The Bridge Project: Improving Heart Failure Care in Skilled Nursing Facilities

Boxer, Rebecca S.; Dolansky, Mary A.; Frantz, Megan; Prosser, Regina; Hitch, Jeanne A.; Piña, Ileana L.

doi:10.1016/j.jamda.2011.01.005

Cited by 36 publications

(39 citation statements)

References 9 publications

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“…A small number of non-randomized studies evaluating HF management interventions in LTC suggest that such initiatives can reduce health service utilization [14][15][16][17][18][19]. However, these interventions relied on access to substantial resources beyond those normally available in LTC homes and targeted less frail residents expected to return to the community.…”

mentioning

confidence: 99%

Understanding organizational context and heart failure management in long term care homes in Ontario, Canada

Marcella¹,

Nadarajah²,

Kelley³

et al. 2012

Health

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Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants; average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident's home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents' hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff's work routines, capacities and resources.

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mentioning

confidence: 99%

Understanding organizational context and heart failure management in long term care homes in Ontario, Canada

Marcella¹,

Nadarajah²,

Kelley³

et al. 2012

Health

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“…Social and environmental factors may influence the severity and adaptability of aging process in older HF patients. Advanced age has been implicated as predictor of re-admissions [20][21][22]. In 161 elderly patients that had four or more HF admissions, it was found that one of the predictors of readmission was increasing age [23].…”

Section: Literature Reviewmentioning

confidence: 99%

Factors associated with heart failure readmissions from skilled nursing facilities

Ak¹

2017

Interventional-Cardiology

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Background: Despite guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital re-admission of heart failure patients and associated costs remain unacceptably high in the SNF populations. Transfer to SNF is one strategy to limit hospitalizations. As such, 25% of patients are still symptomatic at time of discharge.Purpose: The objective of this study is to identify patient factors affecting re-admissions of HF patients residing in SNF within 30-days.Methods: A retrospective electronic chart review was completed on patients > 65 years with HF who were admitted into large medical center between 2012 and 2014. Descriptive statistics and univariate analyses using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney test for continuous data was used to compare patients readmitted within 30 days vs. those who were not readmitted within 30 days. Significant factors associated with readmission in the univariate analysis (p < 0.10) were included for a multivariate logistic regression model. The analysis of LOS was accomplished by applying standard methods of survival analysis, i.e., computing the Kaplan-Meier product limit curves, where the data were stratified by readmission within 30 days (Yes vs. No). No data were considered 'censored'. The groups were compared using the log-rank test. The median rates for each group were obtained from the Kaplan-Meier/Product-Limit Estimates and their corresponding 95% confidence intervals were computed, using Greenwood's formula to calculate the standard error. Unless otherwise specified, a result was considered statistically significant at the p < 0.05 level of significance.Results: Fifteen variables: creatinine, weight difference, CKD, Angina, Arrhythmia, VHD, Tobacco, ADL, independent in bathing, independent in the toilet, S3 Heart sounds present, HJR, AF, Nitrates, and Hydralazine, were identified for the multivariate logistic regression as potential risk factors associated with "readmission within 30 days". Based on 23 readmissions within 30 days, our final model included only 2 predictor variables. Creatinine and ADLs were included in the final model as this subset of predictors was found to be the best for prediction of "readmission within 30 days". Creatinine (p < 0.0087) and ADLs (p < 0.0077) were both significantly associated with readmission within 30 days in the final logistic regression model. Every 1-unit increase in creatinine was associated with an 87% increase in the odds of being readmitted within 30 days (OR = 1.87). Those patients who require assistance with ADLs were over 9 times more likely to be readmitted within 30 days (OR = 9.25) as compared to patients who are independent.

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“…Education for staff, patients, and families is the second component of the SHU model, as it has been shown to impact health outcomes for SNF HF patients (Boxer et al, 2012). Curricula for the education of the SHU staff were adapted from the Bridge Program, an ongoing initiative in a Midwestern university hospital system, that has produced evidence of improvement in HF-related knowledge among the staff (Boxer et al, 2012).…”

Section: Skilled Heart Unit Model Of Carementioning

confidence: 99%

“…Curricula for the education of the SHU staff were adapted from the Bridge Program, an ongoing initiative in a Midwestern university hospital system, that has produced evidence of improvement in HF-related knowledge among the staff (Boxer et al, 2012). Educational resources put forth by the Heart Failure Society of America and the American Heart Association were used for patient/family education program (Lindenfeld et al, 2010).…”

Section: Skilled Heart Unit Model Of Carementioning

confidence: 99%

Implementation of a Heart Failure Quality Initiative in a Skilled Nursing Facility: Lessons Learned

Nazir¹,

Dennis²,

Unroe³

2015

J Gerontol Nurs

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Skilled nursing facilities (SNFs) are organizations that represent complex adaptive systems, offering barriers to the implementation of quality improvement (QI) initiatives. The current article describes the authors’ efforts to use the approach of reflective adaptive process to implement a new model of care (i.e., the Skilled Heart Unit Program) for effective heart failure (HF) care in one SNF. A team of stakeholders from the local hospital system and a local SNF was convened to design and implement this new model. Evaluation of the implementation processes confirmed the value of the implementation approach, which centered on team-based approaches, staff engagement, and flexibility of processes to respect the SNF’s needs and culture. Interviews with facility staff and the administrator revealed their perceptions that the strategy resulted in better HF care, enhanced teamwork between staff and clinicians, and improved staff job satisfaction. This work provides a unique blueprint of strategic QI implementation for patients with HF in the SNF setting. [ Journal of Gerontological Nursing, 41 (5), 26–33.]

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The Bridge Project: Improving Heart Failure Care in Skilled Nursing Facilities

Cited by 36 publications

References 9 publications

Understanding organizational context and heart failure management in long term care homes in Ontario, Canada

Understanding organizational context and heart failure management in long term care homes in Ontario, Canada

Factors associated with heart failure readmissions from skilled nursing facilities

Implementation of a Heart Failure Quality Initiative in a Skilled Nursing Facility: Lessons Learned

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