Nursing Homes as Data Collection Sites

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Slide 1

Nursing Homes as Data Collection Sites

Nursing homes are complex systems with a unique culture Philip D. Sloane, MD, MPH
University of North Carolina at Chapel Hill
ABT team: Rosanna Bertrand, PhD; Lauren Olsho; Louise Hadden; Alrick Edwards.
UNC team: Sheryl Zimmerman, PhD; Anna Beeber, PhD, GNP, RN; Christine Kistler, MD, MASc; C. Madeline Mitchell, MURP

Funding provided by AHRQ contract # HHSA 290200600001I.

Slide 2

Prior Research Experience

UNC Team (CS-LTC)

Nursing home research:

• Over 25 funded NH studies over 20+ years involving primary data collection.
• 7 NH intervention trials.

Infection research:

• 2 NH infection studies.

ABT Team

Nursing home research:

• Over 20 years of NH QI research.
• Over 30 federally-funded intervention/evaluation studies.

Infection research:

• Antibiogram use in NHs.
• Multiple US and international HIV studies.

Slide 3

Goals and Study Design

Goals:

• Implement & evaluate a multicomponent QI program on optimizing antibiotic prescribing.
• Assess the validity of the Loeb Minimum Criteria.

Design:

• LTC provider group / 2 geographically separate regions
  • One region assigned to intervention (6 NHs).
  • Other assigned to comparison (6 NHs).
• 9 months chart abstraction (3m baseline, 6m follow-up).
• QI program (months 4–9)
  • Provider and NH staff training (Pocket Card/Referral Form).
  • Brochure / meetings for residents/families.
  • Monthly data reports / meetings with facility QI teams.

Slide 4

Main Results

Image: A line graph compares the percentage change in Abx prescribing for the Invention Group and Comparison Group for all Indicators.

Slide 5

Using NH Records as Data Sources

• Many NHs pre-electronic; some have EHR.
• Physician notes:
  • If electronic, access limited.
  • If paper, quality often poor.
• Nursing notes:
  • Often quite limited; length, quality, and consistency inferior to hospital setting.
• Assessment data consistent, illness data not.
• Our attempt to introduce a standardized reporting tool for infections → limited acceptance.

Slide 6

Collecting Primary Data in NHs

• No major administrative barriers encountered: NH staff cooperative.
• Data collection staff must be clinical (we used RNs), well trained, and supervised.
• Records can be massive; audit time per record was longer than we’d anticipated.
• Lack of systems for acute illness made standardization of data collection difficult.