A Pilot Health Information Technology-Based Effort to Increase the Quality of Transitions From Skilled Nursing Facility to Home: Compelling Evidence of High Rate of Adverse Outcomes
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Authors
Donovan, Jennifer L.Kanaan, Abir O.
Gurwitz, Jerry H.
Tjia, Jennifer
Cutrona, Sarah L.
Garber, Lawrence D.
Preusse, Peggy
Field, Terry S.
UMass Chan Affiliations
Department of Quantitative Health SciencesDepartment of Medicine, Division of Geriatric Medicine
Meyers Primary Care Institute
Document Type
Journal ArticlePublication Date
2016-04-01Keywords
UMCCTS fundingAmbulatory care
health information technology
medication safety
skilled nursing facilities
Geriatrics
Health Information Technology
Health Services Administration
Metadata
Show full item recordAbstract
OBJECTIVES: Older adults are often transferred from hospitals to skilled nursing facilities (SNFs) for post-acute care. Patients may be at risk for adverse outcomes after SNF discharges, but little research has focused on this period. DESIGN: Assessment of the feasibility of a transitional care intervention based on a combination of manual information transmission and health information technology to provide automated alert messages to primary care physicians and staff; pre-post analysis to assess potential impact. SETTING: A multispecialty group practice. PARTICIPANTS: Adults aged 65 and older, discharged from SNFs to home; comparison group drawn from SNF discharges during the previous 1.5 years, matched on facility, patient age, and sex. MEASUREMENTS: For the pre-post analysis, we tracked rehospitalization within 30 days after discharge and adverse drug events within 45 days. RESULTS: The intervention was developed and implemented with manual transmission of information between 8 SNFs and the group practice followed by entry into the electronic health record. The process required a 5-day delay during which a large portion of the adverse events occurred. Over a 1-year period, automated alert messages were delivered to physicians and staff for the 313 eligible patients discharged from the 8 SNFs to home. We compared outcomes to those of individually matched discharges from the previous 1.5 years and found similar percentages with 30-day rehospitalizations (31% vs 30%, adjusted HR 1.06, 95% CI 0.80-1.4). Within the adverse drug event (ADE) study, 30% of the discharges during the intervention period and 30% of matched discharges had ADEs within 45 days. CONCLUSION: Older adults discharged from SNFs are at high risk of adverse outcomes immediately following discharge. Simply providing alerts to outpatient physicians, especially if delivered multiple days after discharge, is unlikely to have any impact on reducing these rates.Source
J Am Med Dir Assoc. 2016 Apr 1;17(4):312-7. doi: 10.1016/j.jamda.2015.11.008. Epub 2015 Dec 23. Link to article on publisher's siteDOI
10.1016/j.jamda.2015.11.008Permanent Link to this Item
http://hdl.handle.net/20.500.14038/28910PubMed ID
26723801Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.jamda.2015.11.008