Nursing Home Resident Outcomes Research Articles

Comparative safety and cardiovascular effectiveness of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in nursing homes.

Studies examining the safety and effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus glucagon-like peptide-1 receptor agonists (GLP-1RAs) among community-dwelling adults may not generalize to nursing home (NH) residents, who are typically older and more multimorbid. We compared the safety and cardiovascular effectiveness of SGLT2is and GLP-1RAs among US NH residents. Eligible individuals were aged ≥66 years with type 2 diabetes mellitus and initiated an SGLT2i or GLP-1RA in an NH between 2013 and 2018. Safety outcomes included fall-related injuries, hypoglycaemia, diabetic ketoacidosis (DKA), urinary tract infection or genital infection, and acute kidney injury in the year following treatment initiation. Cardiovascular effectiveness outcomes included death, major adverse cardiovascular events and hospitalization for heart failure. Per-protocol adjusted hazard ratios (HR) were calculated using stabilized inverse probability of treatment and censoring weighted cause-specific hazard regression models accounting for 127 covariates. The study population included 7710 residents (31.08% SGLT2i, 68.92% GLP-1RA). Compared with GLP-1RA initiators, SGLT2i initiators had higher rates of DKA (HR 1.95, 95% confidence limits 1.27, 2.99) and death (HR 1.18, 95% confidence limits 1.02, 1.36). Rates of urinary tract infection or genital infection, acute kidney injury, major adverse cardiovascular events, and heart failure were also elevated, while rates of fall-related injuries and hypoglycaemia were reduced, but all estimates were imprecise and highly compatible with no difference. SGLT2is do not have superior, and may have inferior, effectiveness compared with GLP-1RAs for cardiovascular and mortality outcomes in NH residents. Residents initiating SGLT2is should be monitored closely for DKA.

Factors impacting community living outcomes among former long-term nursing home residents using the interdependence-Human Activity Assistive Technology (i-HAAT) model

ABSTRACT Despite an increased application of social theory in assistive technology (AT) outcomes research, there continues to be a gap in integrating AT conceptual models in research design, data analysis, and results interpretation. This paper merged two preexisting AT models, the Human Activity Assistive Technology model (HAAT) and the interdependence frame for AT into a novel framework, the interdependence-HAAT model (i-HAAT). This model was used to examine the outcomes of former long-term nursing home residents using AT. The model was also used as a framework to facilitate quantitative variable identification and categorization, emphasize the interconnectivity between domain variables, and explore the infrastructural supports necessary for the successful community reintegration of deinstitutionalized AT users. Meaningful integration of theory into practice is the essential next step in generating socially responsive research that addresses AT consumer needs and moves the field forward.

NURSES’ PAIN ASSESSMENT AND TREATMENT OUTCOMES IN NURSING HOME RESIDENTS WITH DEMENTIA AND APATHY

Abstract Pain is often undermanaged in nursing home (NH) residents with dementia-related apathy; an understanding of related nursing practices is warranted. This descriptive study examined nurses’ pain assessment and treatment outcomes in NH residents with dementia and apathy. A two-week chart review of nursing progress notes was extracted. Residents’ apathy measured by the Apathy Evaluation Scale (AES) of at least 40 was required. Descriptive and correlation statistical analyses were performed. Seventeen residents were recruited from three NHs; only one NH required daily pain assessment. All residents had pain-related diagnoses (mean=3), with Gastro-esophageal reflux disease and arthritis being the two most common diagnoses. Thirty-four pain-related documentations were identified in progress notes, with 19 pain-related events (e.g., falls, tooth extraction). Among the 19 events, 4 had follow-up documentation of pain management, while the other 15 did not. Among the 34 pain-related documentations, only six described residents’ behaviors, and three used a pain assessment tool (Numeric Rating Scale). More frequent as-needed analgesic administration was associated with lower agitation (-0.56, p< 0.05), yet this association was not found in scheduled analgesic use. Residents who reported pain more frequently received more as-needed analgesics (0.63, p< 0.01). Resident apathy levels were not correlated with analgesic prescriptions. Altogether, nurses recognized residents’ pain reports. As-needed analgesic use correlated with better pain management outcomes; however, pain-related events were not adequately followed up and/or documented. More research is needed to examine the association between nursing pain management practices and resident outcomes in this population.

1221-P: Hypoglycemia in Nursing Home Residents Often Co-occurs with Hyperglycemia

During the transitional period following admission to a nursing home (NH), the primary diabetes management goal is to avoid hypoglycemia and hyperglycemia. However, the frequency and severity of hypo- and hyper-glycemic episodes in this population are unclear. Using the Veterans Affairs NH electronic health records, we examined Veterans aged ≥65 years with diabetes, insulin use, and a NH stay ≥7 days from 1 Jan 2016 to 30 Sept 2019. From fingerstick glucose values from Days 1 through 7, we calculated the proportion of Veterans with Level 1 (<70mg/dL) and Level 2 (<54mg/dL) hypoglycemia and with hyperglycemia ≥250mg/dL (recommended upper limit for NH residents) and severe hyperglycemia ≥400mg/dL. Of 12,031 Veterans, mean age was 74.4, 98% were male, 17% were Black and 77% were White. During Days 1-7 of NH stay, the majority (51%) had only hyperglycemia >250mg/dL. Almost one-third (30%) had neither hypo- nor hyper-glycemia, 6% had only hypoglycemia <70mg/dL, and 13% had both hypo- and hyper-glycemia. Among Veterans with Level 1 hypoglycemia, over two-thirds also had hyperglycemia >250mg/dL, and only one-third had Level 2 hypoglycemia. Of Veterans with hyperglycemia ≥250mg/dL, only 16% had hyperglycemia ≥400mg/dL. In conclusion, most hypoglycemia in NH residents using insulin is mild (54-69mg/dL) and often co-occurs with hyperglycemia ≥250mg/dL, suggesting any deintensification in response to hypoglycemia should be coupled with monitoring for worsening hyperglycemia. Future research is needed to determine whether hypoglycemia 54-70mg/dL or hyperglycemia 250-400mg/dL is associated with adverse outcomes in NH residents. Disclosure A.K.Lee: Other Relationship; GRAIL (acquired by Illumina in 2021). Y.Shi: None. S.J.Lee: None. Funding National Institutes of Health

Racial Disparities in Care Interactions and Clinical Outcomes in Black Versus White Nursing Home Residents With Dementia.

With the increase in Black nursing home residents, racial and ethnic disparities in quality of care have been raised. The purpose of this study was to evaluate racial disparities in care and outcomes over 12 months. This was a secondary data analysis using data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia study. A total of 553 residents, 24% Black residents and 76% White residents, from 55 nursing homes were included. Differences favoring Black resident were noted in agitation, quality of life, inclusion of person-centered care approaches in care plans, and fewer falls and hospitalizations. Differences in quality-of-care interactions favored White residents. There were no differences in depression, resistiveness to care, function, pain, or transfers to the emergency department. Disparities in clinical outcomes were small and generally favored Black versus White residents except for quality-of-care interactions.

To whom health care aides report: Effect on nursing home resident outcomes.

Health care aides (personal support workers and nursing assistants) provide ~80%-90% of direct care to residents in nursing homes; it is therefore important to understand whether supervision of health care aides affects quality of care. We sought to determine whether health care aide reporting practices are associated with resident outcomes in nursing homes. We conducted a cross-sectional secondary analysis of survey data of 3991health care aides from 322 units in 89 nursing homes in Western Canada. We then linked resident data from the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 database to care aide surveys at the unit level. We used hierarchical mixed models to determine if the proportion of health care aides reporting to a respective nursing leader role was associated with 13 practice sensitive quality indicators of resident care. Most health care aides reported to a registered nurse (RN, 44.5%) or licenced practical nurse (LPN, 53.3%). Only 2.2% of health care aides reported to a care manager and were excluded from the analysis. Resident outcomes for only declining behavioural symptoms were more favourable when a higher proportion of health care aides (on a unit) reported to RNs, β=-0.004 (95% CI -0.006, -0.001, p=.004). The remaining indicators were not affected by care aide reporting practices. Resident outcomes as evaluated by the indicators appear largely unaffected by care aide reporting practices. LPNs' increasing scope of practice and changing work roles and responsibilities in nursing homes across Western Canada may explain the findings.

The Adverse Effects of the COVID-19 Pandemic on Nursing Home Resident Well-Being

ObjectiveQuantify the effects of the COVID-19 pandemic on nursing home resident well-being. DesignQuantitative analysis of resident-level assessment data. Setting and participantsLong-stay residents living in Connecticut nursing homes. MethodsWe used Minimum Data Set assessments to measure nursing home resident outcomes observed in each week between March and July 2020 for long-stay residents (eg, those in the nursing home for at least 100 days) who lived in a nursing home at the beginning of the pandemic. We compared outcomes to those observed at the beginning of the pandemic, controlling for both resident characteristics and patterns for outcomes observed in 2017-2019. ResultsWe found that nursing home resident outcomes worsened on a broad array of measures. The prevalence of depressive symptoms increased by 6 percentage points relative to before the pandemic in the beginning of March—representing a 15% increase. The share of residents with unplanned substantial weight loss also increased by 6 percentage points relative to the beginning of March—representing a 150% increase. We also found significant increases in episodes of incontinence (4 percentage points) and significant reductions in cognitive functioning. Our findings suggest that loneliness and isolation play an important role. Though unplanned substantial weight loss was greatest for those who contracted COVID-19 (about 10% of residents observed in each week), residents who did not contract COVID-19 also physically deteriorated (about 7.5% of residents in each week). Conclusions and ImplicationsThese analyses show that the pandemic had substantial impacts on nursing home residents beyond what can be quantified by cases and deaths, adversely affecting the physical and emotional well-being of residents. Future policy changes to limit the spread of COVID-19 or other infectious disease outbreaks should consider any additional costs beyond the direct effects of morbidity and mortality due to COVID-19.

Person-Centered Care as Facilitated by Kansas' PEAK 2.0 Medicaid Pay-for-Performance Program and Nursing Home Resident Clinical Outcomes.

Purpose of the StudyPerson-centered care (PCC) is intended to improve nursing home residents’ quality of life, but the closer bonds it engenders between residents and staff may also facilitate improvements to residents’ clinical health. Findings on whether adoption ameliorates resident clinical outcomes are conflicting, with some evidence of harm as well as benefit. To provide clearer evidence, the present study made use of Kansas’ PEAK 2.0 Medicaid pay-for-performance (P4P) program, which incents the adoption of PCC. The program is distinctive in training facilities’ staff on adopting PCC through a series of well-defined stages and providing regular feedback about their progress.Design and MethodsA retrospective cohort study was performed with 349 Kansas facilities spread across several well-defined PCC adoption stages, ranging from nonadoption to comprehensive adoption. The outcomes were thirteen 2014–2016 Nursing Home Compare long-stay resident clinical measures and a composite measure incorporating only nonimputed data for those 13 outcomes. Observed facility demographic differences were controlled for with propensity score adjustment. Treatment effect analyses were run with each outcome, with the predictor variable of program stage.ResultsSeven of the 13 clinical measures plus the composite measure indicated better health for residents in homes at higher program stages, relative to those in nonparticipating homes, including a 49% lower prevalence of major depressive symptoms in strongly adopting facilities.ImplicationsThe findings suggest that greater PCC adoption through PEAK participation is associated with better quality of care. Policymakers in other states may want to consider implementing a program modeled on PEAK 2.0.

Patient-Important Adverse Events of β-blockers in Frail Older Adults after Acute Myocardial Infarction.

We evaluated the burden of adverse events caused by β-blocker use after acute myocardial infarction (AMI) in frail, older nursing home (NH) residents. This retrospective cohort study used national Medicare claims linked to Minimum Data Set assessments. The study population was individuals aged ≥65 years who resided in a U.S. NH for ≥30 days, had a hospitalized AMI between May 2007 and March 2010, and returned to the NH. Exposure was new use of β-blockers versus nonuse post-AMI. Orthostasis, general hypotension, falls, dizziness, syncope, and breathlessness outcomes were measured over 90 days of follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes were estimated using multinomial logistic regression models after 1:1 propensity score-matching of β-blocker users to nonusers. Among the 10,992 NH propensity score-matched residents with an AMI, the mean age was 84 years and 70.9% were female. β-blocker users were more likely than nonusers to be hospitalized for hypotension (OR = 1.20, 95% CI 1.03-1.39) or experience breathlessness (OR = 1.10, 95% CI 1.01-1.20) after AMI. With the exception of falls, other outcome estimates, though imprecise, were compatible with a potential elevated risk of orthostasis (OR = 1.14, 95% CI 0.96-1.35), syncope, (OR = 1.24, 95% CI 0.55-2.77), and dizziness (OR = 1.28, 95% CI 0.82-1.99) among β-blocker users. Considered alongside prior evidence that β-blockers may worsen functional outcomes in NH residents with poor baseline functional and cognitive status, our results suggest that providers should exercise caution when prescribing for these vulnerable groups, balancing the mortality benefit against the potential for causing adverse events.

Risk factors and consequences of decreased kidney function in nursing home residents: A longitudinal study.

The aim of the present study was to study the renal function and the relationship of deterioration in renal function with major outcomes in elderly nursing home residents. A second aim was to compare the internationally recommended formulae for estimated glomerular filtration rate (eGFR) consisting of both creatinine and cystatin C in a nursing home population. A total of 429 patients from 11 nursing homes were included during 2008-2011. GFR was estimated, from formulae based on both creatinine and cystatin C, at baseline and after 1 and 2 years. The patients were divided into groups based on chronic kidney disease level, and comparisons were made for mortality, morbidity, the use of medications and between the different formulae for eGFR. Survival was lower in the groups with lower renal function. Over 60% of the residents had impaired renal function. Those with impaired renal function were older, had a higher number of medications and a higher prevalence of heart failure. Higher number of medications was associated with a greater risk of rapid decline in renal function with an odds ratio of 1.2 (95% confidence interval 1.06-1.36, P = 0.003). The compared eGFR formulae based on both cystatin C and creatinine were in excellent concordance with each other. Decreased renal function was associated with increased mortality. A majority of nursing home residents had declining renal function, which should be considered when prescribing medications. The more medications, the higher the risk for rapidly declining renal function. Geriatr Gerontol Int 2017; 17: 791-797.

Perceptions of Nursing Practice: Capacity for High-Quality Nursing Home Care

Emerging evidence indicates that harmful nursing home resident outcomes occur because of ineffective collaboration between registered nurses (RNs) and licensed practical nurses (LPNs) during assessment, care planning, delegation, and supervision. This observational, factorial vignette survey related video vignettes of RN–LPN collaboration in nursing home care to RN perceptions of: 1) current practice in their home; and 2) preferred practice in their home ( N = 444 rated vignettes of nursing practice). Current practice ranged from collaboration with few or poor-quality connections and a lack of differentiation between RN and LPN roles (low-capacity practice) to strong RN–LPN connections and clearly differentiated roles (high-capacity practice); RNs identified high-capacity practice as preferred. Interventions that bring together RNs and LPNs to learn new ways of giving care by differentiating roles while also strengthening connections show promise as levers for changing quality of care in nursing homes.

Economic evaluation of registered nurse tenure on nursing home resident outcomes

PurposeLittle is known about the economic implications of nursing home (NH) registered nurse (RN) tenure on resident outcomes. This study evaluated the cost-effectiveness of two nurse workforce scenarios focusing on RN tenure (high versus low), and the associated transfers from NH to the hospital. MethodsA decision tree was constructed to compare the incremental costs and effects of RN tenure scenarios on NH resident transfers to the hospital under two NH staffing scenarios: high versus low levels of RN tenure. Three outcomes were modeled: 1) dollars per hospitalization avoided, 2) dollars per hospitalization and death avoided, and 3) dollars per death avoided. ResultsThe total costs of care for the low tenure scenario were $34,108 per month compared to the high tenure scenario at $29,442 per month. Effectiveness of the high tenure was greater across all 3 outcomes (incremental effectiveness ranged from 0.925 to 0.974 depending on outcome), indicating that high tenure was the dominant strategy (that is less costly and more effective). ConclusionsHigher RN tenure was a dominant strategy across the 3 outcomes. This was a fairly robust finding despite the variations in the model and uncertainty in the input parameters. Aligning quality outcomes with cost effectiveness is imperative to driving the direction of health policy in the United States. Better prevention of hospitalizations by having an experienced RN workforce will not only improve resident quality of care but will allow NHs to realize the value of retaining a skilled workforce.

Leadership education, certification and resident outcomes in US nursing homes: Cross-sectional secondary data analysis

BackgroundLeadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. ObjectivesTo examine associations of education and certification among NHAs and DONs with resident outcomes. DesignCross-sectional secondary data analysis. SettingsThis study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). Participants1142 nursing homes in the survey which represented 16628 nursing homes in the US. MethodsLeadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. ResultsNursing homes led by NHAs with both Master's degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor's degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. ConclusionsSelected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships.

Effect of Part D coverage restrictions for antidepressants, antipsychotics, and cholinesterase inhibitors on related nursing home resident outcomes.

In 2006, Medicare Part D transitioned prescription drug coverage for dual-eligible nursing home residents from Medicaid to Medicare and randomly assigned them to Part D prescription drug plans (PDPs). Because PDPs may differ in coverage, plans may be more or less generous for drugs that an individual is taking. Taking advantage of the fact that randomization mitigates potential selection bias common in observational studies, this study sought to assess the effect of PDP coverage on resident outcomes for three medication classes--antidepressants, antipsychotics, and cholinesterase inhibitors. Retrospective cohort study to examine the effect of coverage restrictions--including noncoverage and coverage with restrictions--on depression, hallucinations and delusions, aggressive behaviors, cognitive performance, and activities of daily living for dual-eligible nursing home residents randomized to PDPs in 2006 to 2008. The analyses further adjusted for baseline health status to address any residual imbalances in the comparison groups. Linked data from Medicare claims, Minimum Data Set assessments, pharmacy claims, and PDP formulary information. Dual-eligible nursing home residents aged 65 and older living in facilities that contracted with a single pharmacy provider. PDP coverage restrictions in three medication classes of interest were not significantly associated with the resident outcomes examined. Although cholinesterase inhibitor users facing coverage restrictions had a 0.04-point lower depression rating score than residents facing no restrictions, this difference was not statistically significant after adjusting for multiple comparisons. The findings suggest that exogenous changes in coverage for three commonly used medication classes had no detectable effect on nursing home resident outcomes in 2006 to 2008. There are several possible explanations for this lack of association, including the role of policy protections for dual-eligible nursing home residents and the possibility that suitable clinical alternatives were identified or that previously used medications offered little clinical benefit.

Effect of Part D Coverage Restrictions for Antidepressants, Antipsychotics, and Cholinesterase Inhibitors on Related Nursing Home Resident Outcomes

Effect of Part D Coverage Restrictions for Antidepressants, Antipsychotics, and Cholinesterase Inhibitors on Related Nursing Home Resident Outcomes

Systematic Review of Interdisciplinary Interventions in Nursing Homes

The role of interdisciplinary interventions in the nursing home (NH) setting remains unclear. We conducted a systematic evidence review to study the benefits of interdisciplinary interventions on outcomes of NH residents. We also examined the interdisciplinary features of successful trials, including those that used formal teams. Medline was searched from January 1990 to August 2011. Search terms included residential facilities, long term care, clinical trial, epidemiologic studies, epidemiologic research design, comparative study, evaluation studies, meta-analysis and guideline. We included randomized controlled trials (RCTs) evaluating the efficacy of interdisciplinary interventions conducted in the NH setting. We used the Cochrane Collaboration tools to appraise each RCT, and an RCT was considered positive if its selected intervention had a significant positive effect on the primary outcome regardless of its effect on any secondary outcome. We also extracted data from each trial regarding the participating disciplines; for trials that used teams, we studied the reporting of various team elements, including leadership, communication, coordination, and conflict resolution. We identified 27 RCTs: 7 had no statistically significant effect on the targeted primary outcome, 2 had a statistically negative effect, and 18 demonstrated a statistically positive effect. Participation of residents' own primary physicians (all 6 trials were positive) and/or a pharmacist (all 4 trials were positive) in the intervention were common elements of successful trials. For interventions that used formal team meetings, presence of communication and coordination among team members were the most commonly observed elements. Overall interdisciplinary interventions had a positive impact on resident outcomes in the NH setting. Participation of the residents' primary physician and/or a pharmacist in the intervention, as well as team communication and coordination, were consistent features of successful interventions.

The Effect on Nursing Home Resident Outcomes of Creating a Household Within a Traditional Structure

Person-centered care (PCC) is a revolutionary approach to the culture change of elder care that is being adopted by nursing home providers across the nation. One aspect of PCC is the introduction of more self-contained units or households within long term care facilities. This study aimed to evaluate the effect of households on nursing home residents' physical and psychological outcomes using the Minimum Data Set (MDS) comprehensive assessment data. A retrospective, longitudinal study. Two care units in a large urban nursing home within the Western New York long term care system. Residents living in two units (household unit and traditional care unit) within one nursing home during January 2005 to April 2007. The MDS 2.0 is a standardized and comprehensive assessment tool that measures long term care facility residents' functional, medical, cognitive, and psycho-social status. The de-identified MDS 2.0 records of residents living in these units during this time period were retrieved from the New York Association of Homes and Services for the Aging. The residents' cognitive patterns, mood and behavior pattern, physical functioning, pain, fall, nutritional status, number of ulcers, medication use, and special treatment were compared. Descriptive and correlational statistics were used for data analysis. MDS records of 35 household-unit residents and 33 traditional-unit residents were analyzed. After adjusting for baseline differences, household-unit residents had better self- performed eating ability, daytime sleepiness, and restraint use; however, more fall incidents were reported for the household unit. Our findings indicate that households generated some better outcomes for residents and provide preliminary evidence to support households in nursing homes. Further research is needed to overcome design issues; however, the MDS may be useful for PCC outcomes measurement.

State Regulatory Oversight of Certified Nursing Assistants and Resident Outcomes

This study aimed to describe state regulatory certified nursing assistant (CNA) oversight in two domains—use of registry or licensing for credentialing and initial CNA training and continuing education (CE) requirements—and to evaluate whether CNA oversight is associated with resident outcomes in nursing homes.This cross-sectional secondary analysis combined 2004 data on state-level regulatory requirements for CNA oversight, training, and CE with nursing home resident outcomes data collected in 2004 from 16,125 U.S. facilities in 49 states. Though 26 states required CNAs to have more initial training hours than the federal requirement of 75 hours, only four states required additional yearly CE hours to maintain CNA certification. The combination of increased initial training and annual CE hours was significantly associated with nursing homes reporting lower antidepressant and antipsychotic use and lower average medication use. Use of a registry or licensing board for credentialing was significantly related to lower catheter use, and CNA licensure was significantly associated with lower odds of falls. Findings suggest that regulatory modifications could be beneficial to improve resident care outcomes in nursing homes.

Effect of Influenza on Functional Decline

To examine the relationship between influenza and activity of daily living (ADL) decline and other clinical indicators in nursing home (NH) residents. Retrospective NH-aggregated longitudinal study. Two thousand three hundred fifty-one NHs in 122 U.S. cities from 1999 to 2005. Long-stay (>90 days) NH residents. Quarterly city-level influenza mortality and state-level influenza severity. Quarterly incidence of Minimum Data Set-derived ADL decline (≥ 4 points), weight loss, new or worsening pressure ulcers (PUs), and infections. Outcome variables chosen as clinical controls were antipsychotic use, restraint use, and persistent pain. City-level influenza mortality and state-level influenza severity were associated with higher rates of large (≥ 4 points) ADL decline (mortality β = 0.20, P < .001; severity β = 0.18, P < .001), weight loss (β = 0.19, P < .001; β = 0.24, P < .001), worsening PUs (β = 0.04, P = .08; β = 0.12, P < .001), and infections (β = 0.41, P < .001; β = 0.47, P < .001) but not with restraint use, antipsychotic use, or persistent pain. NH influenza vaccination rates were weakly associated with the outcomes (e.g., β = -0.009, P = .03 for ADL decline, β = 0.008, P = .07 for infections). Compared with the summer quarter of lowest influenza activity, the results for the other quarters translate to an additional 12,284 NH residents experiencing large ADL decline annually, 15,168 experiencing significant weight loss, 6,284 new or worsening PUs, and 29,753 experiencing infections due to influenza. The results suggest a substantial and potentially costly effect of influenza on NH residents. The effect of influenza vaccination on preventing further ADL decline and other clinical outcomes in NH residents should be studied further.

Effects of Electronic Health Information Technology Implementation on Nursing Home Resident Outcomes

To examine the effects of electronic health information technology (HIT) on nursing home residents. The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents' subjective assessment of the HIT intervention were generally positive. The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on resident behavior.