Advertisement

Defining the Core Skills and Activities of the Attending Physician in Post-Acute and Long-Term Care

      Abstract

      The American Board of Post-Acute and Long-Term Care Medicine (ABPLM) contracted with a psychometric firm to perform a 3-phase Job Analysis following best practices. Literature was reviewed, a task force of subject matter experts was convened, a survey was developed and sent via Survey Monkey to attending physicians practicing in post-acute and long-term care settings (PALTC). The task force refined a comprehensive list of the tasks, knowledge, and medical knowledge needed in the role of attending physician in PALTC. These items were written as statements and edited until consensus was reached on their accuracy, conciseness, and lack of overlap. Task statements described distinct, identifiable, and specific practice-related activities relevant across multiple care settings. Knowledge statements described previously acquired information considered necessary to effectively perform such tasks. The survey consisted of 260 items, including 21 demographic questions, 115 task statements, 73 knowledge statements, and 72 medical knowledge statements. The survey was disseminated via e-mail invitations to Society for Post-Acute and Long-Term Care (AMDA) members and through an online link available through ABPLM’s website. A total of 389 respondents participated. Survey data were analyzed with statistical analysis software SPSS. For each task and knowledge statement, an Overall Task Rating and Knowledge Rating were developed by combining the importance rating weighted at 65% and (for task) the frequency rating or (for knowledge) the cognitive level weighted at 35%. One task statement and 1 medical knowledge statement had a mean importance rating lower than 2.5 and were dropped from further review, resulting in a final count of 114 task, 73 knowledge, and 71 medical knowledge statements (258 total). The results of this Job Analysis highlight the unique and specific nature of medical care provided by attending physicians across a range of PALTC settings. These findings lay a foundation for Focused Practice Designation or Subspecialty in PALTC and changes in practice and policy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Institute of Medicine
        Retooling for an Aging America: Building the Health Care Workforce.
        The National Academies Press, Washington DC2008
        • Houser A.
        • Fox-Grage W.
        • Ujvari K.
        Across the states: profiles of long-term services and supports.
        9th ed. AARP Public Policy Institute, Washington, DC2012
        • David S.
        • Sheikh F.
        • Mahajan D.
        • et al.
        Whom do we serve? Describing the target population for post-acute and long-term care, focusing on nursing facility settings, in the era of population health in the United States.
        J Am Med Dir Assoc. 2016; 17: 574-580
        • Kasper J.
        • O’Malley M.
        Changes in characteristics, needs, and payment for elderly nursing home residents: 1999-2004. Washington, DC: Kaiser Family Foundation, 2007.
        (Available at:)
        www.kff.org/medicaid/upload/7663.pdf
        Date accessed: February 21, 2020
        • Fashaw S.A.
        • Thomas K.S.
        • McCreedy E.
        • Mor V.
        Thirty-year trends in nursing home composition and quality since the passage of the omnibus reconciliation act.
        J Am Med Dir Assoc. 2020; 21: 233-239
        • Katz P.R.
        • Karuza J.
        • Intrator O.
        • Mor V.
        Nursing home physician specialists: A response to the workforce crisis in long-term care.
        Ann Intern Med. 2009; 150: 411-413
        • Steinberg K.
        PALTC, the specialty that dare not speak its name.
        Caring Ages. 2019; 20: 2
        • American Educational Research Association, American Psychological Association, National Council on Measurement in Education
        Standards for educational and psychological testing.
        American Educational Research Association, Washington, DC2014
      1. ISO/IEC 17024:2012 Conformity Assessment standards – General requirements for bodies operating certification of persons. ISO/IEC, Geneva, Switzerland2012
        • Harris-Kojetin L.
        • Sengupta M.
        • Park-Lee E.
        • Valverde R.
        Long-term care services in the United States: 2013 overview. National Center for Health Statistics.
        Vital Health Stat. 2013; 3
        • Institute of Medicine (US)
        Committee on Improving Quality in Long-Term Care.
        in: Wunderlich G.S. Kohler P.O. Improving the Quality of Long-Term Care. National Academies Press, Washington, DC2001
      2. CMS.gov state operations manual. Appendix PP - Guidance to surveyors for long term care facilities. Rev. 107, 04-04-14.

        • Katz P.R.
        • Wayne M.
        • Evans J.
        • et al.
        Examining the rationale and processes behind the development of AMDA’s competencies for post-acute and long-term care.
        Ann Long-Term Care. 2014; 22: 36-39
        • Gerontological Advanced Practice Nurses Association
        GAPNA Consensus Statement on Proficiencies for the APRN Gerontological Specialist.
        Gerontological Advanced Practice Nurses Association, Pitman NJ2015
        • Department of Health and Human Services
        Office of Inspector General. Adverse events in skilled nursing facilities: National incidence among Medicare beneficiaries OEI-06-11-00370.
        Department of Health and Human Service Office of Inspector General, Washington, DC2013
      3. The Core Curriculum on Medical Direction in Long-Term Care. 2014, June 30.
        (Available at:)
        • Levenson S.A.
        The Maryland regulations: Rethinking physician and medical director accountability in nursing homes.
        J Am Med Dir Assoc. 2002; 3: 79-94
        • AMDA-The Society for Post-Acute and Long-Term Care Medicine
        Tool kit for managing attending physicians in post-acute and long-term care.
        AMDA, Columbia, MD2012
        • AMDA-The Society for Post-Acute and Long-Term Care Medicine
        Synopsis of Federal Regulations in the Nursing Facility: Implications for Attending Physicians and Medical Directors.
        AMDA, Columbia, MD2013
        • American Medical Directors Association
        The roles and responsibilities of the nursing home medical director.
        J Am Med Dir Assoc. 2005; 6: 410
        • Dimant J.
        Roles and responsibilities of attending physicians in skilled nursing facilities.
        J Am Med Dir Assoc. 2003; 4: 231-243
        • Raymond M.
        • Neustel S.
        Determining the content of credentialing examinations.
        in: Downing S.M. Haladyna T.M. Handbook of test development. Erlbaum, Mahwah, NJ2006: 181-223
        • Williams B.C.
        • Warshaw G.
        • Leipzig R.M.
        Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.
        J Grad Med Educ. 2010; 2: 373-383
        • Sloane P.D.
        • Zimmerman S.
        • Perez R.
        • et al.
        Physician perspectives on medical care delivery in assisted living.
        J Am Geriatr Soc. 2011; 59: 2326-2331
        • Caprio T.V.
        • Karuza J.
        • Katz P.R.
        Profile of physicians in the nursing home: Time perception and barriers to optimal medical practice.
        J Am Med Dir Assoc. 2009; 10: 93-97
        • Kuo Y.F.
        • Raji M.A.
        • Goodwin J.S.
        Association between proportion of provider clinical effort in nursing homes and potentially avoidable hospitalizations and medical costs of nursing home residents.
        J Am Geriatr Soc. 2013; 61: 1750-1757
      4. Standard Analytical Files (Medicare Claims) – LDS.
        (Available at:)
        • Blumenthal D.
        • Gokhale M.
        • Campbell E.G.
        • Weissman J.S.
        Preparedness for clinical practice: reports of graduating residents at academic health centers.
        JAMA. 2001; 286: 1027-1034
        • White H.K.
        Long-term care in North Carolina.
        N C Med J. 2014; 75: 320-325