed via the Mini-Mental State Examination, and engagement was assessed via the Observational Measure of Engagement. Data pertaining to activities of daily living were obtained from the Minimum Data Set. Results Women had longer mean engagement duration than men, and significant results were not seen with the other demographic variables. Significant, positive correlations were found between higher cognitive functioning and longer engagement duration, more attention, a more positive attitude, and a higher refusal rate. There was a positive and significant correlation between the comorbidity index and engagement duration, and between the number of medications and attention. All functional status variables yielded significance in a positive direction. Participants with poor hearing had a higher refusal rate. Cognitive status was the most consistent and potent predictor of engagement in this population. Conclusion Despite a higher refusal rate among those with higher cognitive levels, their overall engagement with stimuli is higher. Caregivers should anticipate higher refusal rates in those with poor hearing, and therefore compensatory methods should be used in presenting stimuli in this population. The potent role of cognitive and functional status on engagement of persons with dementia underscores the importance of tailoring activities to nursing home residents' needs, interests, and limitations. Copyright © 2009 John Wiley & Sons, Ltd. [source] Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residentsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2007Louis Paquay Abstract Objective To compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly , Revised (CAMDEX-R) was used as the reference standard. Study design and setting This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for aged people. Main outcome measures Indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). Results The CAMDEX-based prevalence of cognitive impairment was 75%. The diagnostic values of a CPS score of two or more for the detection of cognitive impairment were: sensitivity,=,0.81; specificity,=,0.80; PPV,=,0.92; NPV,=,0.57. The diagnostic values of a MMSE score of less than or equal 23 were: sensitivity,=,0.97; specificity,=,0.59; PPV,=,0.88; NPV,=,0.85. For CPS, the area under the receiver operating characteristic (ROC) curve was 0.87 (95% CI, 0.81,0.91), and not significantly different (p,=,0.63) from the MMSE score, 0.88 (0.83,0.93). Conclusions CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents. Copyright © 2006 John Wiley & Sons, Ltd. [source] Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-upINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2006Hanna-Mari Alanen Abstract Objective To analyse the use of antipsychotic medications, change over time and associated factors in a three-year follow-up among elderly residents in long-term institutional care. Design Retrospective study was designed with three identical cross-sectional samples originating from the same long-term care facilities, and collected 1 July to 31 December in 2001, 2002 and 2003, in Finland. These were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set (MDS) assessments. Setting Of the data providers 16 were hospital-based institutions and 25 residential homes. Participants Each of the data sets included 3662-3867 resident assessments. Results The prevalence use of one or more antipsychotic decreased from 42% in 2001 to 39% in 2003. The overall confounder-adjusted decrease in antipsychotic use was not statistically significant. However, the use of antipsychotics decreased among residents who had wandering as a behavioural problem (OR 0.79, 95% CI 0.63,0.99) and increased among residents with concomitant use of anxiolytic medications (OR 1.23, 95% CI 1.03,1.48). Conclusions The use of antipsychotic medications among residents in long-term institutional care was common and the caring patterns were quite stable during the observation period. Adequate indications may not have been achieved in all cases. More attention should be paid to the appropriate use of antipsychotics in this frail population. Copyright © 2006 John Wiley & Sons, Ltd. [source] The first Australian nurse practitioner census: A protocol to guide standardized collection of information about an emergent professional groupINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2010Sandy Middleton RN PhD Middleton S, Gardner G, Gardner A, Della P, Gibb M, Millar L. International Journal of Nursing Practice 2010; 16: 517,524 The first Australian nurse practitioner census: A protocol to guide standardized collection of information about an emergent professional group Internationally, collection of reliable data on new and evolving health-care roles is crucial. We describe a protocol for design and administration of a national census of an emergent health-care role, namely nurse practitioners in Australia using databases held by regulatory authorities. A questionnaire was developed to obtain data on the role and scope of practice of Australian nurse practitioners. Our tool comprised five sections and included a total of 56 questions, using 28existing items from the National Nursing and Midwifery Labour Force Census and nine items recommended in the Nurse Practitioner Workforce Planning Minimum Data Set. Australian Nurse Registering Authorities (n = 6) distributed the survey on our behalf. This paper outlines our instrument and methods. The survey was administered to 238 authorized Australian nurse practitioners (85% response rate). Rigorous collection of standardized items will ensure health policy is informed by reliable and valid data. We will re-administer the survey 2 years following the first survey to measure change over time. [source] Using Nursing Interventions Classification as a Framework to Revise the Belgian Nursing Minimum Data SetINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2009Koen Van den Heede PhD Nursing Interventions Classification (NIC); Minimale Verpleegkundige Gegevens; ontwikkeling van consensus PURPOSE., To develop the revised Belgian nursing minimum data set (B-NMDS). METHODS., The Nursing Interventions Classification (NIC, 2nd edition) was used as a framework. Six expert nurse panels (cardiology, oncology, intensive care, pediatrics, geriatrics, chronic care) were consulted. Seventy-nine panelists completed standardized e-mail questionnaires and discussed results in face-to-face meetings. FINDINGS., We initially selected 256 of 433 NIC interventions. After panel discussions, plenary meetings, and pretesting, the revised B-NMDS (alpha version) contained 79 items covering 22 NIC classes and 196 NIC interventions. CONCLUSIONS., Consensus building promoted acceptance of the B-NMDS, while the NIC provided a good theoretical basis and guaranteed international comparability. IMPLICATIONS FOR NURSING PRACTICE., The revised B-NMDS instrument can be used to visualize nursing activities in different applications (e.g., financing, staffing allocation). DOELSTELLING., Ontwikkeling van een nieuwe versie van de Minimale Verpleegkundige Gegevens (MVG). METHODE., De Nursing Interventions Classification (NIC, 2nd editie) werd gebruikt als raamwerk. Zes experten panels (cardiologie, oncologie, intensieve zorgen, pediatrie, geriatrie, chronische zorg) werden geraadpleegd. Zeven-en-negentig panelleden vulden gestandaardiseerde e-mail vragenlijsten in en bediscussieerden de resultaten in werkgroepvergaderingen. RESULTATEN., We selecteerden initieel 256 van de 433 NIC-interventies. Na panel-discussies, plenaire vergaderingen, en pre-tests, bevatte de herziene MVG (alpha versie) 79 items uit 22 NIC klassen en 196 NIC-interventies. CONCLUSIES., Het draagvlak voor de herziene versie van MVG werd gecreëerd door het nastreven van consensus. Het gebruik van NIC vormde hierbij een geode theoretische basis en verhoogt het internationaal karakter van de nieuwe MVG. IMPLICATIES VOOR DE VERPLEEGKUNDIGE PRAKTIJK., De nieuwe MVG kan gebruikt worden om de dagelijkse verpleegkundige praktijk zichtbaar te maken in verschillende beleidsdomeinen (e.g., financiering, toewijzing personeel). [source] Preparing a large data set for analysis: using the Minimum Data Set to study perineal dermatitisJOURNAL OF ADVANCED NURSING, Issue 4 2005Kay Savik MS Aim., The aim of this paper is to present a practical example of preparing a large set of Minimum Data Set records for analysis, operationalizing Minimum Data Set items that defined risk factors for perineal dermatitis, our outcome variable. Background., Research with nursing home elders remains a vital need as ,baby boomers' age. Conducting research in nursing homes is a daunting task. The Minimum Data Set is a standardized instrument used to assess many aspects of a nursing home resident's functional capability. United States Federal Regulations require a Minimum Data Set assessment of all nursing home residents. These large data would be a useful resource for research studies, but need to be extensively refined for use in most statistical analyses. Although fairly comprehensive, the Minimum Data Set does not provide direct measures of all clinical outcomes and variables of interest. Method., Perineal dermatitis is not directly measured in the Minimum Data Set. Additional information from prescribers' (physician and nurse) orders was used to identify cases of perineal dermatitis. The following steps were followed to produce Minimum Data Set records appropriate for analysis: (1) identification of a subset of Minimum Data Set records specific to the research, (2) identification of perineal dermatitis cases from the prescribers' orders, (3) merging of the perineal dermatitis cases with the Minimum Data Set data set, (4) identification of Minimum Data Set items used to operationalize the variables in our model of perineal dermatitis, (5) determination of the appropriate way to aggregate individual Minimum Data Set items into composite measures of the variables, (6) refinement of these composites using item analysis and (7) assessment of the distribution of the composite variables and need for transformations to use in statistical analysis. Results., Cases of perineal dermatitis were successfully identified and composites were created that operationalized a model of perineal dermatitis. Conclusion., Following these steps resulted in a data set where data analysis could be pursued with confidence. Incorporating other sources of data, such as prescribers' orders, extends the usefulness of the Minimum Data Set for research use. [source] Frequency of and indications for wholly compensatory nursing care related to enteral food intake: a secondary analysis of the Belgium National Nursing Minimum Data SetJOURNAL OF ADVANCED NURSING, Issue 1 2000Georges Evers PhD RN Frequency of and indications for wholly compensatory nursing care related to enteral food intake: a secondary analysis of the Belgium National Nursing Minimum Data Set This study describes the frequency of and indications used for total feeding assistance and tube feeding in a national representative sample of Belgian hospital patients (n = 421 314). Data from the 1990 national minimum nursing data registration was used. Orem's self-care model was used to describe and categorize types of nursing care and related indications. The scope of wholly compensatory nursing care was limited to total feeding assistance and tube feeding. This type of nursing care is indicated when self-care agency is undeveloped or cannot be used and when self-care demands are significantly increased. Based on review of the literature, hypotheses to indicate nursing care were formulated and tested. Wholly compensatory nursing care related to enteral food intake is given to 14·4% of the total patient population in Belgian hospitals. If self-care demand increases due to malnutrition, then this is an indication for total feeding assistance. If self-care agency decreases due to blindness, mental retardation, disorientation or upper extremity dysfunction, then this is also an indication for total feeding assistance. If self-care agency decreases due to impaired chewing, then this is an indication for tube feeding. This study has generated the first representative national nursing statistics about total feeding assistance and tube feeding in hospitals. [source] A Cluster-Randomized Trial of an Educational Intervention to Reduce the Use of Physical Restraints with Psychogeriatric Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2009Anna R. Huizing PhD RN OBJECTIVES: To investigate the effects of an educational intervention on the use of physical restraints with psychogeriatric nursing home residents. DESIGN: Cluster-randomized trial. SETTING: Fifteen psychogeriatric nursing home wards in the Netherlands. PARTICIPANTS: In total, 432 psychogeriatric nursing home residents from 15 psychogeriatric nursing home wards in seven nursing homes were selected for participation; 404 consented, and 371 of these were available at baseline. Two hundred forty-one from 14 wards had complete data and were included in the data analyses. INTERVENTION: The nursing home wards were assigned at random to educational intervention or control status. The educational intervention consisted of an educational program for nursing staff combined with consultation with a nurse specialist (registered nurse (RN) level). MEASUREMENTS: Data were collected at baseline and 1, 4, and 8 months postintervention. At each measurement, the use of physical restraints was measured using observations of blinded, trained observers on four separate occasions over a 24-hour period. Other resident characteristics, such as cognitive status, were determined using the Minimum Data Set. RESULTS: Logistic and linear regression analyses showed no treatment effect on restraint status, restraint intensity, or multiple restraint use in any of the three postintervention measurements. Furthermore, only small changes occurred in the types of restraints used with residents in the experimental group. CONCLUSION: An educational program for nursing staff combined with consultation with a nurse specialist (RN level) had no effect on the use of physical restraints with psychogeriatric nursing home residents. In addition to restraint education and consultation, new measures to reduce the use of physical restraints with psychogeriatric nursing home residents should be developed. [source] Effectiveness of Falls Clinics: An Evaluation of Outcomes and Client Adherence to Recommended InterventionsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008Keith D. Hill PhD OBJECTIVES: To evaluate outcomes associated with falls clinic programs. DESIGN: Longitudinal. SETTING: Thirteen outpatient falls clinics in Victoria, Australia. PARTICIPANTS: Four hundred fifty-four people referred for clinic assessment (mean age±standard deviation 77.9±8.8; 73% female). INTERVENTION: After assessment, multifactorial interventions were organized to address identified risk factors. MEASUREMENTS: A Minimum Data Set was developed and used across all clinics to derive common data on falls, falls injuries, and secondary measures associated with falls risk, including balance, falls efficacy, gait, leg strength, function, and activity. All measures were repeated 6 months later. RESULTS: Clients had a high risk of falls, with 78% having had falls in the preceding 6 months (63% multiple fallers, 10% experiencing fractures from the falls). An average of 7.6±2.8 falls risk factors were identified per client. The clinic team organized an average of 5.7±2.3 new or additional interventions per client. Sixty-one percent of eligible clients returned for the 6-month assessment. At this time, there was more than a 50% reduction in falls, multiple falls, and fall injuries (P,.004) and small but significant improvements evident on secondary measures of balance, leg strength, gait speed, and confidence outcomes (P<.006). Average adherence to recommendations was 74.3%. Factors associated with higher adherence included being male, younger than 65, living with others, and having a caregiver (P<.05). CONCLUSION: This large multicenter study identified high falls risk of older people referred to falls clinics, the multifactorial nature of their presenting problems and provides preliminary evidence of positive outcomes after falls clinic management. [source] Transitioning Residents from Nursing Facilities to Community Living: Who Wants to Leave?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2008(See editorial comments by Dr. Rosalie Kane, 165)., pp 16 OBJECTIVES: To examine nursing facility residents' or their legal proxies' perspectives on transitioning out of nursing facilities by assessing residents' perceptions of their ability to live more independently, their preferences regarding leaving the facility, and the feasibility of transitioning with community support. DESIGN: Analysis of survey findings from the California Nursing Facility Transition Screen (CNFTS). SETTING: Eight nursing facilities in southern California. PARTICIPANTS: All chronic maintenance, long-stay residents receiving Medi-Cal (California's Medicaid program) were eligible for the study (n=218). Of these, 121 (56%) self-consenting residents or legal proxies were interviewed. No presumptions were made as to which residents were appropriate candidates for transition based on health or functional capacity. MEASUREMENTS: CNFTS contains 27 open- and closed-ended questions on preference, ability, and feasibility of transitioning. RESULTS: Twenty-three percent of residents and proxies believed that the resident had the ability to transition; 46% indicated a preference to transition; and after discussing potential living arrangements and services, 33% thought that transitioning would be feasible. Of those who consented to allow access to their Minimum Data Set 2.0 (MDS) information (n=41; 34% of the sample), agreement in the assessment of preference was found in 39% of cases. CONCLUSION: Transition decisions are complex and include preference, as well as perceptions of the resident's ability to live in a more independent setting and the feasibility of transitioning. Compared with the MDS, the screen identified a higher proportion of residents who want to transition, suggesting that a systematic approach to assessing the complex decision to transition is needed. [source] Preliminary Derivation of a Nursing Home Confusion Assessment Method Based on Data from the Minimum Data SetJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2007David Dosa MD OBJECTIVES: To develop a Nursing Home Confusion Assessment Method (NH-CAM) for diagnosing delirium using items found on the Minimum Data Set (MDS) and to compare its performance with that of the delirium Resident Assessment Protocol (RAP) trigger and to an additive score of six of the RAP items. DESIGN: Retrospective cohort study using MDS and Medicare claims data. SETTING: Free-standing NHs in urban markets in the 48 contiguous U.S. states. PARTICIPANTS: Long-stay residents who returned to their NHs after acute hospitalizations between April and September 2000 (N=35,721). MEASUREMENTS: Mortality and rehospitalization rates within 90 days of readmission to the NH from the hospital. RESULTS: Almost one-third (31.8%) of the residents were identified as having delirium according to the RAP; 1.4% had full delirium, 13.2% had Subsyndromal II delirium, and 17.2% had Subsyndromal I delirium. More-severe NH-CAM scores were associated with greater risks of mortality and rehospitalization. NH-CAM levels were strong independent risk factors for survival and rehospitalization in a Cox model (hazard ratios ranging from 1.5 to 1.9 for mortality and 1.1 to 1.3 for rehospitalization) adjusting for cognitive and physical function, diagnoses, inpatient care parameters, care preferences, and sociodemographic factors. CONCLUSION: The NH-CAM successfully stratified NH residents' risk of mortality and rehospitalization. If validated clinically, the NH-CAM may be useful in care planning and in further research on the determinants and consequences of delirium in the NH. [source] Nursing Home Characteristics and Potentially Preventable Hospitalizations of Long-Stay ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004Orna Intrator PhD Objectives: To examine the association between having a nurse practitioner/physician assistant (NP/PA) on staff, other nursing home (NH) characteristics, and the rate of potentially preventable/avoidable hospitalizations of long-stay residents, as defined using a list of ambulatory care,sensitive (ACS) diagnoses. Design: Cross-sectional prospective study using Minimum Data Set (MDS) assessments, Centers for Medicare and Medicaid Services inpatient claims and eligibility records, On-line Survey Certification Automated Records, (OSCAR) and Area Resource File (ARP). Setting: Freestanding urban NHs in Maine, Kansas, New York, and South Dakota. Participants: Residents of 663 facilities with a quarterly or annual MDS assessment in the 2nd quarter of 1997, who had a prior MDS assessment at least 160 days before, and who were not health maintenance organization members throughout 1997 (N=54,631). Measurements: A 180-day multinomial outcome was defined as having any hospitalization with primary ACS diagnosis, otherwise having been hospitalized, otherwise died, and otherwise remained in the facility. Results: Multilevel models show that facilities with NP/PAs were associated with lower hospitalization rates for ACS conditions (adjusted odds ratio (AOR)=0.83), but not with other hospitalizations. Facilities with more physicians were associated with higher ACS hospitalizations (ACS, AOR=1.14, and non-ACS, AOR=1.10). Facilities providing intravenous therapy, and those that operate a nurses' aide training program were associated with fewer hospitalizations of both types. Conclusion: Employment of NP/PAs in NHs, the provision of intravenous therapy, and the operation of certified nurse assistant training programs appear to reduce ACS hospitalizations, and may be feasible cost-saving policy interventions. [source] Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004(See editorial comments by Dr. Debra Weiner on pp 1020, 1022) Objectives: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain. Design: Cross-sectional study. Setting: Nursing homes from 10 U.S. states. Participants: A total of 21,380 nursing home residents aged 65 and older with persistent pain. Measurements: Minimum Data Set (MDS) assessments on pain, analgesics, cognitive, functional, and emotional status were summarized. Logistic regression models identified diagnoses associated with different analgesic classes. Results: Persistent pain as determined using the MDS was identified in 49% of residents with an average age of 83; 83% were female. Persistent pain was prevalent in patients with a history of fractures (62.9%) or surgery (63.6%) in the past 6 months. One-quarter received no analgesics. The most common analgesics were acetaminophen (37.2%), propoxyphene (18.2%), hydrocodone (6.8%), and tramadol (5.4%). Only 46.9% of all analgesics were given as standing doses. Acetaminophen was usually prescribed as needed (65.6%), at doses less than 1,300 mg per day. Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed as a standing dose more than 70% of the time, and one-third of NSAIDs were prescribed at high doses. Conclusion: In nursing home residents, persistent pain is highly prevalent, there is suboptimal compliance with geriatric prescribing recommendations, and acute pain may be an important contributing source of persistent pain. More effective provider education and research is needed to determine whether treatment of acute pain could prevent persistent pain. [source] The Minimum Data Set Weight-Loss Quality Indicator: Does It Reflect Differences in Care Processes Related to Weight Loss?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2003Sandra F. Simmons PhD Objectives: To determine whether nursing homes (NHs) that score differently on prevalence of weight loss, according to a Minimum Data Set (MDS) quality indicator, also provide different processes of care related to weight loss. Design: Cross-sectional. Setting: Sixteen skilled nursing facilities: 11 NHs in the lower (25th percentile,low prevalence) quartile and five NHs in the upper (75th percentile,high prevalence) quartile on the MDS weight-loss quality indicator. Participants: Four hundred long-term residents. Measurements: Sixteen care processes related to weight loss were defined and operationalized into clinical indicators. Trained research staff conducted measurement of NH staff implementation of each care process during assessments on three consecutive 12-hour days (7 a.m. to 7 p.m.), which included direct observations during meals, resident interviews, and medical record abstraction using standardized protocols. Results: The prevalence of weight loss was significantly higher in the participants in the upper quartile NHs than in participants in the lower quartile NHs based on MDS and monthly weight data documented in the medical record. NHs with a higher prevalence of weight loss had a sig-nificantly larger proportion of residents with risk factors for weight loss, namely low oral food and fluid intake. There were few significant differences on care process measures between low- and high-weight-loss NHs. Staff in low-weight-loss NHs consistently provided verbal prompting and social interaction during meals to a greater proportion of residents, including those most at risk for weight loss. Conclusion: The MDS weight-loss quality indicator reflects differences in the prevalence of weight loss between NHs. NHs with a lower prevalence of weight loss have fewer residents at risk for weight loss and staff who provide verbal prompting and social interaction to more residents during meals, but the adequacy and quality of feeding assistance care needs improvement in all NHs. [source] Effect of Nonsteroidal Anti-Inflammatory Drug Use on the Rate of Gastrointestinal Hospitalizations Among People Living in Long-Term CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2001Kate L. Lapane PhD OBJECTIVES: Gastrointestinal (GI) complications are the most-common serious adverse reactions associated with nonsteroidal anti-inflammatory drugs (NSAIDs). We quantified the effect of specific NSAIDs on the rate of GI hospitalizations among older people living in long-term care. DESIGN: Retrospective cohort study. SETTING: All Medicare/Medicaid certified nursing homes in four states (Maine, Minnesota, New York, and South Dakota). PARTICIPANTS: We identified 125,516 newly admitted residents from a database of all residents (1992,1996) of all Medicare/Medicaid certified nursing homes in four states. Using the federally mandated Minimum Data Set, which includes information on all drugs received (prescription and over-the-counter), we identified patients who received at least one prescription for aspirin (n = 19,101) or NSAIDs (n = 9,777). The control population consisted of all institutionalized persons who did not receive these drugs. MEASUREMENTS: From Health Care Financing Administration inpatient claims, we identified the first hospitalization for GI perforation, ulcer, or hemorrhage that occurred during the year of follow up (ICD9-CM discharge codes: 531,534, 578). Cox proportional hazards models provided adjusted estimates of rate ratios. RESULTS: NSAID exposure increased the GI-event-related hospitalization rate in both men (rate ratios (RR) = 2.64; 95% confidence interval (CI) = 1.17,5.99) and women (RR = 3.23; 95% CI = 1.85,5.65). The rate of GI hospitalizations for both men and women taking sulindac, naproxen, or indomethacin was higher than for nonusers. The risk of GI-event-related hospitalizations was greatest among women exposed to diflunisal (RR = 6.08; 95% CI = 2.27,16.26) or oxaprozin (RR = 6.03; 95% CI = 2.49,14.58). CONCLUSIONS: Despite the high background rate of GI events, most NSAIDs increased the risk of GI hospitalization. Careful attention to choice of agent and dosing is needed in prescribing NSAIDs in this frail, older population. [source] Urinary incontinence among institutionalized oldest old Chinese men in Taiwan,NEUROUROLOGY AND URODYNAMICS, Issue 4 2009Yi-Ming Chen Abstract Aims To explore prevalence and related factors for urinary incontinence (UI) among the oldest old institutionalized Chinese men in Taiwan. Methods All residents living in Banciao Veterans Care Home were invited for study. UI was defined as urinary leakage at least once weekly. Additional data items from the Minimum Data Set (MDS Nursing Home Chinese Version 2.1) were used to explore impact associated with physical function, cognitive status and quality of life (social engagement, SocE). Depressive symptoms were screened by the Short Form Geriatric Depression Scale. Results Data from 594 male residents (mean age: 80.9,±,5.3 years) were analyzed. Among all study subjects, 92.8% were functionally independent, 20.4% had certain cognitive impairment and 8.2% had depressive symptoms. The prevalence of UI in the Banciao Veterans Care Home was 10.1%. Compared with residents without UI, subjects with UI had poorer physical function, cognitive status, and more depressive symptoms. The mean SocE score was 1.5,±,1.3, and was similar between UI (+) and UI (,) subjects (1.4,±,1.2 vs. 1.6,±,1.3, P,=,0.411). By multivariate logistic regression, poorer physical functional status, cognitive impairment and depressive symptoms were independent risk factors for UI (P,<,0.05). Conclusions Poorer physical function, poorer cognitive status and depressive symptoms were all statistically significant independent risk factors for UI. However, SocE score (proxy indicator of quality of life) did not differ between subjects with and without UI. Further investigations are needed to evaluate the impact of UI on quality of life among oldest old institutionalized Chinese men in Taiwan. Neurourol. Urodynam. 28:335,338, 2009. © 2008 Wiley-Liss, Inc. [source] Comparing the Psychometric Properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) InstrumentsPAIN MEDICINE, Issue 3 2010FAAN, Mary Ersek PhD Abstract Objective., To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia. Design., In a cross-sectional descriptive study nursing home (NH) residents were videotaped at rest and during a structured movement procedure. Following one training session and one practice session, two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools. Setting., Fourteen NHs in Western Washington State participating in a randomized controlled trial of an intervention to enhance pain assessment and management. Participants., Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment. Measures., Checklist of Nonverbal Pain Indicators (CNPI) and the Pain Assessment in Advanced Dementia (PAINAD), demographic and pain-related data (Minimum Data Set), nursing assistant reports of participants' usual pain intensity, and Pittsburgh Agitation Scale. Results., Internal consistency for both tools was good except for the CNPI at rest for one rater. Inter-rater reliability for pain presence was fair (K = 0.25 for CNPI with movement; K = 0.31 for PAINAD at rest) to moderate (K = 0.43 for CNPI at rest; K = 0.54 for PAINAD with movement). There were significant differences in mean CNPI and PAINAD scores at rest and during movement, providing support for construct validity. However, both tools demonstrated marked floor effects, particularly when participants were at rest. Conclusions., Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD, findings from the current study indicate that these measures warrant further study with clinical users, should be used cautiously both in research and clinical settings and only as part of a comprehensive approach to pain assessment. [source] Predictors of shoulder and back injuries in nursing home workers: A prospective studyAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 6 2002Douglas Myers MA Abstract Background Nursing assistants (NAs) working in nursing homes have among the highest back and shoulder injury rates in the US. Incidence, severity, and cost of non-traumatic soft tissue musculoskeletal disorders in the nursing home industry in Washington State are quite high. Methods To determine whether resident characteristics data reported on the Health Care Financing Administration Minimum Data Set (MDS) could be used as a surrogate measure of cumulative exposure to physical loads, we conducted an 18-month prospective study in one nursing home. Results The combined NA injury incidence rate (IR) was 45.8 self-reported back and shoulder injuries per 100 [FTE] workers per year. In general, MDS reported resident characteristics failed to predict risk with the exception of exposure to loss of voluntary leg mobility (OR,=,1.11 per person-shifts of exposure, 95% CI [0.97,1.27]), with the highest risk on the day shift (OR,=,1.15, 95% CI [0.95,1.40]). Conclusions These findings suggest social integration and work organization issues may be more important predictors of back and shoulder injuries in nursing assistants than reported resident characteristics as measured by the MDS. Am. J. Ind. Med. 41:466,476, 2002. © 2002 Wiley-Liss, Inc. [source] Corn stover feedstock trials to support predictive modelingGCB BIOENERGY, Issue 5 2010DOUGLAS L. KARLEN Abstract To be sustainable, feedstock harvest must neither degrade soil, water, or air resources nor negatively impact productivity or subsequent crop yields. Simulation modeling will help guide the development of sustainable feedstock production practices, but not without field validation. This paper introduces field research being conducted in six states to support Sun Grant Regional Partnership modeling. Our objectives are to (1) provide a fundamental understanding of limiting factor(s) affecting corn (Zea mays L.) stover harvest, (2) develop tools (e.g., equations, models, etc.) that account for those factors, and (3) create a multivariant analysis framework to combine models for all limiting factors. Sun Grant modelers will use this information to improve regional estimates of feedstock availability. A minimum data set, including soil organic carbon (SOC), total N, pH, bulk density (BD), and soil-test phosphorus (P), and potassium (K) concentrations, is being collected. Stover yield for three treatments (0%, 50%, and 90% removal) and concentrations of N, P, and K in the harvested stover are being quantified to assess the impact of stover harvest on soil resources. Grain yield at a moisture content of 155 g kg,1 averaged 9.71 Mg ha,1, matching the 2008 national average. Stover dry matter harvest rates ranged from 0 to 7 Mg ha,1. Harvesting stover increased N,P,K removal by an average of 42, 5, and 45 kg ha,1 compared with harvesting only grain. Replacing those three nutrients would cost $53.68 ha,1 based on 2009 fertilizer prices. This first-year data and that collected in subsequent years is being used to develop a residue management tool that will ultimately link multiple feedstock supplies together in a landscape vision to help develop a comprehensive carbon management plan, quantify corn stover harvest effects on soil quality, and predict regional variability in feedstock supplies. [source] Using Nursing Interventions Classification as a Framework to Revise the Belgian Nursing Minimum Data SetINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2009Koen Van den Heede PhD Nursing Interventions Classification (NIC); Minimale Verpleegkundige Gegevens; ontwikkeling van consensus PURPOSE., To develop the revised Belgian nursing minimum data set (B-NMDS). METHODS., The Nursing Interventions Classification (NIC, 2nd edition) was used as a framework. Six expert nurse panels (cardiology, oncology, intensive care, pediatrics, geriatrics, chronic care) were consulted. Seventy-nine panelists completed standardized e-mail questionnaires and discussed results in face-to-face meetings. FINDINGS., We initially selected 256 of 433 NIC interventions. After panel discussions, plenary meetings, and pretesting, the revised B-NMDS (alpha version) contained 79 items covering 22 NIC classes and 196 NIC interventions. CONCLUSIONS., Consensus building promoted acceptance of the B-NMDS, while the NIC provided a good theoretical basis and guaranteed international comparability. IMPLICATIONS FOR NURSING PRACTICE., The revised B-NMDS instrument can be used to visualize nursing activities in different applications (e.g., financing, staffing allocation). DOELSTELLING., Ontwikkeling van een nieuwe versie van de Minimale Verpleegkundige Gegevens (MVG). METHODE., De Nursing Interventions Classification (NIC, 2nd editie) werd gebruikt als raamwerk. Zes experten panels (cardiologie, oncologie, intensieve zorgen, pediatrie, geriatrie, chronische zorg) werden geraadpleegd. Zeven-en-negentig panelleden vulden gestandaardiseerde e-mail vragenlijsten in en bediscussieerden de resultaten in werkgroepvergaderingen. RESULTATEN., We selecteerden initieel 256 van de 433 NIC-interventies. Na panel-discussies, plenaire vergaderingen, en pre-tests, bevatte de herziene MVG (alpha versie) 79 items uit 22 NIC klassen en 196 NIC-interventies. CONCLUSIES., Het draagvlak voor de herziene versie van MVG werd gecreëerd door het nastreven van consensus. Het gebruik van NIC vormde hierbij een geode theoretische basis en verhoogt het internationaal karakter van de nieuwe MVG. IMPLICATIES VOOR DE VERPLEEGKUNDIGE PRAKTIJK., De nieuwe MVG kan gebruikt worden om de dagelijkse verpleegkundige praktijk zichtbaar te maken in verschillende beleidsdomeinen (e.g., financiering, toewijzing personeel). [source] Prevalence and incidence of urinary incontinence of Swiss nursing home residents at admission and after six, 12 and 24 monthsJOURNAL OF CLINICAL NURSING, Issue 18 2008Susi Saxer Aims and objectives., To study the prevalence and incidence of urinary incontinence in a Swiss nursing home population at admission and at six, 12, 18 and 24 months after admission. Background., No prevalence data for urinary incontinence in people older than 65 years living in nursing homes are available in Switzerland and other German-speaking parts of Europe. Prevalence of urinary incontinence elsewhere varies between 49% and 77%. Methods., This is a secondary analysis of the data of the minimum data set of the Resident Assessment Instrument 2.0 in which 2719 residents were assessed. Prevalence rates and incidence were calculated at admission and at six, 12, 18 and 24 months after admission. Special focus was placed on sex- and age-related differences. Results., Prevalence of urinary incontinence was 51·5% (men 51·4%, women 51·5%) and was found to rise with increasing age. At the time of admission, 37% (men 43%, women 34%) were urinary incontinent. The prevalence increased from admission to 24 months after admission. Conclusion., The high prevalence rates indicate the relevance of the problem for residents and caregivers alike. Early identification of individuals likely to become incontinent is crucial in the development of interventions and the prevention of urinary incontinence in this vulnerable population. Relevance to clinical practice., The study provides valuable data about the extent of the problem of urinary incontinence in nursing homes. [source] Histopathology reporting in colorectal cancer: a proforma improves qualityCOLORECTAL DISEASE, Issue 8 2009P. N. Siriwardana Abstract Aim, The histopathology report is vital to determine the need for adjuvant therapy and prognosis in colorectal cancer (CRC). Completeness of those in text format is inadequate. This study evaluated the improvement of quality of histopathology reports following the introduction of a template proforma, based on standards set by the Royal College of Pathologists (RCP), UK. Method, Sixty-eight consecutive histopathology reports based on 19 items for rectal cancer (RC) and 15 items for colon cancer (CC) using the proforma were prospectively analysed and compared with results of a previous audit of 82 consecutive histopathology reports in text format. The percentage of reports containing a statement for each data item for both series was compared using the Normal test for difference between two proportions. Completeness of each report was assessed and a percentage score (percentage completeness) was given. Mean percentage completeness was calculated for each format and compared using the two sample t -test. Results, Except for comments on the presence of ,histologically confirmed liver metastases' in CC and RC, ,distance from dentate line' and ,distance to circumferential margin' in RC, all other items were commented in more than 90% of reports, where 71% of the items based on the minimum data set were present in all reports. Compared to prose format, the mean percentage completeness (SD) improved from 74% (8) to 91% (4) (P < 0.0001) and from 81% (5) to 99% (1) (P < 0.0001) for RC and CC respectively in template proforma format. Conclusion, A template proforma and surgeon's contribution in relation to operative findings improves the quality of the histopathology report in CRC. [source] O-11 Proposal for extending the role Of ABMSPS in reporting cervical loopsCYTOPATHOLOGY, Issue 2007K. Ellis Introduction:, The advanced biomedical scientist practitioner (ABMSP) in Cervical Cytology was established in the NHS cervical screening programme (NHSCCSP) in 2001 and there are approximately 60 ABMSPs in post. The aim of this study was to explore the potential for further expansion of their role in the NHSCSP by reporting the histology of loop excision biopsies of the cervical transformation zone (LLETZ). Methods:, The initial study included LLETZ specimens from 55 sequential patients, which, according to standard local practice had the diagnosis of CIN confirmed by cervical punch biopsy prior to the procedure. All the cases were independently examined by an ABMSP and a consultant histopathologist and reports complying with the Royal College of pathologists (RCPath) minimum data sets were assembled. The cases were reviewed at the discussion microscope and ABMSP reports were compared to the final reports issued by the histopathologist. Results:, In the preliminary findings, total agreement between ABMSP and consultant histopathologist was reached on just under 90% of cases. Of those cases that did not reach total agreement, none varied by more than one grade. There was agreement on other parameters from the RCPath minimum data sets. Discussion:, Based on our preliminary findings, it appears there may be scope for extending the role of ABMSPs to report LLETZ samples under the supervision of a histopathologist. We plan to increase the number of cases both in our department and through collaboration with other UK centres and to present evidence to the RCPath, with a view to adoption of this role by ABMSPs and development of an appropriate training scheme. [source] | ||||||||||