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P APER
A BSTRACTS
Methods: Data for acute hospital admissions were obtained
from 61 PACE programs across the US(over 25,000 enrollees), for the
time period 6/1/2008-5/31/2010. Program enrollment data for this
time period were also used together with diagnostic data on program
participants. For each program, exposure-adjusted hospitalization, 30-
day all-cause readmission, and PAH rates were calculated. Multivariate
analyses, with program fixed-effects, were used to assess the impact
of individual-level risk factors on hospitalization rates.
Results: The average hospitalization rate in PACE (547/1000
participants) was 43% lower than for non-PACE dually eligible recipients
of home and community-based services (HCBS) (962/1000).
PACE 30-day average readmission rate (19.1%) was 17% lower compared
to non-PACE dually eligible beneficiaries, age 65+ (22.9%).
The average PAH rate in PACE (175/1000) was 30% lower than
among duals in HCBS programs (250/1000). There were significant
variations across PACE sites in all hospital measures, which remained
after risk-adjustment.
Conclusions: Although PACE participants are among the
frailest of Medicare and Medicaid beneficiaries, their risk of hospital
use is significantly reduced in an integrated clinical care model that is
reinforced by integrated financing. Variations in hospital rates across
PACE indicate continued opportunities for further improvement
with regard to hospital use.
P41
Evaluation of a National Care Transition Program.
S. Wee, 1 P. Wang, 1 E. Koh, 1,2 A. Gan, 2 G. Ganesan. 2 1. Research,
Health Information Management and Evaluation, Agency for
Integrated Care, Singapore, Singapore; 2. Health Services Research
and Evaluation, Ministry of Health, Singapore, Singapore.
Background: Transitional care interventions for carefully selected
patients from hospital to other settings had shown promise in
reducing rates of subsequent hospitalizations. We evaluated the effectiveness
of a state funded national care transition care program involving
our five largest public hospitals to reduce acute care utilization.
The program was adapted from Coleman’s Care Transition
Program®.
Objectives: To compare the risk of hospital re-admission and
emergency department (ED) attendance of acutely ill patients on the
program to other patients admitted during a similar time frame,
matched for age, gender and hospital subsidy status.
Methods: Retrospective cohort study of 4132 patients discharged
from the five acute hospitals from Feb 2009 to Jul 2010 on
care transition program and 4132 control patients chosen from the
State Hospital Claim System. Propensity (conditional probability of
enrolment into program) scores were derived by multiple logistic regression
with the covariates age, gender, length of initial hospital stay,
Charlson index, past 180 days hospital admission, past 180 days ED
attendance. A logistic regression model was fitted to the data. Re-admission
and ED attendance were compared after covariate adjustment
and weighting by propensity scores.
Results: The baseline characteristics of patients in the two
groups were similar after weighting by propensity. Baseline characteristics
for the program patients were: age (SD) 79.2 (7.7) y, 44%
male, mean length of hospital stay (SD) 11.6 (13.1) days, mean Charlson
index (SD) 1.6 (1.8), mean no. of hospitalization and ED attendance
180 days prior to index admission were 0.79 and 1.9 respectively.
Subjects enrolled on the program were less likely to be readmitted
and visit the ED. The adjusted odds ratio (95% CI) comparing rehospitalisation
and ED re-attendance of program subjects with that
of controls at 30 days, were 0.68 (0.61, 0.76) and 0.79 ( 0.71, 0.89) respectively;
and at 180 days, were 0.79 (0.72, 0.87) and 0.88 (0.80, 0.97)
respectively.
Conclusion: Supporting patients and caregivers to take a more
active role during care transition through a care transition program is
effective in reducing subsequent re-hospitalization and ED attendance
in acutely ill patients at risk for transitions.
P42
The Epidemiology of Physically and Verbally Aggressive Behaviors
of Nursing Home Residents Directed at Staff.
M. Lachs, 1 A. Rosen, 2 K. Pillemer, 3 J. Teresi. 4 1. Medicine, Geriatrics,
Weill Cornell Medical College, New York, NY; 2. Emergency Medicine
Residency, New York Presbyterian Hospital, New York, NY; 3. Human
Development, Cornell University, Ithaca, NY; 4. Research Division,
Hebrew Home at Riverdale, Riverdale, NY.
Supported By: National Institute on Aging
National Institute of Justice
New York State Department of Health
Background: While considerable media attention has focused on
abuse of nursing home residents by staff, little research focus has
been directed towards examining the opposite phenomenon: physical
and verbal aggression directed at staff by nursing home residents. We
hypothesized that resident-to-staff aggression (RSA) is a potentially
common phenomenon, as dementia-related behavioral problems are
frequent in nursing home residents and often an impetus for nursing
home placement.
Objective: To perform the first methodologically rigorous study
on the prevalence of RSA in nursing homes.
Methods: We conducted this study as part of a large, multisite
NIA-funded study attempting to estimate the prevalence of residentto-resident
elder mistreatment in long term care facilities. For this
project, the behavior of 1,550 residents of 5 nursing homes was evaluated.
Certified nursing assistants primarily responsible for the care of
residents under study in the parent project were asked whether any
physical, verbal, or sexual behaviors were directed at them by the resident
in the previous two weeks using an instrument validated for this
purpose.
Results: Staff reported that 15.7% of residents directed abuse
towards them within the past two weeks. The most commonly reported
types of verbally abusive behavior reported were screaming
(9.0% of residents) and using bad words (7.2%). The most commonly
reported types of physically abusive behavior reported were hitting
(3.9% of residents) and kicking (2.6%). Aggressive behaviors reportedly
occurred most commonly in the patient room (84.8%) and in the
morning (84.3%).
Conclusion: RSA in nursing homes is highly prevalent. This phenomenon
may negatively affect quality of care, resident and staff
safety, and job satisfaction and staff turnover. Further studies are
needed to understand how and why it occurs, and to develop interventions
to mitigate its potential impact.
P43
Defining medically complex patients using chronic conditions,
healthcare utilization and functional status.
W. W. Hung, 1,2 A. S. Kelley, 1 E. Livote, 2 J. Penrod, 1,2 A. Federman, 1
A. L. Siu. 1,2 1. Mt Sinai School of Medicine, NY, NY; 2. JJP VAMC,
Bronx, NY.
Supported By: VA HSRD
Background:
The majority of healthcare costs are concentrated among a
small proportion of medically complex older adults. While complexity
is often defined by multiple chronic conditions, not all patients with
chronic conditions are complex and patients with a single serious illness
can have complex and costly medical needs. Our objective is to
evaluate 3 different definitions of complexity based on chronic conditions,
healthcare utilization, and functional measures by examining
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