Growth of second-generation antipsychotic utilization and costs was similar to trends described in the AHRQ-Rutgers study. Several containment strategies appeared effective in addressing these trends.

Background: Despite advances in stroke care, many patients do not receive recommended care processes. Quality indicator (QI) reporting programs, like GWTG-Stroke, have been shown to improve care. We sought to determine whether training plus QI feedback was more effective than QI feedback alone in improving two stroke QIs. Methods: We conducted a cluster randomized trial in 11 VA hospitals. Sites were randomized to a quality improvement training program plus QI feedback vs. QI feedback alone to improve DVT prophylaxis and dysphagia screening. Intervention sites received face-to-face training, developed individualized improvement plans, and had 6 months of post-training facilitation. Both groups received monthly QI feedback. Eligibility and passing for the two stroke QIs, plus nine other stroke QIs, was determined by centralized chart review. We compared pre-intervention (pre-I) to post-intervention (post-I) performance on the two stroke QIs and on defect-free care (DF, a binary patient-level variable including all QIs) in intervention vs. control sites. We constructed logistic models of the two QIs and DF care, adjusting for patient variables, time, intervention group, and time-group interaction. Results: The five intervention sites had 1147 admissions and the six control sites had 1017 admissions during the study period. DVT prophylaxis was similar pre-I (85% vs. 90%) and improved in both groups (post-I rates 90% intervention and 94% control, ratio of ORs 0.89, p = 0.75). Dysphagia screening was higher pre-I in intervention sites (51% vs. 37%), and improved more in the control sites (post-I 56% and 52%, ratio of ORs 0.67, p=0.04). In logistic models, DVT, Dysphagia, and DF performance were associated with baseline performance and post-I time. Dysphagia performance was also associated with NIHSS and time-group interaction, and DF care was also associated with the presence of a baseline data collection program. Conclusion: Quality improvement training did not add to the impact of data feedback in sites already motivated to participate in QI initiatives. Defect-free stroke care is associated with an ongoing stroke data collection program, emphasizing the importance of audit and feedback to achieve the highest quality stroke care.

Brief, reliable assessment tools are highly valued in both research and clinical settings. The single-item Distress Thermometer (DT) asks participants to rank their overall level of distress from zero to ten. Similar measures of distress perform well in oncology populations, but the validity of the DT has not been well tested with other populations. To determine its validity and reliability, we analyzed data from family surrogates (n=188) of critically ill ICU patients. Surrogates were asked to rate their distress during the first four days of the patient’s ICU stay and 6-8 weeks after discharge (n=127). Data were analyzed using Spearman non-parametric correlation due to the distributions of the data. DT scores at both baseline and follow-up were significantly correlated with anxiety (GAD-7: correlation coefficient (ρ)=.527, p<.0001; ρ=.543, p<.0001, respectively), depression (PHQ-9: ρ=.480, p<.0001; ρ=.399, p=.0002), distress (Kessler-6: ρ=.477, p<.0001; ρ=.528, p<.0001), and negative religious coping (ρ=.149, p=.0426; ρ=.238, p=.0074). Results also indicated that spiritual well-being at baseline and follow-up (FACIT: ρ=-.391, p<.0001, ρ=-.443, p<.0001) and positive religious coping at baseline (RCOPE: ρ=-.164, p=.0253) have an inverse relationship with overall distress. At baseline, surrogates with better positive religious coping and/or more involvement in organizational religious activity (ρ=-.189, p=.0106) were more likely to report lower distress. The DT could be an efficient, single item predictor of outcomes that impact patient and family care. Future research could confirm its validity as a measure of distress, in a variety of clinical populations and environments that could inform clinical care for patients and families.

Technology to support caregivers of people with Alzheimer’s disease or related dementias (ADRD) with tasks may be the next frontier for caregiving research. This single-arm 90-day pilot trial tested the usability, feasibility, and acceptability of a software system called RememberStuff® (R/S) by Eperture. We also tested R/S’s impact on caregiver burden. R/S includes a web-based portal where caregivers add information to a touch screen used by patients. R/S is organized around four main features– Calendar, Messaging, Activities, and Remember, a personalized task list. We collected data from dyads at baseline, 30-, 60-, and 90-days. Measures included the Healthy Aging Brain Care (HABC) monitor, System Usability Scale (SUS), and satisfaction scales indicating caregiver’s willingness to use and behavioral intention. We approached caregivers of patients with ADRD seen in primary care clinics. Of the 469 participants reached, 278 (59.28%) refused, 156 (33.26%) were ineligible due to nursing home placement and 35 dyads were enrolled (7.46%). Among enrolled participants, 65.7% completed data up to 90 days. 73.5% of the caregivers lived with the patients. Mean caregiver age was 59.1 years; 67.7% are female; 88.2% are white. Willingness to use R/S was consistent across time from 30 days (M=3.9, SD=0.7) through 90 days (M=3.8, SD=1.1), while usability decreased (30 days M=57.7, SD=7.5 to 90 days M=54.9, SD 8.7). Caregiver’s overall HABC monitor also decreased from baseline (M=29.0, SD=13.1) to 90 days (M=27.2, SD=12.2) indicating less burden at 90 days. These findings support the feasibility of R/S technology to support caregivers of people with ADRD.

Communication quality between clinical care teams and families impacts important outcomes like satisfaction, depression, and anxiety. Assessment tools must be efficient and reliable to be useful in the clinical environment. We report the development of 5 and 10-item versions of the validated 30-item Family Inpatient Communication Survey (FICS). Data were from 364 surrogate decision makers (SDMs) for incapacitated older adults in the ICU. Most SDMs were adult children (66.8%). SDMs were 70.9% female, 68.9% white, with a mean age of 58.3. Exploratory factor analysis revealed high internal reliability for the single-factor FICS5 (α= .88) and two-factor FICS10 (α= .93). The FICS10 reliably measures two subscales: information (α= .91) and emotional support (α=.81). Good discriminant and predictive validity were demonstrated when comparing total scores to outcomes at 6-8 weeks after hospital discharge, including anxiety (correlation coefficient (ρ)= -.13; p=.0234 ), depression (ρ =-.15; p=.0076), decision regret (ρ =--.15; p=.0066), and satisfaction (ρ =-..48; p<.0001). Repeating analysis with a new sample (n=188) revealed similar results with Cronbach’s alpha ranging from .81 to .93. The FICS5 revealed significant associations (p<.05) at 6-8 weeks after discharge with distress (-.22), while the FICS10 demonstrated significant associations with distress (-.28), anxiety (-.20), depression (-.19) and decision regret (-.27). Confirmatory factor analysis indicated adequate fit (CFI: FICS5= .994, FICS10= .994; RMSEA: FICS5= .093, FICS10= .103). The FICS provides clinicians and interventionists with a reliable, low burden tool to evaluate communication quality and respond quickly, which could impact satisfaction and other important outcomes for patients and families.