Abstract:
OBJECTIVES:Validated process measures that correlate with patient outcomes are needed for research and quality improvement. DESIGN:Cross-sectional analysis within a cluster-randomized fall prevention study. SETTING:Nursing homes in North Carolina (n = 16). PARTICIPANTS:Nursing home staff (n = 541) and residents with 1 or more falls in 6 months (n = 597). MEASUREMENTS:Fall-prevention process measures in 4 categories derived from Assessing Care of Vulnerable Elders quality indicators were measured in 2 ways: (1) chart abstraction; and (2) staff responses to clinical vignettes of hypothetical residents at risk for falls. Recurrent fall rates (falls/resident/year) were measured. The proportion of the total variation in falls rates explained by the scores for each method (chart abstraction or vignette) was calculated using multilevel adjusted models. RESULTS:Chart and vignette measures of comorbidity management were moderately correlated (Pearson correlation coefficient 0.43), whereas other process measure categories had low or negative correlation between the 2 methods (psychoactive medication reduction 0.13, environmental modification -0.42, and exercise/rehabilitation -0.08). Measures of environmental modification and comorbidity management explained a moderate amount of the total variation in recurrent fall fates, vignettes (7%-10% variation explained) were superior to chart abstraction (2%-6% variation explained). Vignette responses from unlicensed staff (nurse aides and rehabilitation aides) explained more variance than registered nurses, licensed practical nurses, or other licensed staff in these categories. Process measures for psychoactive medication reduction and exercise/rehabilitation did not explain any of the variation in fall outcomes. Overall, vignette process measures explained 3.9% and chart abstraction measures explained 0% of the variation in fall outcomes. CONCLUSIONS:Clinical vignettes completed by nursing home staff had greater association with resident recurrent fall rates than traditional chart abstraction process measures.
journal_name
J Am Med Dir Assocjournal_title
Journal of the American Medical Directors Associationauthors
Colón-Emeric CS,Corazzini KN,McConnell ES,Pan W,Toles MP,Hall R,Batchelor-Murphy M,Yap TL,Anderson AL,Burd A,Amarasekara S,Anderson RAdoi
10.1016/j.jamda.2017.10.018subject
Has Abstractpub_date
2018-05-01 00:00:00pages
405-410issue
5eissn
1525-8610issn
1538-9375pii
S1525-8610(17)30600-Xjournal_volume
19pub_type
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2012.05.013
更新日期:2012-09-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1097/01.JAM.0000094062.31602.D9
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamda.2015.01.074
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVES:Examine the association between completion of an outpatient visit with a physician or advanced practice provider (PCP) within 7 days of discharge from a short skilled nursing facility (SNF) stay and 30-day readmission and determine if functional status at discharge moderates visit effectiveness. DESIGN:Retr...
journal_title:Journal of the American Medical Directors Association
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更新日期:2017-09-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamda.2006.06.001
更新日期:2006-11-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2010.04.009
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journal_title:Journal of the American Medical Directors Association
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journal_title:Journal of the American Medical Directors Association
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journal_title:Journal of the American Medical Directors Association
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doi:10.1016/j.jamda.2015.01.072
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pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2020.05.035
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journal_title:Journal of the American Medical Directors Association
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,随机对照试验
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更新日期:2015-02-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
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更新日期:2020-08-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2018.07.023
更新日期:2019-02-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamda.2015.12.008
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pub_type: 杂志文章
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,meta分析,评审
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:
更新日期:2001-05-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2010.06.004
更新日期:2011-11-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.06.046
更新日期:2020-08-02 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.11.011
更新日期:2021-01-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:
更新日期:2001-01-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
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更新日期:2010-11-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2014.03.015
更新日期:2014-08-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.03.034
更新日期:2019-11-01 00:00:00
abstract::Because long-term care residents often have chronic illnesses and complex care regimens, nutritional issues are common in these populations. Furthermore, management is complicated because some residents are terminally ill and under palliative care treatment plans that allow for dehydration and low oral intake. As a re...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2008.03.005
更新日期:2008-09-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.05.013
更新日期:2013-11-01 00:00:00