CLINICAL DIAGNOSIS IS NOT THE KEY SOLUTION IN PREDICTING AND AVOIDING REHOSPITALIZATION IN NURSING HOME RESIDENTS
Nursing home administrators traditionally seeks clinical diagnosis to keep their frail older residents from rehospitalization, because it impacts their state of health affecting continuity of care and mounting costs to the healthcare system.
But in a new study, they might be looking in the wrong place.
A recent study from the Regenstrief Institute and Indiana University Center for Aging Research, reports that a patient's diagnosis is not the best predictor of whether that individual will be transferred to a hospital or remain in place.
"Our data show that preventing avoidable hospitalization is less about clinical diagnosis and more about having coordinated systems in place," said Kathleen Unroe, M.D., M.H.A. of Regenstrief and IU. "These systems can prevent potentially harmful events that result from unnecessary transfers to the hospital.
"We need to be asking and answering a lot of questions in order to determine if a nursing home patient should be transported to the hospital."
Dr. Unroe, who led the new study, co-directed Phase I of OPTIMISTIC, short for Optimizing Patient Transfers, Impacting Medical quality and Improving Symptoms: Transforming Institutional Care, and is directing Phase II of OPTIMISTIC. She is the interim director of the Regenstrief and IU Center for Aging Research.
Nurses were embedded in 19 homes, and reviewed details on hundreds of transfers to the hospital. They pointed if residents had one of the six diagnoses most commonly linked with avoidable hospitalizations — pneumonia, urinary tract infections, dehydration, pressure ulcers, cellulitis, heart failure and chronic obstructive pulmonary disease/asthma.
About 25 percent of acute transfers of patients had a diagnosis in one of those six categories, while 22 percent did not. Meanwhile, the most common trait (45%) found amongst transfers was that the condition could have been managed safely if appropriate resources were available. Problems with communication between stakeholders were the most commonly noted area for improvement at about 48 percent of the time.
“From the nursing home's perspective, it should be less about specific disease states, and more about putting in place excellent communication protocols, appropriate clinical staffing, access to diagnostic testing, and robust palliative care programs. Those are the answer to help all residents who have a change in status. Don't over-focus on a specific condition or disease state,” Unroe said in a news release.
Erudite Nursing Institute™ encourages nursing home administrators to furtherly study the aspect concerning their residents’ health to prevent rehospitalizations and added costs in healthcare.
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