Admission of nursing home residents to a hospital internal medicine department.
J…

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A Comparative Effectiveness Trial Between a Post-Acute Care Hospitalist Model and a Community-Based Physician Model of Nursing Home Care.
J Am Med Dir Assoc. 2010 Dec 20;
Authors: Gloth FM, Gloth MJ
INTRODUCTION: To ev…

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Bacteriuria in a geriatric hospital: impact of an antibiotic improvement program.

J Am Med Dir Assoc. 2008 Oct;9(8):605-9

Authors: Bonnal C, Baune B, Mion M, Armand-Lefevre L, L’Heriteau F, Wolmark Y, Lucet JC

OBJECTIVES: To prospectively evaluate a management approach to bacteriuria including advice from an infectious diseases consultant (IDC) in geriatric inpatients. DESIGN: Prospective study from July 1, 2003, to June 30, 2004. SETTING: A 205-bed geriatric university-affiliated hospital. PARTICIPANTS: Consecutive hospitalized patients with positive urine cultures. INTERVENTION: The hospital’s infection control department developed recommendations about antimicrobial use for bacteriuria, which were discussed at staff meetings. Treatments for bacteriuria prescribed by ward physicians were reviewed by an IDC, who suggested changes where appropriate. Physicians were free to follow or to disregard the IDC’s suggestions. MEASUREMENTS: Patients with positive urine cultures (UC) were classified as having asymptomatic bacteriuria (AB), urinary tract infection (UTI) or pyelonephritis (PN). Prescribed and actual treatments were compared. RESULTS: Of 252 consecutive positive UCs in 181 patients, 124 (49%) were classified as AB, 88 (35%) as UTI, and 38 (15%) as PN; 2 cases of prostatitis were excluded. The total number of prescribed antimicrobial days before IDC advice was 729 and the actual number (after IDC advice) was 577, for a 152-day (21%) reduction. Most of the reduction was generated by shortening the treatment duration. CONCLUSION: Intervention of an IDC resulted in reduced antimicrobial use in older inpatients with bacteriuria.

PMID: 19083296 [PubMed - indexed for MEDLINE]

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Rehabilitation and nursing home admission after hospitalization in acute geriatric patients.

J Am Med Dir Assoc. 2008 May;9(4):265-70

Authors: Marengoni A, Agüero-Torres H, Timpini A, Cossi S, Fratiglioni L

OBJECTIVES: This study explored the effect of multimorbidity, cognitive and physical impairment, and sociodemographic factors on the choice of allocation of geriatric patients at hospital discharge. DESIGN: Cross-sectional study SETTING AND PARTICIPANTS: Eight hundred thirty patients 65 years or older admitted into an acute geriatric ward in Italy were evaluated (1998-2000). MEASUREMENTS: Social characteristics before hospitalization, multimorbidity, physical functioning, and cognitive status were related to allocation of living place after hospitalization (home, rehabilitation unit, or nursing home). RESULTS: Most patients were discharged to their homes (85%); 7% of the younger patients (65-74 years) and 11% of the very old (75+ years) were referred to a rehabilitation unit, while only among the very old 4% were discharged to a nursing home. Worse functional status, longer hospitalization, and being affected by dementia and cerebrovascular diseases (CVD) were associated with the admission to both rehabilitation and nursing home. Cognitive impairment and multimorbidity played a role in discharge destination, but only in functionally impaired patients. Living alone before hospitalization was correlated only with being discharged to a rehabilitation unit. CONCLUSION: In geriatric patients, both medical and sociodemographic characteristics are key factors for referral to rehabilitation or nursing home at discharge.

PMID: 18457803 [PubMed - indexed for MEDLINE]

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Do hemoglobin and creatinine clearance affect hospital readmission rates from a skilled nursing facility heart failure rehabilitation unit?

J Am Med Dir Assoc. 2008 Mar;9(3):194-8

Authors: Tamhane U, Voytas J, Aboufakher R, Maddens M

OBJECTIVES: Cardio renal anemia syndrome is being increasingly recognized in patients with congestive heart failure (CHF) and is associated with increased mortality and rehospitalization rates. Our objective was to assess the relationship between hemoglobin (Hb), creatinine clearance (C(Cr)), and hospital readmission in elderly patients enrolled in a skilled nursing facility (SNF)-based CHF rehabilitation unit. METHODS: We retrospectively identified 127 consecutive patients admitted to an SNF-based CHF rehabilitation unit between July 2001 and September 2002. The patients were grouped into quintiles of hemoglobin and creatinine clearance (C(Cr)) The rate of hospital readmission between quintiles of above variables was compared using the chi-square test. RESULTS: We found a higher prevalence of anemia than reported earlier in the literature for CHF patients discharged from hospital. Rehospitalization rates were increased two- and fivefold in lower compared to higher quintiles of hemoglobin and creatinine clearance, respectively. Anemia predicted rehospitalization in patients with renal dysfunction. CONCLUSION: Our study suggests an association between anemia and rehospitalization rates in patients with renal dysfunction enrolled in an SNF-based CHF rehabilitation unit.

PMID: 18294603 [PubMed - indexed for MEDLINE]

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Internal medicine residents’ perception of nursing home demographics and regulations: a pilot study.

J Am Med Dir Assoc. 2008 Feb;9(2):120-3

Authors: Lester PE, Doubrovskaia M, Ghosn M, Gomolin IH

OBJECTIVES: Internal medicine residents often provide hospital care for patients who are admitted from and discharged to nursing homes. This pilot study surveyed internal medicine residents for their assumptions and perceptions about demographics and regulations in the nursing home setting. DESIGN/SETTING/PARTICIPANTS: Internal medicine residents at Winthrop University Hospital in Long Island, New York, were asked to participate in this anonymous, voluntary, and self-administered written survey during October 2006. MEASUREMENTS: Survey answers were collected and analyzed using SAS 9.1 (SAS Institute, Inc., Cary, NC). RESULTS: The mean responses were very close to the actual data; however, the range and standard deviations (SD) of responses revealed a wide variation in perceptions about nursing home demographics and regulations. For example, the internal medicine residents estimated that 60% of nursing home beds are for long-term care but the responses ranged from 20% to 90%, with an SD of 21. Awareness about regulations such as payment sources and the role of the medical director was poor. Fifty-two percent of respondents stated that Medicare is the primary source of payment for long-term care. Eighty-five percent of the respondents believed that the medical director of a nursing home could be a physician, nurse, social worker, or nursing home administrator. CONCLUSION: Although internal medicine residents have high exposure to nursing home patients, many of those surveyed have incorrect perceptions about nursing home demographics and requirements. Further research is required to demonstrate the impact of formal geriatric medicine education on internal medicine residents’ knowledge regarding nursing home demographics and regulations.

PMID: 18261705 [PubMed - indexed for MEDLINE]

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