Long Term Care Facilities With CMD or Geriatric Certified Medical Directors Display Fewer...
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condition). Ages ranged from 75 to 98 years. Baseline mean MOCA score was 15.5. Method: A two-group (treatment and control) randomized control trial design with pre- and post-test measures is used. The treat- ment is BB (12 cps audio stimulation through headphones and visually by way of a pair of flashing LED lights) and control is a sham (.1 to .2 cps.) treatment. After random group assignment, 20 BB or sham treatments are delivered 5 times/week over 4 weeks. Groups are compared on outcomes of EEG modal brain wave frequency and amplitude, cognition, motor performance, and behavioral disturbances at baseline and upon comple- tion of treatment. Measures include the MOCA, GDS, Timed Get up and Go, Zairt Behavior Checklist, and the Katz ADL. Chart review is conducted to record confounding events and changes in medications and condition. Results: Of the 14 consenting participants 10 (4 sham; 6 intervention) completed participation. Mean age was 84.35 (SD¼7.41) years. Baseline mean MOCA score was 13.6. Initial comparison of the data demonstrated an increase in brain waves in 25% of control and 50% of intervention group members. No differences in the other variables measured were found. Those who participated were able to complete the 30 minute sessions without difficulty. Conclusion/Discussion: Feasibility of BB was supported as a potential intervention for those with mild to moderate dementia. Continued study of BB as a cost effective, non-pharmacological treatment for dementia is recommended for identification of individuals with potential for benefit. Author Disclosures: Internal university funds have supported the conduct of this study. Estimating the Cost Savings by Incorporating Palliative Medicine in Long Term Care: A Growing Need for Arkansas Older Adults Presenting Author: Masil George, MD, University of Arkansas for Medical Sciences Author(s): Masil George, MD, Kimberly Curseen, MD; and Appathurai Balamurugan, MD, MPH Introduction/Objective: It is estimated that there will be a 40% increase in Adults 65 years and older in Arkansas by 2020. This will significantly in- crease the proportion of long term care (LTC) residents in Arkansas. Only 1% of Arkansas residents have LTC insurance. Medicaid is the primary public financing mechanism for LTC services in Arkansas. It is estimated that approximately 25-40% of costs associated with LTC institutions are related to hospital readmissions. Studies have shown that up to 45% of hospital readmissions among Medicaid LTC beneficiaries can be prevented by incorporating palliative medicine in LTC facilities. Our study objective is to estimate the Medicaid LTC costs in Arkansas by 2020, and evaluate the cost savings by incorporating palliative medicine in Arkansas LTC facilities. Design/Methodology: In 2007, Arkansas Medicaid expenditures for LTC institutions totaled $678 million dollars, which accounts for 20.5% of overall Arkansas Medicaid program spending. We analyzed the de- mographic and cost projections for LTC services in Arkansas, in 2020. We also assessed the costs associated with hospital readmissions, and cost savings by incorporating palliative medicine in Arkansas LTC facilities among Medicaid population. All cost data were adjusted for inflation. Results: Based on our preliminary analysis, it is estimated that by 2020, Arkansas Medicaid expenditures for LTC institutions will be approximately $1.14 billion dollars. An estimated $285-456 million dollars of which will be associated with hospital readmissions. If palliative care is incorporated in to LTC facilities in Arkansas, Medicaid could save $ 128-205 million dollars per year by 2020 in hospital readmission costs alone. This does not include indirect or opportunity costs, and also improved quality of care among our LTC residents. Conclusion/Discussion: Incorporating palliative medicine in LTC facilities offer substantial cost savings for Medicaid and the state. Utilizing evi- dence-based models for incorporating palliative care in LTC facilities such as external palliative care consultation team, internal palliative care team/ unit, or hospice care delivered by hospice agency in collaboration with LTC staff could be cost-effective, and improve quality of care. Author Disclosures: All authors have stated there are no financial dis- closures to be made that are pertinent to this abstract. Is Weight Gain in Long Term Care Residents Associated With Lower Mortality Outcome? Presenting Author: Wei Zhou, North Shore LIJ Author: Wei Zhou Introduction/Objective: Despite the numerous health risks associated with being overweight, the effect of weight loss on health and longevity remains controversial, particularly in older adults. We explored the asso- ciation between weight fluctuations in older residents in long term care facilities and health outcomes, including number of inter-current hospi- talizations and mortality. Design/Methodology: A five year retrospective chart review of long term care residents was conducted, collecting monthly weights in addition to demographic data of all residents institutionalized for at least one year. Weight fluctuations were classified in increments of 5% from baseline month 1 though 12 and classified as stable, loss, or gain. Demographics, weight changes, body mass index (BMI), co-morbidities, number of hos- pitalizations and mortality were analyzed. Comparisons between weight change groups were performed using Kruskal-Wallis test, Chi-squared test or Fisher’s exact test, as appropriate. Results: In the 135 patients who met study criteria, average age was 82.3 years (range: 58-98), with 71.1% female and 85.9% Caucasian. Median length of stay was 760 days (range: 349-2032). Average body weight at baseline was 143.3 lbs (range: 83-315 lbs) with BMI of 25.0 (range: 15.2- 50.8). Thirty percent of residents had stable weight, 42.6.1% gained weight and 19.4% lost weight. Weight change was significantly associated with disposition (p ¼.045): residents who lost weight were more likely to die in the nursing home (57.1%) compared to those who had gained weight (22.2%) or had maintained a stable weight (24.4%). There was no significant difference between the weight change groups with regard to number of hospitalizations (p ¼ .111). Conclusion/Discussion: In our study, weight gain in long term care resi- dents appears to be associated with lower mortality, in contrast with the widely accepted and publicized benefits of weight reduction in the younger adult population. Author Disclosures: All authors have stated there are no financial dis- closures to be made that are pertinent to this abstract. Long Term Care Facilities With CMD or Geriatric Certified Medical Directors Display Fewer Deficiencies on Annual State Survey in Virginia Presenting Author: Vanessa S. Fant, MD, CMD, Mid-Atlantic Eldercare Author: Vanessa S. Fant, MD, CMD Introduction/Objective: Certified Medical Directors and geriatric trained physicians have additional training to provide oversight for improving quality measures in the long term care setting. The objective is to gather data from thirty eight facilities in a large region of Virginia and to evaluate the results of the annual state survey and the credentials of medical di- rectors serving in these roles. Design/Methodology: The survey window for thirty-eight facilities in a sixty mile radius from Radford, Virginia was evaluated from June 2012 June 2013. The study criteria included medical directors with extended qualifications in the intervention group for at least a year during the study window. The extended qualifications included Certified Medical Director certification (CMD) and/or geriatric fellowship training with board certi- fication. All information from the annual state survey was obtained through the Centers for Medicare and Medicaid Services. The long term care facility size ranged from 60-250 bed. Results: The credentials of medical directors at thirty eight facilities in Virginia and the results of the annual state survey at each facility were reviewed. Nineteen facilities have medical directors with CMD qualification and/or geriatric board certified (intervention group). Nineteen facilities have medical directors without these added qualifications (control group). The average number of deficiences on annual state survey for the intervention group was 3.0 with a range of 0-11. The average number of deficiencies on annual state survey for the control group was 6.9 with a range of 2-20. Poster Abstracts / JAMDA 15 (2014) B3eB28 B27
Transcript of Long Term Care Facilities With CMD or Geriatric Certified Medical Directors Display Fewer...
Poster Abstracts / JAMDA 15 (2014) B3eB28 B27
condition). Ages ranged from 75 to 98 years. Baseline mean MOCA scorewas 15.5. Method: A two-group (treatment and control) randomizedcontrol trial design with pre- and post-test measures is used. The treat-ment is BB (12 cps audio stimulation through headphones and visually byway of a pair of flashing LED lights) and control is a sham (.1 to .2 cps.)treatment. After random group assignment, 20 BB or sham treatments aredelivered 5 times/week over 4 weeks. Groups are compared on outcomesof EEG modal brain wave frequency and amplitude, cognition, motorperformance, and behavioral disturbances at baseline and upon comple-tion of treatment. Measures include the MOCA, GDS, Timed Get up and Go,Zairt Behavior Checklist, and the Katz ADL. Chart review is conducted torecord confounding events and changes in medications and condition.Results: Of the 14 consenting participants 10 (4 sham; 6 intervention)completed participation. Mean age was 84.35 (SD¼7.41) years. Baselinemean MOCA score was 13.6. Initial comparison of the data demonstratedan increase in brain waves in 25% of control and 50% of intervention groupmembers. No differences in the other variables measured were found.Those who participated were able to complete the 30 minute sessionswithout difficulty.Conclusion/Discussion: Feasibility of BB was supported as a potentialintervention for those with mild to moderate dementia. Continued studyof BB as a cost effective, non-pharmacological treatment for dementia isrecommended for identification of individuals with potential for benefit.Author Disclosures: Internal university funds have supported the conductof this study.
Estimating the Cost Savings by Incorporating Palliative Medicine inLong Term Care: A Growing Need for Arkansas Older Adults
Presenting Author: Masil George, MD, University of Arkansas for MedicalSciencesAuthor(s): Masil George, MD, Kimberly Curseen, MD; andAppathurai Balamurugan, MD, MPH
Introduction/Objective: It is estimated that there will be a 40% increase inAdults 65 years and older in Arkansas by 2020. This will significantly in-crease the proportion of long term care (LTC) residents in Arkansas. Only1% of Arkansas residents have LTC insurance. Medicaid is the primarypublic financing mechanism for LTC services in Arkansas. It is estimatedthat approximately 25-40% of costs associated with LTC institutions arerelated to hospital readmissions. Studies have shown that up to 45% ofhospital readmissions among Medicaid LTC beneficiaries can be preventedby incorporating palliative medicine in LTC facilities. Our study objective isto estimate the Medicaid LTC costs in Arkansas by 2020, and evaluate thecost savings by incorporating palliative medicine in Arkansas LTC facilities.Design/Methodology: In 2007, Arkansas Medicaid expenditures for LTCinstitutions totaled $678 million dollars, which accounts for 20.5% ofoverall Arkansas Medicaid program spending. We analyzed the de-mographic and cost projections for LTC services in Arkansas, in 2020. Wealso assessed the costs associated with hospital readmissions, and costsavings by incorporating palliative medicine in Arkansas LTC facilitiesamong Medicaid population. All cost data were adjusted for inflation.Results: Based on our preliminary analysis, it is estimated that by 2020,Arkansas Medicaid expenditures for LTC institutions will be approximately$1.14 billion dollars. An estimated $285-456 million dollars of which willbe associated with hospital readmissions. If palliative care is incorporatedin to LTC facilities in Arkansas, Medicaid could save $ 128-205 milliondollars per year by 2020 in hospital readmission costs alone. This does notinclude indirect or opportunity costs, and also improved quality of careamong our LTC residents.Conclusion/Discussion: Incorporating palliative medicine in LTC facilitiesoffer substantial cost savings for Medicaid and the state. Utilizing evi-dence-based models for incorporating palliative care in LTC facilities suchas external palliative care consultation team, internal palliative care team/unit, or hospice care delivered by hospice agency in collaborationwith LTCstaff could be cost-effective, and improve quality of care.Author Disclosures: All authors have stated there are no financial dis-closures to be made that are pertinent to this abstract.
Is Weight Gain in Long Term Care Residents Associated With LowerMortality Outcome?
Presenting Author: Wei Zhou, North Shore LIJAuthor: Wei Zhou
Introduction/Objective: Despite the numerous health risks associatedwith being overweight, the effect of weight loss on health and longevityremains controversial, particularly in older adults. We explored the asso-ciation between weight fluctuations in older residents in long term carefacilities and health outcomes, including number of inter-current hospi-talizations and mortality.Design/Methodology: A five year retrospective chart review of long termcare residents was conducted, collecting monthly weights in addition todemographic data of all residents institutionalized for at least one year.Weight fluctuations were classified in increments of 5% from baselinemonth 1 though 12 and classified as stable, loss, or gain. Demographics,weight changes, body mass index (BMI), co-morbidities, number of hos-pitalizations and mortality were analyzed. Comparisons between weightchange groups were performed using Kruskal-Wallis test, Chi-squared testor Fisher’s exact test, as appropriate.Results: In the 135 patients who met study criteria, average age was 82.3years (range: 58-98), with 71.1% female and 85.9% Caucasian. Medianlength of stay was 760 days (range: 349-2032). Average body weight atbaseline was 143.3 lbs (range: 83-315 lbs) with BMI of 25.0 (range: 15.2-50.8). Thirty percent of residents had stable weight, 42.6.1% gained weightand 19.4% lost weight. Weight change was significantly associated withdisposition (p ¼.045): residents who lost weight were more likely to die inthe nursing home (57.1%) compared to those who had gained weight(22.2%) or hadmaintained a stable weight (24.4%). Therewas no significantdifference between the weight change groups with regard to number ofhospitalizations (p ¼ .111).Conclusion/Discussion: In our study, weight gain in long term care resi-dents appears to be associated with lower mortality, in contrast with thewidely accepted and publicized benefits of weight reduction in theyounger adult population.Author Disclosures: All authors have stated there are no financial dis-closures to be made that are pertinent to this abstract.
Long Term Care Facilities With CMD or Geriatric Certified MedicalDirectors Display Fewer Deficiencies on Annual State Survey in Virginia
Presenting Author: Vanessa S. Fant, MD, CMD, Mid-Atlantic EldercareAuthor: Vanessa S. Fant, MD, CMD
Introduction/Objective: Certified Medical Directors and geriatric trainedphysicians have additional training to provide oversight for improvingquality measures in the long term care setting. The objective is to gatherdata from thirty eight facilities in a large region of Virginia and to evaluatethe results of the annual state survey and the credentials of medical di-rectors serving in these roles.Design/Methodology: The survey window for thirty-eight facilities in asixty mile radius from Radford, Virginia was evaluated from June 2012 �June 2013. The study criteria included medical directors with extendedqualifications in the intervention group for at least a year during the studywindow. The extended qualifications included Certified Medical Directorcertification (CMD) and/or geriatric fellowship training with board certi-fication. All information from the annual state survey was obtainedthrough the Centers for Medicare and Medicaid Services. The long termcare facility size ranged from 60-250 bed.Results: The credentials of medical directors at thirty eight facilities inVirginia and the results of the annual state survey at each facility werereviewed. Nineteen facilities have medical directors with CMD qualificationand/or geriatric board certified (intervention group). Nineteen facilities havemedical directors without these added qualifications (control group). Theaverage number of deficiences on annual state survey for the interventiongroup was 3.0 with a range of 0-11. The average number of deficiencies onannual state survey for the control group was 6.9 with a range of 2-20.
Poster Abstracts / JAMDA 15 (2014) B3eB28B28
Conclusion/Discussion: Long term care facilities with medical directorswho are Certified Medical Directors (CMDs) or geriatric board certifieddisplayed fewer deficiences on annual state survey during the June 2012-June 2013 time period. These facilities also displayed fewer deficienciesthan the Virginia state average (7.6) or the national average (6.8). Medicaldirectors with extended training can facilitate improvements in qualitymeasures and medical oversight in the long term care setting as correlatedwith decreased deficiences on annual state survey.Author Disclosures: All authors have stated there are no financial disclo-sures to be made that are pertinent to this abstract.
Medical Foster Homes: Shifting Nursing Home Care to “Micro” Homesin the Community
Presenting Author: Cari Levy, MD, PhD, CMD, Denver VA Medical CenterAuthor(s): Cari Levy, MD, PhD, CMD; and Emily Whitfield, PhD
Introduction/Objective: Medical Foster Homes (MFH) are an alternative tonursing home care for Veterans who prefer care in a private home ratherthan an institutional setting. Referred to as “micro homes,” up to three res-idents can receive care in the home from a primary caregiver who owns thehome and receives room and board payment from the Veteran. All medicalcare is provided by the VA Home Based Primary Care (HBPC) Program.Design/Methodology: Demographics, utilization and costs for all Veteransenrolled in the MFH Program in Fiscal Year 2009-2010 (N¼208) werecompared to all HBPC (N¼25,247) and long stay Community Living Center(CLC) enrollees (2,180) for the same time period.Results: MFH enrollees remained in the program an average of 251 days.While significantly more HBPC visits occurred in the year following MFHenrollment (42.2 vs 9.9, p<0.001), total costs to VAwere $53,171 less than inthe year prior to enrollment ($101,164 vs. $48,993, p<0.001) primarily dueto significantly fewer hospitalizations (2.5 vs. 1.7, p¼0.04) and nursinghome encounters (1.1 vs. 0.4, p ¼ 0.001).Conclusion/Discussion: MFHs or “micro homes,” provide an alternative tonursing homes by partnering HBPC with unskilled community caregivers.Hospitalizations and nursing home utilization decreased in the yearfollowing enrollment resulting in lower total costs to VA. Applicationoutside the VA is needed and the Medicare Independence at Home Initia-tive represents an opportunity to explore application of this care model inthe broader Medicare population.Author Disclosures: VA Geriatrics and Extended Care.
Prevention of Serious Events in Adults 65 Years of Age or Older: AComparison Between High-dose and Standard-dose InactivatedInfluenza Vaccines
Presenting Author: Carlos A. DiazGranados, MD, MS, Sanofi PasteurAuthor(s): Carlos A. DiazGranados, MD, MS, Corwin A. Robertson, MD,MPH, H. Keipp Talbot, MD, MPH, Victoria Landolfi, MS, MBA,Andrew J. Dunning, PhD; and David P. Greenberg, MD
Introduction/Objective: A recently completed trial demonstrated that ahigh-dose (HD) inactivated influenza vaccine was 24.2% more efficaciousthan a standard-dose (SD) inactivated influenza vaccine in preventinglaboratory-confirmed symptomatic influenza in adults 65 years of age andolder. The objective of this analysis is to evaluate the relative effectivenessof HD vaccine compared to SD vaccine in preventing all-cause seriousadverse events (SAEs), all-cause hospitalizations, and serious cardio-res-piratory events (including congestive heart failure and pneumonia)possibly related to influenza infection.Design/Methodology: The study was a double-blind, randomized, active-controlled, multicenter clinical trial conducted during the 2011-2012 and2012-2013 influenza seasons in adults 65 years of age and older(NCT01427309). Participants were randomized to receive either HD vaccineor SDvaccine in a 1:1 ratio, andwere followed for approximately 6-8monthsfor theoccurrenceof influenzaandSAEs. SAEsweredefinedasevents leadingto hospitalization or death, considered as life-threatening or medicallyimportant, or resulting in disability. Before study unblinding, a listing of allSAE diagnoses was reviewed independently by two physicianswho selected
cardio-respiratory SAEs generally considered in clinical practice to bepossibly related to influenza infection. A third physician arbitrated conflict-ing decisions of the first two. Rates of all-cause SAEs, all-cause hospitaliza-tions, and selected serious cardio-respiratory events were calculated, alongwith corresponding relative risks (RRs) and 95% confidence intervals (CIs).Results: A total of 31,989 participants were enrolled across 126 researchcenters in the United States and Canada, with 15,991 and 15,998 random-ized to the HD and SD vaccine groups, respectively. During the entire sur-veillance period, 8.27% and 9.02% of participants in the HD and SD vaccinegroups, respectively, experienced at least one SAE (RR¼0.92; 95% CI 0.85,0.99). In the HD and SD groups, the rates per 1000 subject-seasons for all-cause hospitalization were 95.7 and 102.7 (RR¼0.93; 95% CI 0.87, 1.00)respectively. Corresponding rates were 26.8 and 32.5 (RR¼0.82; 95% CI 0.73,0.93) for selected serious cardio-respiratory events, 4.4 and 7.4 (RR¼0.60;95% CI 0.45, 0.81) for serious pneumonia, and 3.6 and 4.7 (RR¼0.76; 95% CI0.54, 1.07) for serious congestive heart failure.Conclusion/Discussion: The HD vaccinewas not only more efficacious thanthe SD vaccine in preventing laboratory-confirmed symptomatic influenza,it also provided improved protection against the occurrence of seriousevents, including cardio-respiratory events and pneumonia. Trends towardimproved protection against all-cause hospitalization and congestive heartfailure were also observed. The results are particularly meaningful consid-ering the disproportionate burden of influenza-related morbidity andmortality in the elderly.Author Disclosures: The study was sponsored by Sanofi Pasteur.
Reusable Vinyl Covered Hospital Pillows a Reservoir for NosocomialPathogens: The Importance of Adequate Decontamination
Presenting Author: Victor Lange, MS, MPH, Promise HospitalAuthor: Victor Lange, MS, MPH
Introduction/Objective: Mounting evidence suggests that the hospitalenvironment including hospital surfaces, bedding, and various equipmentplay a significant role in the transmission of nosocomial pathogens inhealthcare settings. Studies have shown that nearly one-third of high-touch, high-risk objects in hospital patient rooms remain contaminated forthe next patient; yet the environment inwhich the patient is in contact themost, the patient bed and pillow, are often overlooked in outbreak in-vestigations. Reusable hospital pillows are a potentially important site ofbacterial contamination.Design/Methodology: Over a 5 week period, swab cultures (n¼100) wereobtained from reusable vinyl covered pillows to determine if pathogensremained on the pillow post environmental services disinfection with acommonly used quaternary ammonium solution. The vinyl surface of thepillow was swabbed with a sterile, polyester-tipped applicator and placedin a sterile tube of sodium chloride solution. The tube was vortexed andswab discarded. Soybean-Casein Digest Agar plates were inoculated with100microliters of the eluate and incubated at 360C for 72 hours. Pathogenswere identified according to established industry practices.Results: Thirty eight (38%) of the 100 disinfected patient ready pillowscultured were contaminated with infection causing pathogens includingMethicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-ResistantEnterococcus (VRE), Enterococcus faecalis (E faecalis), Escherichia coli (E coli),Providencia stuartii (P stuartii), Yeast, Coagulase-negative Staphylococci(CNS),Klebsiellapneumoniae (Kpneumoniae),Bacillus species,Gram-PositiveCocci andDiptheroids (95% CI, P< .016). Three pillowswere found to harbor>3 pathogens on each pillow and 15 pillows had> 2 pathogens on each pillow.Conclusion/Discussion: Reusable hospital pillows may serve as reservoirsfor nosocomial pathogens. Thirty eight percent (38%) of disinfected patientready pillows were found to harbor pathogens associated with hospital ac-quired infections. Clear and rigorous guidelines should be established fordecontamination of patient beds and pillows. Outbreak investigations shouldinclude assessment of pillows and mattresses. At our institution this findingled us to make a temporary switch to disposable pillows. We are currentlyreviewing other options such as a barrier pillow cover with and withoutantimicrobial protection.Author Disclosures: All authors have stated there are no financial disclo-sures to be made that are pertinent to this abstract.
