Journal of the American Medical Directors Association最新文献

{"title":"Using Machine Learning to Identify Social Determinants of Health that Impact Discharge Disposition for Hospitalized Patients","authors":"He Ren MS ,&nbsp;Chun Wang PhD ,&nbsp;David J. Weiss PhD ,&nbsp;Kathryn Bowles PhD, RN ,&nbsp;Gongjun Xu PhD ,&nbsp;Tamra Keeney DPT, PhD ,&nbsp;Andrea L. Cheville MD, MSCE","doi":"10.1016/j.jamda.2025.105524","DOIUrl":"10.1016/j.jamda.2025.105524","url":null,"abstract":"<div><h3>Objective</h3><div>To identify self-reported social determinants of health (SDOH) among hospitalized patients that predict discharge to a skilled nursing facility (SNF).</div></div><div><h3>Design</h3><div>A retrospective cohort analysis of 134,807 hospitalized patients from electronic medical records.</div></div><div><h3>Setting and Participants</h3><div>All patients admitted to hospitals within a large multistate tertiary health system.</div></div><div><h3>Methods</h3><div>The primary outcome was hospital disposition (home discharge vs SNF). The cohort was split into derivation and validation sets (75/25). We adopted 2 regularized regression-based statistical approaches, namely, the stacked elastic net (SENET) and bootstrap imputation-stability selection (BISS), to implement variable selection with incomplete data. After variable selection, logistic regression with the selected variables was conducted to create the final predictive model. The prediction accuracy and model fairness were evaluated on the test dataset using the area under the curve (AUC), equal AUC, and calibration.</div></div><div><h3>Results</h3><div>In the sample, 8.72% of patients were discharged to an SNF. The final models included between 11 and 15 variables. Significant SDOH variables included alcohol consumption, dental check, employment status, financial resources, nutrition, physical activities, social connection, and transportation needs. The final models also included 1 clinical (Charlson Comorbidity Index) and 2 demographic (marital status and education level) characteristics. The final models were confirmed across methods and datasets, predicted well in the validation cohort (AUC around 0.77), and were well calibrated.</div></div><div><h3>Conclusions and Implications</h3><div>Multiple SDOH characteristics predict SNF disposition, especially the lack of a life partner or spouse, are potentially mitigable (nutrition, physical activities, and transportation needs), and offer actionable targets to increase home discharge rates. The collection and integration of SDOH data may optimize the appropriateness and efficiency discharge planning.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105524"},"PeriodicalIF":4.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Specific Fall Trajectories and Associated Self-Reported Risk Factors: A Prospective Analysis of the 3-Year 5-Country DO-HEALTH Trial","authors":"Maud Wieczorek PhD ,&nbsp;Gregor Freystaetter MD ,&nbsp;Robert Theiler MD ,&nbsp;Uwe Siebert MD ,&nbsp;Andreas Egli MD ,&nbsp;Tahir Masud MD ,&nbsp;John A. Kanis MD ,&nbsp;Heike A. Bischoff-Ferrari MD, DrPH ,&nbsp;DO-HEALTH Research Group","doi":"10.1016/j.jamda.2025.105542","DOIUrl":"10.1016/j.jamda.2025.105542","url":null,"abstract":"<div><h3>Objective</h3><div>Few studies have explored specific trajectories or patterns of falls over time in older adults, and the role of sex and self-reported risk factors for these trajectories were overlooked. This study aimed to identify sex-specific fall trajectories over 3 years and the self-reported risk factors associated with each trajectory in European older adults.</div></div><div><h3>Design</h3><div>Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial.</div></div><div><h3>Setting and Participants</h3><div>Multicenter trial conducted in 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without major health events in the 5 years prior to enrollment, with sufficient mobility and good cognitive status.</div></div><div><h3>Methods</h3><div>Falls were recorded prospectively via phone calls and in-person assessments every 3 months over 3 years of follow-up. Group-based trajectory modeling was used to identify sex-specific trajectories based on the number of falls experienced over the follow-up, and penalized logistic regression models identified the self-reported risk factors most associated with each trajectory.</div></div><div><h3>Results</h3><div>A total of 1958 participants were included in this analysis (mean age: 74.9 years, 61.7% women). We identified a “lower fall trajectory” and a “higher fall trajectory” among women and a “lower fall trajectory” and an “increasing fall trajectory” among men. In women, living alone was the only self-reported risk factor associated with the higher fall trajectory. In men, living alone (marginal), as well as reporting fatigue, pain or discomfort, mobility issues, and higher self-rated health, were significantly associated with experiencing the increasing fall trajectory.</div></div><div><h3>Conclusions and Implications</h3><div>This study provides a comprehensive assessment of falls over 3 years, highlighting differences in fall patterns and associated self-reported risk factors between men and women. These findings may offer valuable insights for developing sex-specific fall risk prediction models and targeted fall prevention strategies.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105542"},"PeriodicalIF":4.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Initial Rehabilitation Type after Hip Fracture Surgery: A Retrospective Cohort Study","authors":"Chantal Backman RN, MHA, PhD ,&nbsp;Wenshan Li PhD ,&nbsp;Soha Shah MD ,&nbsp;Steve Papp MD, MSc, FRCSC ,&nbsp;Stephen G. Fung MPH ,&nbsp;Asnake Yohannes Dumicho MSc ,&nbsp;Meltem Tuna PhD ,&nbsp;Franciely Daiana Engel BN, PhD ,&nbsp;Colleen Webber PhD ,&nbsp;Luke Turcotte PhD ,&nbsp;Daniel I. McIsaac MD, MPH, FRCPC ,&nbsp;Paul E. Beaulé MD, FRCSC ,&nbsp;Véronique French-Merkley MD, CCFP, CoE ,&nbsp;Stéphane Poitras PT, PhD ,&nbsp;Benoit Lafleur MD ,&nbsp;Jennifer Watt MD, PhD ,&nbsp;Corita Vincent MD, MSc ,&nbsp;Sharon Straus MD, MSc ,&nbsp;Alexandre Tran MD ,&nbsp;Kristen Pitzul PhD ,&nbsp;Peter Tanuseputro MHSc, MD, CCFP, FRCPC","doi":"10.1016/j.jamda.2025.105521","DOIUrl":"10.1016/j.jamda.2025.105521","url":null,"abstract":"<div><h3>Objective</h3><div>To describe and compare the factors that impact initial rehabilitation type after hip fracture surgery.</div></div><div><h3>Design</h3><div>Retrospective population-based cohort study.</div></div><div><h3>Setting and Participants</h3><div>People aged between 50 and 105 with a hip fracture who had a surgical repair in Ontario, Canada, between January 1, 2015, and December 31, 2021.</div></div><div><h3>Methods</h3><div>Descriptive statistics and a multinomial logistic regression model were used to identify factors associated with initial rehabilitation type.</div></div><div><h3>Results</h3><div>In this study, 63,401 individuals were included with a mean age of 80 years [standard deviation (SD) 10.9], mostly female (67.3%), with 86.3% living in urban areas at the time of hospitalization and most (72.6%) admitted from the community without home care. A total of 24.5% of individuals did not receive any form of rehabilitation. Rurality of residence decreased the odds of having an initial rehabilitation type in complex continuing care [odds ratio (OR), 0.23; 95% CI, 0.21–0.26], in inpatient rehabilitation (OR, 0.26; 95% CI, 0.24–0.28), or in community rehabilitation (OR, 0.54; 95% CI, 0.50–0.58) compared with no rehabilitation. Dementia decreased the odds of having an initial rehabilitation type in complex continuing care (OR, 0.75; 95% CI, 0.69–0.81), in inpatient rehabilitation (OR, 0.44; 95% CI, 0.41–0.47), or in community rehabilitation (OR, 0.88; 95% CI, 0.82–0.95) compared with receiving no rehabilitation. Previous history of fragility fracture decreased the odds of having an initial rehabilitation type in either complex continuing care (OR, 0.30; 95% CI, 0.27–0.34), in inpatient rehabilitation (OR, 0.27; 95% CI, 0.24–0.29), or in community rehabilitation (OR, 0.33; 95% CI, 0.30–0.37) compared with no rehabilitation.</div></div><div><h3>Conclusions and Implications</h3><div>Rurality of residence, dementia, and previous history of fragility fractures reduced the odds of receiving specialized inpatient rehabilitation and increased the odds of receiving no rehabilitation. Future research should focus on achieving more equitable care for individuals living in rural settings, with dementia, or with previous fragility fractures to enhance the quality of care and achieve best outcomes for the overall hip fracture population.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105521"},"PeriodicalIF":4.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consumer-Directed Personal Care in the New York Metropolitan Area: Trends in Use From 2017 to 2022","authors":"Jennifer M. Reckrey MD ,&nbsp;David Russell PhD ,&nbsp;Julia G. Burgdorf PhD ,&nbsp;Melissa Aldridge PhD","doi":"10.1016/j.jamda.2025.105535","DOIUrl":"10.1016/j.jamda.2025.105535","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite growing interest in expansion of consumer- (or self-) directed models of Medicaid-funded personal care, research characterizing program use is limited. We leverage health plan and claims data from a large health plan in New York to examine (1) trends in use of consumer-directed care and (2) the impact of the COVID-19 pandemic on consumer-directed care use.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>All individuals enrolled in a large, New York health plan who received Medicaid-funded personal care between January 2017 and December 2022 (n = 47,216).</div></div><div><h3>Methods</h3><div>Proportion of enrollees receiving consumer-directed care during each month and year was calculated for all enrollees and the subgroups of new and existing enrollees. An interrupted time series model was estimated to examine time trends and impact of the COVID-19 pandemic onset on trends.</div></div><div><h3>Results</h3><div>Between 2017 and 2022, the proportion of enrollees receiving consumer-directed care increased from 10.3% to 47.9%. Sociodemographic characteristics and average personal care hours remained stable. Models identified a 6% yearly increase in the proportion of enrollees using consumer-directed care pre-pandemic, (<em>P</em> &lt; .001) an immediate 4% bump in use in March 2020 at the onset of the COVID-19 pandemic (<em>P</em> = .001), and an 8% yearly increase in use post pandemic onset (<em>P</em> = .01). Although trends among existing enrollees mirrored overall trends, new enrollees had larger increases in consumer-directed care use early in the study period, which leveled off after March 2020.</div></div><div><h3>Conclusions and Implications</h3><div>While there was a statistically significant and sustained increase in the proportion of enrollees receiving consumer-directed care at onset of the COVID-19 pandemic, the magnitude of this increase was small in comparison with overall program growth between 2017 and 2022. Additional work to understand how other factors contribute to enrollees choosing consumer-directed care is needed to ensure all Medicaid-funded personal care recipients can have their needs met in the community.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105535"},"PeriodicalIF":4.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skilled Nursing Facility Utilization Among Community-Dwelling Older Adults With Alzheimer's Disease and Related Dementias During the COVID-19 Pandemic.","authors":"Meiling Ying, Zijing Cheng, Richard A Hirth, Brent K Hollenbeck, Karen E Joynt Maddox, Vahakn B Shahinian, Yue Li","doi":"10.1016/j.jamda.2025.105551","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105551","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association between skilled nursing facility (SNF) utilization and Alzheimer's disease and related dementias (ADRD) both before and during the COVID-19 pandemic.</p><p><strong>Design: </strong>An observational cohort study.</p><p><strong>Setting and participants: </strong>The study included community-dwelling respondents aged 65 or older.</p><p><strong>Methods: </strong>This study analyzed data from 3 waves of the Health and Retirement Study and employed multivariable, individual-level regressions. The primary outcomes were any SNF stays, the number of SNF stays, and the total number of SNF days, in the past 2 years of the survey. Respondents were classified as cognitively normal, having cognitive impairment but not dementia (CIND), or having ADRD.</p><p><strong>Results: </strong>The study included 23,654 respondent-years, representing 12,529 unique respondents. Before the pandemic, differences in any SNF stays, and the number of SNF stays between the cognitively normal and CIND and ADRD groups were statistically insignificant in multivariable regressions. During the pandemic, compared with respondents with normal cognition, those with CIND had higher odds of any SNF stays (OR, 1.53; 95% CI, 1.06-2.20) and more SNF stays (incidence rate ratio [IRR], 2.40; 95% CI, 1.30-4.40); similarly, the ADRD group showed higher odds of any SNF stays (OR, 1.68; 95% CI, 1.08-2.59) and more SNF stays (IRR, 2.48; 95% CI, 1.36-4.47) than cognitively normal older adults. The total number of SNF days for CIND and ADRD respondents remained statistically insignificantly different from those of the cognitively normal group, both before and during the pandemic, in regression analyses.</p><p><strong>Conclusions and implications: </strong>This cohort study suggests that the pandemic was associated with increased differences in any SNF stays and number of transitions to SNFs between cognitively normal individuals and those with CIND or ADRD. These findings provide a foundation for understanding the potential impact of a public health emergency on post-acute care utilization among older adults with varying degrees of cognitive impairment.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105551"},"PeriodicalIF":4.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalization-Associated Disability and 1-Year Mortality Risk in Older Patients With Heart Failure.","authors":"Michitaka Kato, Koji Sakurada, Masakazu Saitoh, Tomoyuki Morisawa, Yuki Iida, Kentaro Kamiya, Yuji Kono, Masanobu Taya, Kentaro Iwata, Yoshinari Funami, Kazuya Kito, Eiji Nakatani, Tetsuya Takahashi","doi":"10.1016/j.jamda.2025.105549","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105549","url":null,"abstract":"<p><strong>Objectives: </strong>Hospitalization-associated disability (HAD) is the loss of the ability to perform one of the basic activities of daily living (ADLs) required for independent living during hospitalization. This study aimed to determine whether HAD is a significant prognostic risk factor in older patients with heart failure (HF) and independent ADLs.</p><p><strong>Design: </strong>Prospective, nationwide, multicenter registry study conducted between December 2020 and March 2022.</p><p><strong>Setting and participants: </strong>This study was conducted across 96 centers in Japan and included 6519 older patients (aged ≥65 years) with HF who were independent in ADL before hospitalization.</p><p><strong>Methods: </strong>HAD was defined as a drop of at least 5 points in the Barthel Index (BI) at discharge, relative to a stable score before hospitalization. Subgroup analysis classified HAD as mild (a decrease of 5-15 points in the BI) and severe (a decrease of ≥20 points in the BI). The primary outcome was all-cause mortality within 1 year after hospital discharge, and the secondary outcomes were HF-related mortality and rehospitalization.</p><p><strong>Results: </strong>All-cause mortality, HF-related mortality, and rehospitalization rates within 1 year were 12%, 5%, and 41%, respectively. Multivariate Cox regression analysis revealed that HAD increased the risk of 1-year all-cause mortality after hospital discharge (adjusted hazard ratio, 1.749; 95% CI, 1.475-2.075). Subgroup analysis showed a significantly higher risk of all-cause mortality among patients with severe HAD than among those with mild HAD (1.388; 1.109-1.739). HAD was a significant risk factor for HF-related mortality (1.556; 1.216-2.017). However, no relationship was observed between HAD and readmission (1.062; 0.970-1.163).</p><p><strong>Conclusions and implications: </strong>The development of HAD was identified as a significant risk factor for 1-year post-discharge mortality among older patients with HF who were independent in ADLs before hospitalization. Preventing minor declines in ADL and mitigating any ADL impairments during hospitalization are crucial to avoiding a worsening prognosis.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105549"},"PeriodicalIF":4.2,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intervention Response of Muscle Architecture and Composition Markers Assessed via Ultrasound Imaging: A Systematic Review and Meta-Analysis of Randomized Clinical Trials","authors":"Yosuke Osuka PhD ,&nbsp;Takahisa Ohta PhD ,&nbsp;Jiaqi Li PhD ,&nbsp;Kanae Furuya PhD, RD ,&nbsp;Kaori Kinoshita PhD, RD ,&nbsp;Rei Otsuka PhD ,&nbsp;Michiyo Kawamura BA ,&nbsp;Yutaka Watanabe PhD, DDS ,&nbsp;Ko Matsudaira PhD, MD ,&nbsp;Hiroyuki Oka PhD, MD ,&nbsp;Sho Hatanaka PhD","doi":"10.1016/j.jamda.2025.105526","DOIUrl":"10.1016/j.jamda.2025.105526","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the response of skeletal muscle architecture (fascicle length and pennation angle) and composition (echo intensity) markers assessed by ultrasonography to intervention in older adults.</div></div><div><h3>Design</h3><div>This is a subsection of a more comprehensive systematic review of clinical trials focusing on changes in muscle quality, registered in PROSPERO (registration number: CRD42022357116).</div></div><div><h3>Setting and Participants</h3><div>Randomized controlled trials evaluating the effectiveness of interventions lasting ≥8 weeks in adults aged ≥60 years on fascicle length, pennation angle, and echo intensity.</div></div><div><h3>Methods</h3><div>After the literature search, 6 peer reviewers and 1 decider conducted a 2-stage screening process, including studies that met the eligibility criteria. Random-effects modeling for Hedges’ g was applied to a meta-analysis of studies with sufficient data. The risk of bias in the included studies was assessed using version 2 of the Cochrane Risk-of-Bias tool for randomized trials.</div></div><div><h3>Results</h3><div>In total, 4832 studies were initially searched, and 28 trials involving 1101 participants were included. Six trials were analyzed for fascicle length, 8 for pennation angle, and 8 for echo intensity. The standardized mean differences with 95% CIs, where a positive direction indicates improvement due to treatment, were fascicle length, −0.04 (−0.27 to 0.19); pennation angle, 0.08 (−0.02 to 0.18); and echo intensity, 0.00 (−0.02 to 0.02). No heterogeneity was observed for the outcomes (<em>I</em>² = 0%). The Cochrane Risk-of-Bias tool showed that 78.6% of the trials had a high risk of bias.</div></div><div><h3>Conclusions and Implications</h3><div>Muscle architecture and composition markers assessed via ultrasound did not respond to the intervention. Further well-designed clinical trials are necessary to confirm the clinical validity of these markers.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105526"},"PeriodicalIF":4.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Point-of-Care Ultrasound in Home vs Non-home Medical Care Physicians in Japan","authors":"Toru Yamada MD, PhD ,&nbsp;Takuma Kimura MD, PhD ,&nbsp;Takahiro Shinohara MD ,&nbsp;Shuji Ouchi MD ,&nbsp;Suguru Mabuchi MD, PhD ,&nbsp;Takeshi Ishida MD ,&nbsp;Masayoshi Hashimoto MD, PhD","doi":"10.1016/j.jamda.2025.105536","DOIUrl":"10.1016/j.jamda.2025.105536","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the use of point-of-care ultrasound between physicians providing home medical care and other physicians in Japan.</div></div><div><h3>Design</h3><div>A cross-sectional comparative study.</div></div><div><h3>Setting and Participants</h3><div>The participants were members of 3 societies related to home medical care in Japan.</div></div><div><h3>Method</h3><div>A web-based survey was conducted between April and June 2024 to assess use of point-of-care ultrasound, physicians’ training history and needs in this technique, ultrasound machine availability and types, and barriers and facilitators for wider adoption.</div></div><div><h3>Results</h3><div>Overall, 692 physicians (461 providing home medical care) participated. There were more point-of-care ultrasound users among those providing home medical care (75.9% vs 67.1%; <em>P</em> = .014). There was no significant difference in training history (34.3% vs 36.4%; <em>P</em> = .587), but training needs were significantly greater among home medical care providers (80.9% vs 66.7%; <em>P</em> &lt; .001). This group also had better access to ultrasound machines (53.6% vs 35.5%; <em>P</em> &lt; .001), with higher personal ownership rates and handheld device usage (29.1% vs 4.8%, <em>P</em> &lt; .001; 59.7% vs 13.2%, <em>P</em> &lt; .001). The main barrier was insufficient training opportunities, especially for home care providers (61.6% vs 51.5%; <em>P</em> = .011), followed by inadequate training environments (46.4% vs 32.9%; <em>P</em> = .001), challenges in image acquisition (59.0% vs 37.2%; <em>P</em> &lt; .001), and interpretation skills (51.4% vs 32.9%; <em>P</em> &lt; .001). Facilitators included improved access to ultrasound machines and increased training opportunities and available mentors, with home care providers significantly emphasizing training opportunities (71.2% vs 62.3%; <em>P</em> = .019).</div></div><div><h3>Conclusions and Implications</h3><div>Home medical care providers were more likely to use point-of-care ultrasound and have better access to machines; however, they faced barriers related to skills and training opportunities. As handheld devices become prevalent, systematic training in this technique is becoming essential.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105536"},"PeriodicalIF":4.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Racial and Ethnic Composition with Staff Levels in Nursing Homes: 2013-2019","authors":"Yejin Kang MPH ,&nbsp;Sam Kang BS ,&nbsp;John R. Bowblis PhD ,&nbsp;Brian Downer PhD ,&nbsp;Matthew D. McHugh PhD, JD, MPH, RN, FAAN ,&nbsp;Huiwen Xu PhD","doi":"10.1016/j.jamda.2025.105496","DOIUrl":"10.1016/j.jamda.2025.105496","url":null,"abstract":"<div><h3>Objectives</h3><div>The nursing home (NH) population has become increasingly diverse, yet many facilities remain de facto racially segregated. This study examines whether a high proportion of Black, Indigenous, and People of Color (BIPOC) residents is associated with nursing staff levels.</div></div><div><h3>Design</h3><div>We constructed a longitudinal cohort of NHs (2013-2019) by linking Certification and Survey Provider Enhanced Reports, <span><span>LTCFocUS.org</span><svg><path></path></svg></span>, Medicare Cost Reports, and Payroll-Based Journal data. Separate multivariable random effects linear regressions were conducted.</div></div><div><h3>Setting and Participants</h3><div>14,075 Medicare- and Medicaid-certified NHs in the United States.</div></div><div><h3>Methods</h3><div>The proportion of BIPOC residents was categorized as the 10% of nursing homes serving the highest minority residents in each state each year (High-BIPOC) and the remaining 90% (Low-BIPOC). Total nursing staff levels in hours per resident-day (HPRD) included both hours paid (2013-2019) and hours worked (2017-2019). The total staff included registered nurses, licensed practical nurses, and certified nurse aides.</div></div><div><h3>Results</h3><div>The unadjusted difference in total staff levels between High-BIPOC and Low-BIPOC NHs increased from −0.23 HPRD (4.19 vs 4.42) in 2013 to −0.35 HPRD (3.94 vs 4.29) in 2019 for hours paid. The difference in hours worked increased from −0.19 (3.55 vs 3.74) in 2017 to −0.23 (3.50 vs 3.73) in 2019. The difference became smaller but remained significant after controlling for covariates (−0.037 HPRD for hours paid, and −0.038 for hours worked). Analyses of individual staff types found lower levels of registered nurses and certified nurse aides (but not licensed practical nurses) among High-BIPOC nursing homes. Findings were robust to treating racial and ethnic composition as a continuous variable or excluding payer mix from the models.</div></div><div><h3>Conclusions and Implications</h3><div>NHs with high concentrations of minority residents reported lower nursing staff levels. Improving staffing in NHs serving primarily marginalized racial and ethnic groups remains a policy priority.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 4","pages":"Article 105496"},"PeriodicalIF":4.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data Quality of Resident Documentation in Long-Term Care: A Systematic Review and Meta-analysis","authors":"Aurora Monticelli MSc ,&nbsp;Franziska Zúñiga PhD ,&nbsp;Jianan Huang PhD ,&nbsp;Magdalena Osińska MSc ,&nbsp;Emmanuelle Poncin PhD ,&nbsp;Nathalie I.H. Wellens PhD ,&nbsp;Nereide Curreri PhD ,&nbsp;Laurie Corna PhD ,&nbsp;Bastiaan Van Grootven PhD","doi":"10.1016/j.jamda.2025.105531","DOIUrl":"10.1016/j.jamda.2025.105531","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the impact of interventions aimed at improving data quality in resident documentation in the residential long-term care setting, and to explore the experiences related with the implementation strategies and key determinants influencing data quality.</div></div><div><h3>Design</h3><div>A systematic review.</div></div><div><h3>Setting and Participants</h3><div>Residential long-term care.</div></div><div><h3>Methods</h3><div>PubMed and Embase were searched from inception to January 2025. This search was supplemented with screening study registries, references, prospective citation searching, and reviewing gray literature. Studies were selected and data were abstracted by 2 researchers. A narrative synthesis and random effects meta-analyses were performed. The GRADE level of evidence was determined. A thematic analysis was conducted for the qualitative data.</div></div><div><h3>Results</h3><div>A total of 30 studies were included. The introduction of electronic health records, educational strategies, incident reporting systems, and reminder strategies were associated with small to moderate improvements. The average effect across interventions was an improvement of 13% (95% CI, 7%–20%, <em>I</em>² = 60%, very low GRADE) in data completeness. Overall data quality was improved in 3 studies, accuracy of data was improved in 1 study, and 1 study observed a nonsignificant improvement in reliability. Small effect sizes and very low-GRADE evidence were observed. Key determinants influencing data quality included the perceived usefulness of documentation systems, access to electronic health records, staff knowledge about clinical assessments, and perceptions of the appropriateness of quality indicators and data reliability. Implementation of interventions was supported by the following strategies: (1) identify and prepare champions, (2) audit and feedback on implementation, (3) provide ongoing consultation, and (4) disseminate implementation materials.</div></div><div><h3>Conclusions and Implications</h3><div>Small to moderate improvements in data quality were observed, with a very low GRADE of evidence. Most findings were limited to the completeness of documentation, although aspects such as timeliness and accuracy remain understudied. It remains unclear what interventions are effective in ensuring solid data quality.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 5","pages":"Article 105531"},"PeriodicalIF":4.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}