JAMDA
Volume 7, Issue 6 , Pages 383-387 , July 2006

Inpatient Care for Nursing Home Patients: An Opportunity to Improve Transitional Care

  • Huai Y. Cheng, MD, MPH

      Affiliations

    • Columbia University, Department of Medicine, Division on Aging, New York, NY
    • ,
  • Emily Tonorezos, MD

      Affiliations

    • Department of Medicine, Johns Hopkins University, Baltimore, MD
    • ,
  • Robert Zorowitz, MD, MBA, CMD

      Affiliations

    • The Hebrew Home at Riverdale, Riverdale, New York, NY.
    • ,
  • John Novotny, MD

      Affiliations

    • Columbia University, Department of Medicine, Hospitalist Program, New York, NY
    • ,
  • Shelly Dubin, GNP

      Affiliations

    • Columbia University, Department of Medicine, Division on Aging, New York, NY
    • ,
  • Mathew S. Maurer, MD

      Affiliations

    • Columbia University, Department of Medicine, Division on Aging, New York, NY
    • Corresponding Author InformationAddress correspondence to Mathew S. Maurer, MD, Columbia University, Allen Pavilion, 5141 Broadway, 3 Field West, Room 035, New York, NY 10034.

References 

  1. Barker WH , Zimmer JG , Hall WJ , et al.   Rates, patterns, causes, and costs of hospitalization of nursing home residents (a population-based study) . Am J Public Health . 1994;84:1615–1620
  2. Castle NG , Mor V . Hospitalization of nursing home residents (A review of the literature, 1980–1995) . Med Care Res Rev . 1996;53:123–148
  3. Teresi JA , Holmes D , Bloom HG , et al.   Factors differentiating hospital transfers from long-term care facilities with high and low transfer rates . Gerontologist . 1991;31:795–806
  4. Freiman MP , Murtaugh CM . Interactions between hospital and nursing home use . Public Health Rep . 1995;110:546–554
  5. Fried T , Mor V . Frailty and the hospitalization of long term stay nursing home residents . J Am Geriatr Soc . 1997;45:265–269
  6. Lews MA , Cretin S , Kane RL . The natural history of nursing home patients . Gerontologist . 1985;25:382–388
  7. Coburn AF , Keith RG , Bolda EJ . The impact of rural residence on multiple hospitalizations in the nursing facility residents . Gerontologist . 2002;42:661–666
  8. Bookvar K , Fishman E , Kyriacou CK , et al.   Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities . Arch Int Med . 2004;164:545–550
  9. Saliba D , Kington R , Buchanan J , et al.   Appropriateness of the decision to transfer nursing facility residents to the hospital . J Am Geriatr Soc . 2000;48:154–163
  10. Parry C , Coleman EA , Smith JD , et al.   The Care Transitions Intervention (a patient-centered approach to ensuring effective transfers between sites of geriatric care) . Home Health Care Serv Q . 2003;22:1–16
  11. Coleman EA , Boult C . Improving the quality of transitional care for persons with complex care needs-position statement of the American Geriatrics Society Health Care Systems Committee . J Am Geriatr Soc . 2003;51:556–557
  12. Coleman EA . Falling through the cracks (Challenges and opportunities for improving transitional care for persons with continuous complex care needs) . J Am Geriatr Soc . 2003;51:549–555
  13. Coleman EA , Berenson RA . Lost in transition (Challenges and opportunities for improving the quality of transitional care) . Ann Intern Med . 2004;140:533–536
  14. Charette S . Hospitalization of the nursing home patient . J Am Med Dir Assoc . 2003;4:90–94
  15. Creditor MC . Hazards of hospitalization of the elderly . Arch Intern Med . 1993;156: 219-213
  16. Suri DN , Egleston BL , Brody JA , Rudberg MA . Nursing home resident use of care directives . J Gerontol A Biol Sci Med Sci . 1999;54:M225–M229
  17. Zerzan J , Sterarns S , Hanson L . Access to palliative care and hospice in nursing homes . JAMA . 2000;284:2489–2494
  18. Parker D , Porock D , Zweig S . End-of-life care in U.S. nursing homes (A review of the evidence) . J Am Med Dir Assoc . 2004;5:147–155
  19. Miller SC , Gozalo P , Mor V . Hospice enrollment and hospitalization of dying nursing home patients . Am J Med . 2001;111:38–44
  20. Brooks S , Warshaw G , Hasse L , Kues JR . The physician decision-making process in transferring nursing home patients to the hospital . Arch Intern Med . 1994;154:902–908
  21. Callahan EH , Thomas DC , Goldhirsch SL , Leipzig WM . Geriatric hospital medicine . Med Clin N Am . 2002;86:707–729
  22. Jacobs LG , Bonuck K , Burton W , Mulvihill M . Hospital care at the end of life (An institutional assessment) . J Pain Symptom Manage . 2002;24:291–298
  23. Gillick MR . Choosing appropriate medical care for the elderly . J Am Med Dir Assoc . 2001;2:305–309
  24. Volicer L , Rheaume Y , Brown J , et al.   Hospice approach to the treatment of patients with advanced dementia . JAMA . 1986;256:2210–2213
  25. Sachs G . Dementia and the goals of care . J Am Geriatric Soc . 1998;46:440–446
  26. Brody H , Campbell M , Faber-Langendoen K , Ogle K . Withdrawing intensive life-sustaining treatment recommendations for compassionate clinical management . N Engl J Med . 1997;336:652–657
  27. Clinical Care Committee . Optimum care for hopelessly ill patients. A report of the Clinical Care Committee of the Massachusetts General Hospital . N Engl J Med . 1976;295:362–364
  28. Tsevat J , Dawson NV , Wu AW , et al.   Health values of hospitalized patients 80 years or older . JAMA . 1998;279:371–375
  29. Somogyi-Zalud E , Zhong Z , Lynn J , Hamel MB . Elderly person’s last six months of life (Finding from the hospitalized Elderly Longitudinal Project) . J Am Geriatr Soc . 2000;48(5 Suppl):S31–S39
  30. Happ MB , Capezuti E , Strumpf NE , et al.   Advanced care planning and end-of-life care for hospitalized nursing home residents . J Am Geriatr Soc . 2002;50:829–835
  31. Quill TE . Initiating end-of-life discussions with seriously ill patients (Addressing the “elephant in the room.”) . JAMA . 2000;284:2502–2507
  32. Tschann JM , Kaufman SR , Micco GP . Family involvement in end-of-life hospital care . J Am Geriatr Soc . 2003;51:835–840
  33. Lynn J , Goldstein NE . Advanced care planning for fetal chronic illness (Avoid commonplace errors and unwanted suffering) . Ann Intern Med . 2003;138:812–818
  34. Rabow MW , Hauser JM , Adams J . Supporting family caregivers at the end of life (“they don’t know what they don’t know.”) . JAMA . 2004;291:483–491
  35. Davis MN , Smith ST , Tyler S . Improving transition and communication between acute care and long-term care (A system for better continuity of care) . Annals of Long-term Care . 2005;13:25–32
  36. Gloth FM , Coleman EA , Philips SL , Zorowitz RA . Using electronic health records to improve care (will “high tech” allow a return to “high touch” medicine?) . J Am Med Dir Assoc . 2005;6:270–275
  37. Terrell KM , Brizendine EJ , Bean WF , et al.   An extended care facility-to-emergency department transfer form improves communication . Acad Emerg Med . 2005;12:114–118
  38. Thompson CA . JCAHO views medication reconciliation as adverse-event prevention . Am J Health Syst Pharm . 2005;62:1528; 1530, 1532

PII: S1525-8610(06)00077-6

doi: 10.1016/j.jamda.2006.01.025

JAMDA
Volume 7, Issue 6 , Pages 383-387 , July 2006

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