Accreditation The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Designation Statement: The American Medical Directors Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AMDCP Credit Designation: This session has been approved for a total of 1.5 Management credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).
Session Description: This session presents the results of a tri-state collaborative to design and test a toolkit for nursing homes to reduce avoidable hospitalizations of residents. Improved communication strategies, as well as resources for improving advance care planning will be discussed. The role of the medical director in improving communication among nurses, CNAs, residents and families will be addressed.
List the most common reasons for hospitalization of nursing home residents.
Discuss barriers to managing residents with a change in condition in the nursing home.
Explain how to initiate a community collaborative between nursing home and hospital staff as a forum to discuss care of residents across settings.
Discuss the role of the medical director in reducing avoidable hospitalizations.
Speakers(s): Alice Bonner, PhD, RN; Joseph Ouslander, MD
Disclosure(s): Alice Bonner, PhD, RN has no disclosures to report. Joseph Ouslander, MD has no disclosures to report.
References: 1. Ackermann RJ, Kemle KA. The effect of a physician assistant on the hospitalization of nursing home residents. J Am Geriatr Soc 46(5):610-614, 1998. 2. American Medical Directors Association (AMDA): Clinical Practice Guideline on "Acute Change in Condition in the Long-Term Care Setting"; 2003. 3. Buchanan, J, Murkofsly, RL, O'Malley, AJ, et al: Nursing Home Capabilities and Decisions to Hospitalize: A Survey of Medical Directors and Directors of Nursing. J Amer Ger Soc 54: 458-465, 2006. 4. Carter MW: Variations in hospitalization rates among nursing home residents: the role of discretionary hospitalizations. Health Services Research 38:1177-206, 2003. 5. Colon-Emeric CS, Lekan D, Utley-Smith Q, et. al.: Barriers to and facilitators of clinical practice guideline use in nursing homes. JAGS 55:1404-1409, 2007. 6. Creditor MC: Hazards of hospitalization of the elderly. Ann Intern Med 118:219-223, 1993 7. Grabowski, DC, O'Malley, AJ, and Barhydt, NR: The Costs and Potential Savings Associated with Nursing Home Hospitalizations, Health Affairs 26: 1753-1761, 2007 8. Grabowski, DC: Medicare and Medicaid: Conflicting Incentives for Long-Term Care. Milbank Quarterly 85:579-610, 2007. 9. Gruneir A, Miller SC, Feng Z, et. al.: Relationship between State Medicaid Policies, Nursing Home Racial Composition, and the Risk of Hospitalization for Black and White Residents. Health Services Research 10.1111/j.1475-6773.2007.00806.x, 2007. 10. Kane RL, Keckhafer G, Flood S, et. al.: The effect of Evercare on hospital use. JAGS 51:1427-1434, 2003. 11. Konetzka RT, Spector W, Limcangco RM: Reducing hospitalizations from long-term care settings. Med Care Res Rev, Vol. 0: pp. 1077558707307569v1, 2007. 12. Molloy, DW, Guyatt, GH, Russo, R et al. Systematic Implementation of an Advance Directive Program in Nursing Homes: A Randomized Controlled Trial JAMA 283: 1437 - 1444, 2000. 13. Ouslander JG: Reducing the Hospitalization of Nursing Home Patients (Editorial). J Am Geriatr Soc 36:171-173, 1988. 14. Ouslander JG, Weinberg AD: Inappropriate Hospitalization of Nursing Facility Residents: A Symptom of a Sick System of Care for Frail Older People (Editorial). J Am Geriatr Soc 48:230-231, 2000. 15. Rueben D, Buchanan J, Farley D, Hirsch S, Kington R, Ouslander J, Schnelle J, Zellman G. Primary Care of Long-Stay Nursing Home Residents: A Comparison of 3 HMO Programs with Fee-For-Service Care. J Amer Ger Soc 47:131-138, 1999. 16. Saliba D, Kington R, Buchanan J, et al. Appropriateness of the decision to transfer nursing facility residents to hospital. J Am Geriatr Soc 48:154-163, 2000. 17. Saliba D. Solomon D. Rubenstein L. Young R. Schnelle J. Roth C. Wenger N. Quality indicators for the management of medical conditions in nursing home residents. J Am Med Dir Assoc 5(S):297-309, 2004.
PhD, RN, GNP,
Secretary, Executive Office of Elder Affairs,
Commonwealth of Massachusetts