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2017 INTERACT Null Findings |
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by Albert Lam, MD
A new study from the Interventions to Reduce Acute Care Transfers (INTERACT) team at Florida Atlantic University appears to cast doubt on the ability of INTERACT to reduce readmission rates. The study, published in the Journal of the American Medical Association Internal Medicine, showed no significant reduction in overall hospital admissions (per 1000 resident-days) in the intervention group that received INTERACT training and no difference in 30-day readmissions or ED visits compared to facilities that did not receive INTERACT training.
These findings are striking, and bring into question the effectiveness of INTERACT in reducing nursing facility to hospital readmissions. Yet, despite all of this, our own experience is that INTERACT makes an incredible difference in nursing facilities.
So what does this really mean?
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by Tim Gieseke MD, CMD
As a person on the front line assisting facilities caring for patients of increasing medical complexity and disability, I’ve often seen facilities react to patient care problems that develop rather than developing care processes proactively that may prevent or minimize them. It’s challenging to take the latter approach given our limited resources, staff turnover, and high volume of care with shorter lengths of stay of our post-acute patients.
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Managing Warfarin Dosing In the Post-Acute Facility |
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by Flora Bessey, Pharm.D., BCGP
Those of us who have been in long-term care for a while have noticed the trend toward ever-higher levels of acuity being “pushed down” towards our facilities. Conditions that were nearly always the purview of acute care hospitals are now being routinely managed within our buildings, especially those with post-acute units. Complex medical conditions necessitate complex medication regimes, and often warfarin is a part of the equation.
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The End of Life Option Act (EOLOA) has been in effect in California since June 2016, and the California Department of Public Health released information for the first six months, that included just fewer than 200 patients who were qualified for physician aid-in-dying, with about 175 doctors participating and 111 known deaths from ingestion of the prescribed medications. Of the patients who qualified, 90% were white and 96% had insurance. To our knowledge, none of these ingestions occurred in skilled nursing facilities. Clearly in 2017, many more patients have participated.
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In the News: Nephrologist Calls for ‘Age-Attuned Approach’ to Chronic Kidney Disease |
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We are grateful to Caring for Ages allowing us to reprint this article on CKD. This is a balanced article that informs us on the need to help our patients make informed decisions about starting and continuing dialysis, as well as address common causes of distress appropriately.
Shared with permission from AMDA/Elsevier/Caring for the Ages
Nephrologist Calls for ‘Age-Attuned Approach’ to Chronic Kidney Disease
Christine Kilgore
PHOENIX — Conservative management and supportive care may offer elderly patients with end-stage renal disease (ESRD) the same survival as dialysis, as well as less functional decline, fewer hospitalizations, and better satisfaction with life, said Fahad Saeed, MD, at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference.
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