Integration Activities Between Hospitals and Skilled Nursing Facilities: A National Survey

Burke, Robert E.; Phelan, Jessica; Cross, Dori A.; Werner, Rachel M.; Adler‐Milstein, Julia

doi:10.1016/j.jamda.2021.05.005

Cited by 14 publications

(23 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, decisions to integrate electronic data sources is also dependent on organizational characteristics. For example, contrary to our findings, Burke et al [ 31 ] found that there were lower odds (OR=0.11; P =.04) of formal data integration between NHs and hospitals if an NH were for-profit versus not-for-profit. In a related work, Adler-Milstein et al [ 8 ] reported that higher odds (OR=1.96; P =.008) of sharing more complete resident information occur between Hospitals and NHs in metropolitan versus rural locations.…”

Section: Discussioncontrasting

confidence: 99%

“…NHs designated as a special focus facility were also excluded, because these facilities have a history of serious quality issues and are automatically included in a program to stimulate quality-of-care improvements [ 30 ]. Finally, NHs with a hospital-based designation was not included as their HIT maturity is likely different due to national incentives for HIT adoption in acute care [ 8 , 31 ]. After applying the exclusion criteria, the population size was 14,109 ( Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity

Alexander¹,

Liu²,

Powell³

2022

JMIR Aging

View full text Add to dashboard Cite

Background There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. Objective The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. Methods NHs (n=6123, >20%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity

Alexander¹,

Liu²,

Powell³

2022

JMIR Aging

View full text Add to dashboard Cite

show abstract

“…The procedures were improved so as to strengthen the cooperation between medical care and avoid the problems such as unclear responsibilities, unclear responsibilities, unclear handover, nursing interruption, and nursing gap from delaying the treatment [ 19 ]. In addition, the medical and nursing integration emergency first-aid care process can ensure that the dying myocardial cells are saved in the shortest time, thereby improving the success rate of rescue and reducing the occurrence of complications, death, and relapse [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of SWOT Analysis Combined with the Medical and Nursing Integration Emergency Nursing Process on Emergency Treatment Efficiency and Prognosis of Patients with Acute Myocardial Infarction

Jin

2022

Emergency Medicine International

View full text Add to dashboard Cite

Acute myocardial infarction (AMI) is a common clinical emergency. Effective emergency treatment at the early stage of onset can effectively reduce the mortality rate. Time is the key of emergency treatment, which is directly related to the treatment effect and the prognosis of patients, and clinical intensive nursing intervention for emergency treatment is of great significance in improving the efficiency of emergency treatment and prognosis. In this study, the effects of routine emergency care flow and SWOT analysis combined with medical and nursing integration on emergency treatment efficiency and prognosis of patients with acute myocardial infarction were compared. The results showed that the combined scheme could improve the rescue effect and success rate of patients with acute myocardial infarction, shorten the rescue time, and reduce the mortality and complication rate of myocardial infarction, which provided a new direction for clinical emergency treatment of acute myocardial infarction.

show abstract

“…Hospitals are indeed investing more, though unevenly, in strengthened coordination with SNF referral partners ( 47 ). Many hospitals lack sufficient exposure to value-based payment to motivate these care delivery changes; those that do often focus their investment of time and resources for transitional care quality improvement only with select facilities ( 19 , 47 , 48 ). This means that only a percentage of SNFs could be expected to benefit from these investments, and the incentives under value-based payment only indirectly influence digital advancement.…”

Section: Current Snf Care Environmentmentioning

confidence: 99%

“…This underresourcing of SNFs poses broader challenges to fostering an environment of learning and quality improvement—IT-related and beyond. Recently synthesized evidence demonstrates that knowledge translation—bringing evidence into practice—is particularly challenging in SNFs and other long-term or post-acute settings and impedes individual and organizational-level change ( 48 ). Motivated leadership, engaged staff, and organizational slack (ie, the extra energy and resources that facilitate goal-setting/innovation beyond basic organizational obligations) are critical components of organizational capacity for digital advancement.…”

Section: Current Snf Care Environmentmentioning

confidence: 99%

Progress Toward Digital Transformation in an Evolving Post-Acute Landscape

Cross

Adler‐Milstein

2022

Innovation in Aging

Self Cite

View full text Add to dashboard Cite

Digitization has been a central pillar of structural investments to promote organizational capacity for transformation, and yet skilled nursing facilities (SNFs) and other post-acute providers have been excluded and/or delayed in benefitting from the past decade of substantial public and private sector investment in information technology (IT). These settings have limited internal capacity and resources to invest in digital capabilities on their own, propagating a limited infrastructure that may only further sideline SNFs and their role in an ever-evolving healthcare landscape that needs to be focused on age-friendly, high-value care. Meaningful progress will require continuous refinement of supportive policy, financial investment, and scalable organizational best practices specific to the SNF context. In this essay, we lay out an action agenda to move from age-agnostic to age-friendly digital transformation. Key to the value proposition of these efforts is a focus on interoperability- the seamless exchange of electronic health information across settings that is critical for care coordination and for providers to have the information they need to make safe and appropriate care decisions. Interoperability is not synonymous with digital transformation, but a foundational building block for its potential. We characterize the current state of digitization in SNFs in the context of key health IT policy advancements over the past decade, identifying ongoing and emergent policy work where the digitization needs of SNFs and other post-acute settings can be better addressed. We also discuss accompanying implementation considerations and strategies for optimally translating policy efforts into impactful practice change across an ever-evolving post-acute landscape. Acting on these insights at the policy and practice level provides cautious optimism that nursing home care – and care for older adults across the care continuum – may benefit more equitably from the promise of future digitization.

show abstract

Integration Activities Between Hospitals and Skilled Nursing Facilities: A National Survey

Cited by 14 publications

References 23 publications

Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity

Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity

Effect of SWOT Analysis Combined with the Medical and Nursing Integration Emergency Nursing Process on Emergency Treatment Efficiency and Prognosis of Patients with Acute Myocardial Infarction

Progress Toward Digital Transformation in an Evolving Post-Acute Landscape

Contact Info

Product

Resources

About