Harvard Graduate School of Arts and Sciences, Boston, Massachusetts, USA.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2023 Jul;71(7):2141-2150. doi: 10.1111/jgs.18331. Epub 2023 Mar 14.
Nursing home quality of care is a persistent challenge, with recent reports calling for increased reforms to improve quality and safety. Less is known about the clinical approaches currently used and the barriers perceived by skilled nursing facilities (SNFs) to provide care for their short-stay residents.
We conducted a nationally representative survey of SNFs from October 2020 to May 2021 to understand their care delivery approaches and perceived barriers. Our primary outcomes were the reported number of 23 separate care delivery approaches and the reported number of 12 separate barriers to reduce spending or improve care for SNF short-stay residents. We also performed stratified analyses by facility participation in bundled payments and other SNF characteristics.
We received 377 responses from 693 SNFs contacted (response rate = 54%). SNFs reported an average of 16.8 care delivery approaches and an average of 5.0 barriers. While there were some differences observed in SNF characteristics, such as by bundled payments participation or ownership type, there were common care delivery approaches and barriers shared by most facilities. Care management practices, including reviewing the patient census and medication reconciliation on discharge, were the most common delivery approaches reported. SNFs were less likely to ensure the completion of a follow-up appointment with a primary care provider or track repeat emergency room visits. Issues concerning staffing, such as staff turnover and/or burnout, and lack of resources to provide patients social support, mental health, and substance use services, were the most cited barriers to care delivery.
Nationally, SNFs implemented a wide array of care delivery approaches, but challenges with staffing and limited resources to address patients' social and mental health needs were dominant. Individual SNFs may have limited ability to address these key barriers, so the involvement of many stakeholders across the entire healthcare system may be necessary.
养老院的护理质量一直是一个难以解决的问题，最近的报告呼吁进行更多改革，以提高质量和安全性。目前，人们对熟练护理设施（SNF）为短期居住居民提供护理所采用的临床方法以及感知到的障碍知之甚少。
我们于 2020 年 10 月至 2021 年 5 月对 SNF 进行了一项全国代表性调查，以了解他们的护理提供方法和感知到的障碍。我们的主要结果是报告了 23 种不同的护理提供方法的数量，以及报告了 12 种不同的减少支出或改善 SNF 短期居住居民护理的障碍。我们还按设施参与捆绑支付和其他 SNF 特征进行了分层分析。
我们从联系的 693 家 SNF 中收到了 377 份回复（回复率为 54%）。SNF 报告了平均 16.8 种护理提供方法和平均 5.0 种障碍。虽然 SNF 特征，如参与捆绑支付或所有权类型，存在一些差异，但大多数设施都有共同的护理提供方法和障碍。护理管理实践，包括在出院时审查患者普查和药物调整，是报告中最常见的提供方法。SNF 不太可能确保完成与初级保健提供者的后续预约或跟踪重复急诊就诊。涉及人员配备的问题，如人员流动和/或倦怠，以及缺乏资源为患者提供社会支持、心理健康和药物使用服务，是护理提供的最主要障碍。
在全国范围内，SNF 实施了广泛的护理提供方法，但人员配备和解决患者社会和心理健康需求的有限资源方面的挑战占主导地位。个别 SNF 可能无法解决这些关键障碍，因此整个医疗保健系统的许多利益相关者的参与可能是必要的。
