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  1. Article ; Online: State scope of practice restrictions and nurse practitioner practice in nursing homes: 2012-2019.

    Ryskina, Kira L / Liang, Junning / Ritter, Ashley Z / Spetz, Joanne / Barnes, Hilary

    Health affairs scholar

    2024  Volume 2, Issue 2, Page(s) qxae018

    Abstract: Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. ... ...

    Abstract Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, and health care workforce characteristics; state fixed effects; and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least 1 NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.
    Language English
    Publishing date 2024-02-12
    Publishing country England
    Document type Journal Article
    ISSN 2976-5390
    ISSN (online) 2976-5390
    DOI 10.1093/haschl/qxae018
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  2. Article ; Online: Effects Of An Employee COVID-19 Vaccination Mandate At A Long-Term Care Network.

    Golos, Aleksandra M / Buttenheim, Alison M / Ritter, Ashley Z / Bair, Elizabeth F / Chapman, Gretchen B

    Health affairs (Project Hope)

    2023  Volume 42, Issue 8, Page(s) 1140–1146

    Abstract: We assessed COVID-19 vaccination and employment status among employees of a long-term care network that announced an employee vaccination mandate on July 29, 2021. The day before the announcement, 1,208 employees were unvaccinated; of these workers, 56.2  ...

    Abstract We assessed COVID-19 vaccination and employment status among employees of a long-term care network that announced an employee vaccination mandate on July 29, 2021. The day before the announcement, 1,208 employees were unvaccinated; of these workers, 56.2 percent subsequently were vaccinated, whereas 20.9 percent (3.7 percent of active employees) were terminated because of noncompliance with the mandate.
    MeSH term(s) Humans ; COVID-19 Vaccines ; Health Personnel ; Long-Term Care ; Influenza, Human/prevention & control ; COVID-19/prevention & control ; Vaccination
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2023-08-07
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 632712-6
    ISSN 1544-5208 ; 0278-2715
    ISSN (online) 1544-5208
    ISSN 0278-2715
    DOI 10.1377/hlthaff.2022.01596
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  3. Article ; Online: Stemming the Rising Toll of People Living with Complex Care Needs.

    Naylor, Mary D / Morgan, Brianna / Ritter, Ashley Z

    JAMA health forum

    2020  Volume 1, Issue 4, Page(s) e200282

    Language English
    Publishing date 2020-04-01
    Publishing country United States
    Document type Journal Article
    ISSN 2689-0186
    ISSN (online) 2689-0186
    DOI 10.1001/jamahealthforum.2020.0282
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  4. Article ; Online: Outcomes of post-acute care in skilled nursing facilities in Medicare beneficiaries with and without a diagnosis of dementia.

    Burke, Robert E / Xu, Yao / Ritter, Ashley Z

    Journal of the American Geriatrics Society

    2021  Volume 69, Issue 10, Page(s) 2899–2907

    Abstract: Background: More than 600,000 Medicare beneficiaries with a diagnosis of dementia are discharged to skilled nursing facilities (SNFs) after hospitalization annually. However, it is unclear how their risks and benefits of a SNF stay compare to ... ...

    Abstract Background: More than 600,000 Medicare beneficiaries with a diagnosis of dementia are discharged to skilled nursing facilities (SNFs) after hospitalization annually. However, it is unclear how their risks and benefits of a SNF stay compare to beneficiaries without a diagnosis of dementia.
    Design: Retrospective analysis comparing SNF outcomes for Medicare beneficiaries with and without a diagnosis of dementia.
    Setting: One hundred percent sample of Medicare beneficiaries from 2015 to 2016.
    Participants: Dementia was identified using validated diagnosis codes. In beneficiaries who had an acute hospitalization followed by SNF stay, we used propensity score matching to balance demographics, comorbidities, characteristics of the index hospital stay, prior hospital and SNF utilization, and cognitive status on SNF admission.
    Measurements: Outcomes included unplanned hospital readmission, community discharge rate, and mortality during the SNF stay. Multivariate models were adjusted for hospital and SNF characteristics.
    Results: Our sample included 2,418,853 Medicare beneficiaries discharged from hospital to SNF; 830,524 (34.3%) carried a diagnosis of dementia. Overall, 14.7% of the sample had a hospital readmission, 5.0% died, and 61.5% were successfully discharged to the community. In the propensity-matched cohort, beneficiaries with a diagnosis of dementia had a lower odds ratio of mortality (OR 0.87; 95% confidence interval [CI] 0.86-0.89), similar odds of hospital readmission (OR 0.99; 95% CI 0.98-1.00), and reduced odds of discharge to the community (OR 0.92; 95% CI 0.91-0.93). However, these findings varied by the severity of cognitive impairment on SNF admission: in beneficiaries with no impairment, those with a diagnosis of dementia had higher odds of adverse outcomes. In beneficiaries with severe impairment, beneficiaries with a diagnosis of dementia had lower odds of adverse outcomes.
    Conclusions: Cognitive dysfunction on SNF admission is a stronger predictor of outcomes than a diagnosis of dementia, suggesting the need to individualize decisions about the benefits and risks of SNF care in populations with cognitive impairment.
    MeSH term(s) Aged ; Aged, 80 and over ; Dementia/mortality ; Dementia/therapy ; Female ; Humans ; Male ; Medicare/statistics & numerical data ; Multivariate Analysis ; Odds Ratio ; Outcome Assessment, Health Care ; Patient Acceptance of Health Care/statistics & numerical data ; Patient Discharge/statistics & numerical data ; Patient Readmission/statistics & numerical data ; Retrospective Studies ; Skilled Nursing Facilities/statistics & numerical data ; Subacute Care/statistics & numerical data ; United States
    Language English
    Publishing date 2021-06-25
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.17321
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  5. Article ; Online: Use of Post-Acute Care by Medicare Beneficiaries With a Diagnosis of Dementia.

    Burke, Robert E / Xu, Yao / Ritter, Ashley Z

    Journal of the American Medical Directors Association

    2021  Volume 23, Issue 5, Page(s) 877–879.e3

    Abstract: Objectives: Hospitalized patients with dementia transitioning to post-acute care may be particularly vulnerable to changes in post-acute care utilization driven by payment reforms; however, use of post-acute care in this population is incompletely ... ...

    Abstract Objectives: Hospitalized patients with dementia transitioning to post-acute care may be particularly vulnerable to changes in post-acute care utilization driven by payment reforms; however, use of post-acute care in this population is incompletely understood. We sought to describe post-acute care utilization in skilled nursing facilities (SNFs) and from home health (HH) agencies among Medicare beneficiaries with a diagnosis of dementia.
    Design: Retrospective, observational study using 100% sample of Medicare beneficiaries from 2013 to 2016.
    Setting and participants: We identified hospitalizations and diagnoses using Medicare Provider Analysis and Review (MedPAR), SNF stays using the Minimum Data Set, HH episodes using the Outcome and Assessment Information Set, and dementia diagnoses using the Medicare Beneficiary Summary File Chronic Conditions segment.
    Methods: We calculated overall utilization and trends in post-acute care use over time, stratified by dementia diagnosis, type of post-acute care (SNF vs HH), and payer (fee-for-service vs Medicare Advantage).
    Results: Of the 9,762,208 Medicare fee-for-service beneficiaries who received post-acute care from 2013 to 2016, 3,155,560 (32.3%) carried a diagnosis of dementia. Rates of post-acute care use were similar over time. More beneficiaries with a diagnosis of dementia received post-acute care (44.2% vs 27.7%) and proportionally more SNF care (71.7% vs 49.6%). Overall use and trends were similar in the Medicare Advantage population.
    Conclusions and implications: One-third of all fee-for-service Medicare beneficiaries receiving post-acute care have a diagnosis of dementia, and more than 7 in 10 receive this care in an SNF. These findings serve as a foundation for needed evaluations of how best to meet the post-hospital needs of older adults with dementia.
    MeSH term(s) Aged ; Dementia/diagnosis ; Humans ; Medicare Part C ; Patient Discharge ; Retrospective Studies ; Skilled Nursing Facilities ; Subacute Care ; United States
    Language English
    Publishing date 2021-10-10
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2021.09.016
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    Zs.A 5971: Show issues Location:
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  6. Article ; Online: Younger Individuals Increase Their Use of Nursing Homes Following ACA Medicaid Expansion.

    Ritter, Ashley Z / Freed, Salama / Coe, Norma B

    Journal of the American Medical Directors Association

    2021  Volume 23, Issue 5, Page(s) 852–857.e5

    Abstract: Objectives: This study examines the effect of Medicaid eligibility expansion under the Affordable Care Act (ACA) on the utilization of nursing home services by younger individuals and those covered by Medicaid.: Design: Compared the age of nursing ... ...

    Abstract Objectives: This study examines the effect of Medicaid eligibility expansion under the Affordable Care Act (ACA) on the utilization of nursing home services by younger individuals and those covered by Medicaid.
    Design: Compared the age of nursing home residents, proportion of individuals covered by Medicaid, annual nursing home admissions in those younger than 65, and nursing home length of stay in states that expanded Medicaid eligibility through the ACA to states that did not. We used data from LTCFocus (nursing home level), the Minimum Data Set (individual level), and Medicaid expansion status from the Kaiser Family Foundation.
    Setting and participants: The study included 15,005,888 nursing home admissions, 2,446,950 of which were residents younger than 65, across 14,132 nursing homes between 2009 and 2016.
    Methods: A time-varying difference-in-difference model including state and year fixed effects with effect modification by pre-2014 nursing home occupancy.
    Results: Facilities in expansion states with a pre-ACA occupancy rate of more than 70% increased the fraction of residents younger than 65 by 2.74% to 6.32%, compared with similar facilities in nonexpansion states. Medicaid admissions varied, with an increase in year 2 after expansion compared with nonexpansion states. Among residents entering from an acute care hospital, the proportion younger than 65 increased in facilities with pre-2014 occupancy rates of more than 70%, compared with similar facilities in nonexpansion states, an increase of up to 6.51%. Median nursing home length of stay for individuals younger than 65 decreased relative to nonexpansion states across all occupancy categories, ranging from 1.68 to 6.06 days after Medicaid expansion.
    Conclusions and implications: Medicaid expansion increased access to nursing home post-acute care for individuals younger than 65. It remains unclear if the benefit of post-acute care is the same among this group, or if the needs of younger individuals can be adequately met in this setting.
    MeSH term(s) Hospitalization ; Humans ; Medicaid ; Nursing Homes ; Patient Protection and Affordable Care Act ; United States
    Language English
    Publishing date 2021-09-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2021.08.020
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  7. Article ; Online: Postacute care outcomes in home health or skilled nursing facilities in patients with a diagnosis of dementia.

    Burke, Robert E / Xu, Yao / Ritter, Ashley Z / Werner, Rachel M

    Health services research

    2021  Volume 57, Issue 3, Page(s) 497–504

    Abstract: Objective: To compare the outcomes of postacute care between home health (HH) and skilled nursing facilities (SNFs) following hospitalization among Medicare beneficiaries with a diagnosis of dementia.: Data sources: 100% MedPAR data, Minimum Data Set, ...

    Abstract Objective: To compare the outcomes of postacute care between home health (HH) and skilled nursing facilities (SNFs) following hospitalization among Medicare beneficiaries with a diagnosis of dementia.
    Data sources: 100% MedPAR data, Minimum Data Set, and Outcome and Assessment Information Set assessment data from January 1, 2015 to December 31, 2016.
    Study design: Retrospective cohort analysis using an instrumental variable design to compare outcomes (30-day readmission and mortality, 100-day mortality) of HH versus SNF following acute hospitalization. We used the differential distance between patients' home and the closest HH agency and SNF to instrument for nonrandom allocation of patients.
    Data collection/extraction methods: We identified hospital discharges followed by SNF and HH stays for Medicare fee-for-service beneficiaries with dementia. We excluded beneficiaries younger than age 65, admitted to the hospital from a nursing home, or enrolled in hospice. We identified dementia using validated diagnostic codes with a 3-year look-back.
    Principal findings: Our sample included 977,946 beneficiaries with a diagnosis of dementia; 297,732 (30.4%) received HH, while 680,214 (69.6%) went to SNF. Overall, 16.8% were readmitted to the hospital and 6.1% died within 30 days, while 15.4% died within 100 days of hospital discharge. In the instrumental variable analysis, there were no differences in any outcome between the two postacute care settings.
    Conclusions: Medicare beneficiaries with a diagnosis of dementia receiving postacute care in HH or SNF experienced similar rates of readmission and mortality across settings. This finding raises important questions about current postacute care referral patterns, given 7 in 10 patients with a diagnosis of dementia in our sample were discharged to SNF.
    MeSH term(s) Aged ; Dementia/diagnosis ; Dementia/therapy ; Humans ; Medicare ; Patient Discharge ; Patient Readmission ; Retrospective Studies ; Skilled Nursing Facilities ; Subacute Care ; United States
    Language English
    Publishing date 2021-08-12
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 410435-3
    ISSN 1475-6773 ; 0017-9124
    ISSN (online) 1475-6773
    ISSN 0017-9124
    DOI 10.1111/1475-6773.13855
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  8. Article ; Online: Fight Like a Nerdy Girl: The Dear Pandemic Playbook for Combating Health Misinformation.

    Leininger, Lindsey J / Albrecht, Sandra S / Buttenheim, Alison / Dowd, Jennifer Beam / Ritter, Ashley Z / Simanek, Amanda M / Valentino, Mary-Jo / Jones, Malia

    American journal of health promotion : AJHP

    2022  Volume 36, Issue 3, Page(s) 563–567

    MeSH term(s) Communication ; Female ; Humans ; Pandemics ; Social Media
    Language English
    Publishing date 2022-02-14
    Publishing country United States
    Document type Editorial
    ZDB-ID 645160-3
    ISSN 2168-6602 ; 0890-1171
    ISSN (online) 2168-6602
    ISSN 0890-1171
    DOI 10.1177/08901171211070956
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    Zs.A 2531: Show issues Location:
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  9. Article ; Online: Incidence and Outcomes of SARS-CoV-2 in Post-Acute Skilled Nursing Facility Care.

    Ritter, Ashley Z / Kosar, Cyrus M / White, Elizabeth M / Feifer, Richard A / Blackman, Carolyn / Mor, Vincent

    Journal of the American Medical Directors Association

    2022  Volume 23, Issue 8, Page(s) 1269–1273

    Abstract: Objectives: To examine the risk of contracting SARS-CoV-2 during a post-acute skilled nursing facility (SNF) stay and the associated risk of death.: Design: Cohort study using Minimum Data Set and electronic health record data from a large multistate ...

    Abstract Objectives: To examine the risk of contracting SARS-CoV-2 during a post-acute skilled nursing facility (SNF) stay and the associated risk of death.
    Design: Cohort study using Minimum Data Set and electronic health record data from a large multistate long-term care provider. Primary outcomes included testing positive for SARS-CoV-2 during the post-acute SNF stay, and death among those who tested positive.
    Setting and participants: The sample included all new admissions to the provider's 286 SNFs between January 1 and December 31, 2020. Patients known to be infected with SARS-CoV-2 at the time of admission were excluded.
    Methods: SARS-CoV-2 infection and mortality rates were measured in time intervals by month of admission. A parametric survival model with SNF random effects was used to measure the association of patient demographic factors, clinical characteristics, and month of admission, with testing positive for SARS-CoV-2.
    Results: The sample included 45,094 post-acute SNF admissions. Overall, 5.7% of patients tested positive for SARS-CoV-2 within 100 days of admission, with 1.0% testing positive within 1-14 days, 1.4% within 15-30 days, and 3.4% within 31-100 days. Of all newly admitted patients, 0.8% contracted SARS-CoV-2 and died, whereas 6.7% died without known infection. Infection rates and subsequent risk of death were highest for patients admitted during the first and third US pandemic waves. Patients with greater cognitive and functional impairment had a 1.45 to 1.92 times higher risk of contracting SARS-CoV-2 than patients with less impairment.
    Conclusions and implications: The absolute risk of SARS-CoV-2 infection and death during a post-acute SNF admission was 0.8%. Those who did contract SARS-CoV-2 during their SNF stay had nearly double the rate of death as those who were not infected. Findings from this study provide context for people requiring post-acute care, and their support systems, in navigating decisions around SNF admission during the SARS-CoV-2 pandemic.
    MeSH term(s) COVID-19/epidemiology ; Cohort Studies ; Humans ; Incidence ; SARS-CoV-2 ; Skilled Nursing Facilities ; Subacute Care
    Language English
    Publishing date 2022-05-23
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2022.05.014
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    Zs.A 5971: Show issues Location:
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  10. Article ; Online: A Systematic Review of Nursing Home Palliative Care Interventions: Characteristics and Outcomes.

    Carpenter, Joan G / Lam, Karissa / Ritter, Ashley Z / Ersek, Mary

    Journal of the American Medical Directors Association

    2020  Volume 21, Issue 5, Page(s) 583–596.e2

    Abstract: Background: Despite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal.: Objective: To examine the characteristics and effectiveness of nursing home interventions that ... ...

    Abstract Background: Despite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal.
    Objective: To examine the characteristics and effectiveness of nursing home interventions that incorporated multiple palliative care domains (eg, physical aspects of care-symptom management, and ethical aspects-advance care planning).
    Design: Systematic review.
    Methods: We searched MEDLINE via PubMed, Embase, CINAHL, and Cochrane Library's CENTRAL from inception through January 2019. We included all randomized and nonrandomized trials that compared palliative care to usual care and an active comparator. We assessed the type of intervention, outcomes, and the risk of bias.
    Results: We screened 1167 records for eligibility and included 13 articles. Most interventions focused on staff education and training strategies and on implementing a palliative care team. Many interventions integrated advance care planning initiatives into the intervention. We found that palliative care interventions in nursing homes may enhance palliative care practices, including processes to assess and manage pain and symptoms. However, inconsistent outcomes and high or unclear risk of bias among most studies requires results to be interpreted with caution.
    Conclusions and implications: Heterogeneity in methodology, findings, and study bias within the existing literature revealed limited evidence for nursing home palliative care interventions. Findings from a small group of diverse clinical trials suggest that interventions enhanced nursing home palliative care and improved symptom assessment and management processes.
    MeSH term(s) Advance Care Planning ; Humans ; Nursing Homes ; Palliative Care ; Symptom Assessment
    Language English
    Publishing date 2020-01-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review ; Systematic Review
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2019.11.015
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