A5088391410- Geriatric Care and Nursing Homes
- Palliative Care and End-of-Life Issues
- Frailty in Older Adults
- Dementia and Cognitive Impairment Research
- Adolescent and Pediatric Healthcare
- Chronic Disease Management Strategies
- Health Policy Implementation Science
- Interprofessional Education and Collaboration
- Health disparities and outcomes
- Healthcare Policy and Management
- Migration, Aging, and Tourism Studies
- Emergency and Acute Care Studies
- Intergenerational Family Dynamics and Caregiving
- Family and Patient Care in Intensive Care Units
- Primary Care and Health Outcomes
- Family Support in Illness
- Health Systems, Economic Evaluations, Quality of Life
- Intensive Care Unit Cognitive Disorders
- Community Health and Development
- Statistical Methods and Bayesian Inference
- Aging, Elder Care, and Social Issues
- Substance Abuse Treatment and Outcomes
- Global Health Workforce Issues
- Pressure Ulcer Prevention and Management
- Global Health Care Issues
University of North Carolina at Chapel Hill
2015-2025
University of North Carolina Health Care
2021-2024
Anderson University - South Carolina
2012
University of Puerto Rico at Carolina
2012
Duke University
2008-2012
Queen's Medical Center
2006-2008
Objectives To describe the time to first acute care use (e.g., emergency department ( ED ) without hospitalization or rehospitalization) for older adults discharged home after receiving postacute in skilled nursing facilities SNF s); identify predictors of use. Design Retrospective cohort study using administrative claims data. Setting SNFs providing patients N orth and S outh C arolina = 1,474). Participants A Medicare beneficiaries aged 65 55,980) who were hospitalized then transferred a...
Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial an intervention to improve staff communication (CONNECT), we conducted focus groups direct and managers elicit their perceptions factors that enhance or reduce LTC setting. The overall aim was generate hypotheses how sustain complex LTC.In eight facilities, 15 with 83 who had participated at least one session. Where possible, separate were managers. An...
Hospitals are focused on improving postdischarge services for older adults, such as early follow-up care after hospitalization to reduce readmissions and unnecessary emergency department (ED) use. Rural Medicare beneficiaries face many barriers receiving quality care, but little is known about their outcomes. We hypothesize that rural compared with urban beneficiaries, will have fewer visits, a greater likelihood of readmission ED use.We conducted retrospective analysis elderly discharged...
Among hospitalized older adults who transfer to skilled nursing facilities (SNF) for short stays and subsequently home, twenty two percent require additional emergency department or hospital care within 30 days. Transitional services, that provide continuity coordination of as transition between settings care, decrease complications during transitions in however, they have not been examined SNFs. Thus, this study described how existing staff SNFs delivered transitional identify opportunities...
Rationale: Family caregivers of patients with acute cardiorespiratory failure are at high risk for distress, typically defined as the presence psychological symptoms such anxiety, depression, or post-traumatic stress. Interventions to reduce caregiver distress and increase wellness have been largely ineffective date. An incomplete understanding may hinder efforts developing effective support interventions. Objectives: To allow family define their experiences six months after patient...
The purpose of this study was two-fold: (1) describe the relationship between patient or caregiver reported preparedness for care transitions, and acute use in 30 days after discharge from a skilled nursing facility (SNF); (2) explore how is influenced by patient, Charlson index, race social determinants. design secondary analysis data collected as part cluster randomized trial Connect-Home transitional intervention. setting 6 facilities located US state North Carolina. sample 249 dyads with...
To describe relationship patterns and management practices in nursing homes (NHs) that facilitate or pose barriers to better outcomes for residents staff. We conducted comparative, multiple-case studies selected NHs (N = 4). Data were collected over six months from managers staff 406), using direct observations, interviews, document reviews. Manifest content analysis was used identify explore within between cases. Participants described interaction strategies they explained could either...
Background Older adults that transfer from skilled nursing facilities ( SNF ) to home have significant risk for poor outcomes. Transitional care of patients (i.e., time‐limited services ensure coordination and continuity care) is poorly understood. Objective To determine the feasibility relevance Connect‐Home transitional intervention, compare preparedness discharge between comparison intervention dyads. Design A non‐randomized, historically controlled design‐enrolling dyads their family...
To support the development of internationally comparable common data elements (CDEs) that can be used to measure essential aspects long-term care (LTC) across low-, middle-, and high-income countries, a group researchers in medicine, nursing, behavioral, social sciences from 21 different countries have joined forces launched Worldwide Elements Harmonize Research LTC Living Environments (WE-THRIVE) initiative. This initiative aims develop infrastructure for international use domains...
Abstract Background Implementation science emerged from the recognized need to speed translation of effective interventions into practice. In US, has evolved place an ever-increasing focus on implementation strategies. The long list strategies, terminology used name and time required tailor strategies all may contribute delays in translating evidence-based (EBIs) To EBI translation, we propose a streamlined approach classifying tailoring Main text A multidisciplinary team eight scholars...
Recipients of long-term services and supports (LTSS) frequently transition between LTSS settings (e.g., assisted living facilities, nursing homes) hospitals for acute changes in health. In this qualitative study, we analyzed findings from interviews with 57 recently hospitalized recipients their family caregivers described barriers facilitators to high-quality care support older adults through these transitions. The themes that emerged strongly suggest do not receive needed information about...
Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors are associated with effective care. We explored influence on behavior as it relates resident outcomes, and offer a theoretical explanation why sometimes enhance mindfulness other times it. analyzed data from an in-depth, multiple-case study including field notes, interviews, documents collected in eight homes. completed...
Older adults with ESRD often receive care in skilled nursing facilities (SNFs) after an acute hospitalization; however, little is known about use SNF discharge to home.This study used Medicare claims for North and South Carolina identify patients who were discharged home from a between January 1, 2010 August 31, 2011. Nursing Home Compare data ascertain characteristics. The primary outcome was time first (hospitalization or emergency department visit) within 30 days. Cox proportional hazards...
Little is known about how nursing home staff use resident characteristics to individualize care delivery or whether affected by implicit bias.Randomized factorial clinical vignette survey.Sixteen homes in North Carolina.Nursing, rehabilitation, and social services (n = 433).Vignettes describing hypothetical residents were generated from a matrix of demographic characteristics. Resident age, race gender suggested photo. Participants completed up four randomly assigned vignettes 1615), rating...
Stepped wedge designs have uni-directional crossovers at randomly assigned time points (steps) where clusters switch from control to intervention condition. Incomplete stepped are increasingly used in cluster randomized trials of health care interventions and periods without data collection due logistical, resource patient-centered considerations. The development sample size formulae for has primarily focused on complete continuous responses. Addressing this gap, a general, fast,...
Abstract Background Skilled nursing facility (SNF) patients and their caregivers who transition to home experience complications frequently return acute care. We tested the efficacy of Connect‐Home transitional care intervention on patient caregiver preparedness for at home, other caregiver‐reported outcomes. Methods used a stepped wedge, cluster‐randomized trial design test against standard discharge planning (control). The setting was six SNFs health offices in one agency. Participants...
New approaches are needed to enhance implementation of complex interventions for geriatric syndromes such as falls.To test whether a complexity science-based staff training intervention (CONNECT) promoting high-quality interactions improves the impact an evidence-based falls quality improvement program (FALLS).Cluster-randomized trial in 24 nursing homes receiving either CONNECT followed by FALLS (intervention), or alone (control). Nursing home all positions were asked complete surveys at...
Abstract Background Skilled nursing facility (SNF) patients are medically complex with multiple, advanced chronic conditions. They dependent on caregivers and have experienced recent acute illnesses. Among SNF patients, the rate of mortality or care use is over 50% within 90 days discharge, yet these their often do not receive quality transitional that prepares them to manage serious illnesses at home. Methods The study will test efficacy Connect-Home, a successfully piloted intervention...