The Quality Improvement Program for Missouri's Long - Term Care Facilities (QIPMO) is committed to Missouri's Elderly.
The "Aging-in-place" model allows older adults to receive health care in their preferred place of living, eliminating the need for a more restricted living space, such as a nursing home.
TigerPlace is a specially designed elder housing project initiated by the MU Sinclair School of Nursing, working to provide elders a better quality of life.
Objective: Our purpose was to describe how we prepared 16 nursing homes (NHs) for health information exchange (HIE) implementation.
Background: NH HIE connecting internal and external stakeholders are in their infancy. U.S. initiatives are demonstrating HIE use to increase access and securely exchange personal health information to improve patient outcomes.
Method: To achieve our objectives we conducted readiness assessments, performed 32 hours of clinical observation and developed 6 use cases, and conducted semi-structured interviews with 230 participants during 68 site visits to validate use cases and explore HIE.
Results: All 16 NHs had technology available to support resident care. Resident care technologies were integrated much more with internal than external stakeholders. A wide range of technologies were accessible only during administrative office hours. Six non-emergent use cases most commonly communicated by NH staff were: 1) scheduling appointments, 2) laboratory specimen drawing, 3) pharmacy orders and reconciliation, 4) social work discharge planning, 5) admissions and pre-admissions, and 6) pharmacy-medication reconciliation. Emerging themes from semi-structured interviews about use cases included: availability of information technology in clinical settings, accessibility of HIE at the point of care, and policies/procedures for sending/receiving secure personal health information.
Conclusion: We learned that every facility needed additional technological and human resources to build an HIE network. Also, use cases help clinical staff apply theoretical problems of HIE implementation and helps them think through the implications of using HIE to communicate about clinical
Alexander, G.L., Rantz, M., Galambos, C. Vogelsmeier, A., Flesner, M., Popejoy, L.L., Mueller, J., Shumate, S., & Elvin, M. (2015). Preparing nursing homes for the future of health information exchange. Applied Clinical Informatics, 6, 248-266.*
Hearing loss, the partial or total inability to perceive sound (Bance, 2007), is the third leading chronic illness in older adults, exceeded only by hypertension and arthritis (Hannula, 2011). In nursing homes, the prevalence of hearing loss is staggering, with reports between 82%-90% (Cohen-Mansfield & Taylor, 2004). More than 77% of nursing home residents with hearing loss have not purchased hearing aids or any other amplification device (Cohen-Mansfield & Taylor, 2004; Pryce & Gooberman-Hill, 2012). Hearing loss greatly interferes with communication, impeding the ability to impart health information (Cohen-Mansfield & Taylor, 2004; Pryce & Gooberman-Hill, 2012). Untreated hearing loss detracts from interactions with family, cognitive status, functional status, and social integration (Gopinath et al., 2012; Lin et al., 2011; Schneider et al., 2010; Shah et al., 2011; Solheim, Kvaerner, & Falkenberg, 2011).
Amplification has many benefits. Hearing aids improve audiometry scores by 15-20 decibels (dB), a measure of sound intensity. Aids improve hearing handicap scores by an average of 55% (Kochkin, 2011), and improve speech understanding, especially in one-on-one situations (Lewis, 2006). People who hear better and communicate more effectively experience less depression, anxiety, fear, isolation, and cognitive decline (Kiebling & Kreikemeier, 2013). Those who adopt hearing aids participate more in leisure activities than those with uncorrected hearing loss (Gonsalves & Pichora-Fuller, 2008). Those who wear hearing aids show improved cognition scores over those with uncorrected hearing loss
Many methods exist to assist in communication and speech understanding. These include amplifiers (such as frequency modulator (FM) systems or pocket talkers), dry erase boards, electronic boards, sign language, and writing notes. (Lancioni et al., 2012; Shinohara, 2012; Shinohara & Wobbrock, 2011). Older adults become hard of hearing with age and so have not learned sign language. Writing notes or using dry erase boards and electronic boards can be cumbersome and time consuming.
This study aimed to explore the acceptability and use of FM systems among long-term care residents and staff.
Lane, K., Rantz, M., Rawn, C., & Bien, A. (2015). Are older persons willing to accept and use amplifiers to better understand speech? Clinical Gerontologist, 38(5), 351-358.
Public health advances have contributed to increased longevity; however, individuals are more likely to live longer with multiple chronic conditions. The existing health care system primarily focuses on treating disease rather than addressing well-being as a holistic construct that includes physical, social, and environmental components. The current commentary emphasizes the importance of supporting healthy active aging and aging in community. The barriers to aging in community and the state of the intervention science in response to this problem are discussed, and recommendations for future research are provided. Active aging is more than managing illness or care transitions—it promotes engagement, participation, dignity, self-fulfillment, self-determination, and support for older adults. To support aging in community and healthy active aging, a paradigm shift is needed in how the well-being of older adults is thought about and supported.
Davitt, J.K., Madigan, E.A., Rantz, M., & Skemp, L. (2016). Aging in community: developing a more holistic approach to enhance older adults’ well-being. Research in Gerontological Nursing, 9(1), 6-13.
The goal of this study was to compare utilization and cost outcomes of patients who received long-term care coordination in an Aging in Place program to patients who received care coordination as a routine service in home health care.
This research offered the unique opportunity to compare two groups of patients who received services from a single home health care agency, using the same electronic health record, to identify the impact of long-term and routine care coordination on utilization and costs to Medicare and Medicaid programs.
This study supports that long-term care coordination supplied by nurses outside of a primary medical home can positively influence functional, cognitive, and health care utilization for frail older people.
Popejoy, L., Stetzer, F., Hicks, L., Rantz, M.J., Galambos, C., Popescu, M., Khalilia, M.A., & Marek, K. (2015). Comparing Aging in Place to home health care: impact of nurse care coordination on utilization and costs. Nursing Economics, 33(6), 306-313.*