Characteristics of Transitions from Skilled Nursing Facility to Home Following Heart Failure Hospitalization

心力衰竭住院后从专业护理机构过渡到家庭的特点

• 批准号: 10711710
• 负责人: Himali Weerahandi
• 金额: $ 5.4万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10711710
• 关键词: Acute; Address; Administrative Supplement; Adverse event; Affect; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Caregivers; Caring; Characteristics; Data; Dementia; Disease; Elderly; Ensure; Failure; Funding; Goals; Grant; Heart failure; Home; Hospitalization; Hospitals; Impaired cognition; Instruction; Intervention; K-Series Research Career Programs; Length of Stay; Medical; Medicare; Mentors; Parents; Patient Discharge; Patient-Focused Outcomes; Patients; Prevalence; Process; Prospective, cohort study; Research; Research Infrastructure; Research Personnel; Risk Factors; Sampling; Skilled Nursing Facilities; Structure; Surveys; System; United States; Work; adverse outcome; care coordination; career development; experience; frailty; functional improvement; high risk; hospital readmission; improved; inclusion criteria; innovation; older patient; parent grant; participant enrollment; programs; readmission risk; recruit; tool

Project Summary/Abstract Many older patients are discharged to a skilled nursing facility (SNF) after hospitalization to improve function before returning home; consequently, they may incur a second transition, from SNF to home, within 30 days of hospital discharge. Despite the prevalence of discharge to SNF, little is known about the transition from SNF to home. We previously demonstrated that almost a quarter of patients discharged from SNF to home after heart failure hospitalization were readmitted within 30 days of SNF discharge. This high proportion of readmissions among temporary SNF patients suggests further work is needed to examine the transition from SNF to home and to identify drivers of rehospitalization after SNF discharge. Dr. Weerahandi’s long term goal is to create effective systems level interventions to improve transitions of care. Cognitive impairment and frailty resulting from disease states such as Alzheimer’s disease and related dementias (AD/ADRD) are a risk factors for adverse events in the hospital to home transition, and likely also affects the transition from SNF to home. Ideally, these factors should be addressed upon discharge from SNF to ensure a safe transition home. Yet it is uncertain to what degree and with what quality such practices are performed and if they are tailored to the needs of those with AD/ADRD. The objectives of this administrative supplement are to (1) build on the research infrastructure from Dr. Weerahandi’s career development award to study the transition from SNF to home after hospitalization in patients with AD/ADRD and (2) to expand Dr. Weerahandi’s research program to focus on outcomes for patients that are at particularly high risk of adverse outcomes during care transitions: patients with AD/ADRD. Funding from this supplement will be used to analyze Medicare data to determine the risk of readmission from SNF to home for patients with AD/ADRD and evaluate the quality and experience of the SNF discharge process for these patients.

项目概要/摘要 许多老年患者住院后会出院到专业护理机构 (SNF) 以改善病情 因此，他们可能会在 30 天内进行第二次从 SNF 到家的过渡 尽管出院到 SNF 的情况很常见，但人们对从出院到 SNF 的转变知之甚少。 我们之前证明，近四分之一的患者从 SNF 出院回家。 心力衰竭住院后 30 天内再次入院的 SNF 出院比例很高。 临时 SNF 患者的再入院表明需要进一步的工作来检查从 SNF 回家并确定 SNF 出院后再次住院的驱动因素。 Weerahandi 博士的长期目标是创建有效的系统级干预措施以改善转变 阿尔茨海默病及相关疾病导致的认知障碍和虚弱。 痴呆症 (AD/ADRD) 是从医院到家庭过渡过程中发生不良事件的危险因素，并且也可能 理想情况下，这些因素应在从 SNF 出院时得到解决。 以确保安全过渡回家，但尚不确定这种做法的程度和质量如何。 是否执行以及它们是否适合 AD/ADRD 患者的需求。 本行政补充的目标是 (1) 建立在 Dr. 的研究基础设施之上。 Weerahandi 的职业发展奖用于研究住院后从 SNF 到家庭的过渡 AD/ADRD 患者，以及 (2) 扩大 Weerahandi 博士的研究项目，重点关注 AD/ADRD 患者的结果 在护理过渡期间出现不良后果的风险特别高的患者：AD/ADRD 患者。 该补充资金将用于分析医疗保险数据，以确定再次入院的风险 SNF 到 AD/ADRD 患者家中并评估 SNF 出院的质量和体验 这些患者的流程。

项目成果

Post-acute sequelae of SARS-CoV-2 infection in nursing homes: Do not forget the most vulnerable.

• DOI: 10.1111/jgs.17760
• 发表时间: 2022-05
• 期刊: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
• 影响因子: 6.3
• 作者: Weerahandi, Himali;Rao, Mana;Boockvar, Kenneth S.
• 通讯作者: Boockvar, Kenneth S.

Characteristics of Physical, Occupational, and Speech Therapy Received by COVID-19 Patients in a Skilled Nursing Facility: A Retrospective Cohort Study.

• DOI: 10.1016/j.jamda.2023.01.010
• 发表时间: 2023-04
• 期刊: JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
• 影响因子: 7.6
• 作者: Canter, Benjamin E.;Raschen, Lauren;Reinhardt, Joann P.;Weerahandi, Himali;Mak, Wingyun;Burack, Orah R.;Escher, Anne;Boockvar, Kenneth S.
• 通讯作者: Boockvar, Kenneth S.

Six-Month Outcomes in Patients Hospitalized with Severe COVID-19.

• DOI: 10.1007/s11606-021-07032-9
• 发表时间: 2021-12
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Horwitz LI;Garry K;Prete AM;Sharma S;Mendoza F;Kahan T;Karpel H;Duan E;Hochman KA;Weerahandi H
• 通讯作者: Weerahandi H