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Article ; Online: The balance of prescriptive and dynamic regulatory policies in nursing homes: Lessons learned from the COVID-19 pandemic.

Berry, Sarah D / Bakaev, Innokentiy / Chen, Helen / Lipsitz, Lewis A

Journal of the American Geriatrics Society

2023 Volume 71, Issue 8, Page(s) 2672–2675

MeSH term(s)	Humans ; COVID-19 ; Pandemics ; Nursing Homes
Language	English
Publishing date	2023-03-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18339
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Universal Testing-Based Response to COVID-19 Outbreak by a Long-Term Care and Post-Acute Care Facility.

Bakaev, Innokentiy / Retalic, Tammy / Chen, Helen

Journal of the American Geriatrics Society

2020 Volume 68, Issue 7, Page(s) E38–E39

MeSH term(s)	Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; COVID-19 Testing ; Clinical Laboratory Techniques/methods ; Coronavirus Infections/diagnosis ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Female ; Health Plan Implementation/methods ; Humans ; Infection Control/methods ; Long-Term Care ; Male ; Pandemics/prevention & control ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; SARS-CoV-2 ; Subacute Care
Keywords	covid19
Language	English
Publishing date	2020-06-11
Publishing country	United States
Document type	Letter
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.16653
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Universal Testing-Based Response to COVID-19 Outbreak by a Long-Term Care and Post-Acute Care Facility

Bakaev, Innokentiy / Retalic, Tammy / Chen, Helen

J Am Geriatr Soc

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #593326
Database	COVID19

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Article ; Online: A Sustainable Interdisciplinary Approach to the Appropriate Use of Antipsychotic Medications in Long-Term Care.

Bakaev, Innokentiy / McDougall, Mary / B Retalic, Tammy / Mooza, Julie

Journal of the American Medical Directors Association

2020 Volume 22, Issue 1, Page(s) 182–184

Abstract: Prior research in geriatric medicine has shown that the use of antipsychotic medications by older people can result in significant adverse effects and increased mortality. This article focuses on the implementation of a methodology created by the ... ...

Abstract	Prior research in geriatric medicine has shown that the use of antipsychotic medications by older people can result in significant adverse effects and increased mortality. This article focuses on the implementation of a methodology created by the Appropriate Use of Antipsychotics (AUA) collaborative, a project developed by the Senior Quality Leap Initiative (SQLI) in Canada, to reduce the use of antipsychotic medications among a population of older individuals at a long-term chronic hospital. The methodology included use of a variety of standardized AUA tools, the establishment of staff awareness and alignment, focused internal reporting with benchmarks, and collaborative teamwork with the use of person-centered care. Through this framework, the facility was able to reduce antipsychotic medication use from 22.0% to 14.9% over 2 years.
MeSH term(s)	Aged ; Antipsychotic Agents/therapeutic use ; Canada ; Geriatrics ; Humans ; Long-Term Care
Chemical Substances	Antipsychotic Agents
Language	English
Publishing date	2020-09-18
Publishing country	United States
Document type	Journal Article ; 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.2020.07.025
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Article ; Online: Universal Testing‐Based Response to COVID‐19 Outbreak by a Long‐Term Care and Post‐Acute Care Facility

Bakaev, Innokentiy / Retalic, Tammy / Chen, Helen

Journal of the American Geriatrics Society

2020 Volume 68, Issue 7

Keywords	Geriatrics and Gerontology ; covid19
Language	English
Publisher	Wiley
Publishing country	us
Document type	Article ; Online
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.16653
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Recovery from Coronavirus Disease 2019 among Older Adults in Post-Acute Skilled Nursing Facilities.

Shi, Sandra / Lo, On-Yee / Newmeyer, Natalie / Bakaev, Innokentiy / Kim, Dae Hyun

Journal of the American Medical Directors Association

2021 Volume 22, Issue 6, Page(s) 1138–1141.e1

Abstract: Objectives: To examine functional outcomes of post-acute care for coronavirus disease 2019 (COVID-19) in skilled nursing facilities (SNFs).: Design: Retrospective cohort.: Setting and participants: Seventy-three community-dwelling adults ≥65 years ...

Abstract	Objectives: To examine functional outcomes of post-acute care for coronavirus disease 2019 (COVID-19) in skilled nursing facilities (SNFs). Design: Retrospective cohort. Setting and participants: Seventy-three community-dwelling adults ≥65 years of age admitted for post-acute care from 2 SNFs from March 15, 2020, to May 30, 2020. Measure(s): COVID-19 status was determined from chart review. Frailty was measured with a deficit accumulation frailty index (FI), categorized into nonfrail, mild frailty, and moderate-to-severe frailty. The primary outcome was community discharge. Secondary outcomes included change in functional status from SNF admission to discharge, based on modified Barthel index (mBI) and continuous functional scale scored by physical (PT) and occupational therapists (OT). Results: Among 73 admissions (31 COVID-19 negative, 42 COVID-19 positive), mean [standard deviation (SD)] age was 83.5 (8.8) and 42 (57.5%) were female, with mean FI of 0.31 (0.01) with no differences by COVID-19 status. The mean length of SNF stay for rehabilitation was 21.2 days (SD 11.1) for COVID-19 negative with 20 (64.5%) patients discharged to community, compared to 23.0 (SD 12.2) and 31 (73.8%) among patients who tested positive for COVID-19. Among those discharged to the community, all groups improved in mBI, PT, and OT score. Those with moderate-to-severe frailty (FI >0.35) had lower mBI scores on discharge [92.0 (6.7) not frail, 81.0 (15.4) mild frailty, 48.6 (20.4) moderate-to-severe frailty; P = .002], lower PT scores on discharge [54.2 (3.9) nonfrail, 51.5 (8.0) mild frailty, 37.1 (9.7) moderate-to-severe frailty; P = .002], and lower OT score on discharge [52.9 (3.2) nonfrail, 45.8 (9.4) mild frailty, 32.4 (7.4) moderate or worse frailty; P = .001]. Conclusions and implications: Older adults admitted to a SNF for post-acute care with COVID-19 had community discharge rates and functional improvement comparable to a COVID-19 negative group. However, those who are frailer at admission tended to have lower function at discharge.
MeSH term(s)	Aged ; COVID-19/diagnosis ; Female ; Frailty ; Humans ; Male ; Patient Discharge ; Physical Functional Performance ; Retrospective Studies ; Skilled Nursing Facilities ; Subacute Care
Language	English
Publishing date	2021-04-12
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.2021.04.003
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Focusing on Provider Quality Measurement: Continued Consensus and Feasibility Testing of Practice-Based Quality Measures for Primary Care Providers in Long-Term Care.

Dash, Darly / Moser, Andrea / Feldman, Sid / Saliba, Debra / Bakaev, Innokentiy / Smalbrugge, Martin / Robert, Benoît / Karuza, Jurgis / Heckman, George / Katz, Paul R / Costa, Andrew P

Journal of the American Medical Directors Association

2023 Volume 25, Issue 2, Page(s) 189–194

Abstract: Medical providers in long-term care (LTC) use a unique skillset in delivering comprehensive resident care. Publicly reported quality measures (QMs) do not directly emphasize medical provider competency and their role in care. The impact of providers is ... ...

Abstract	Medical providers in long-term care (LTC) use a unique skillset in delivering comprehensive resident care. Publicly reported quality measures (QMs) do not directly emphasize medical provider competency and their role in care. The impact of providers is understudied and to a large extent, unknown. Our objective was to define, test, and validate QMs to pragmatically measure the practice-based quality of medical providers in a pilot study. We included 7 North American LTC homes with data from practicing medical providers for LTC residents. We engaged in a 4-phased approach. In phase 1, experts rated 95 candidate QMs using 5 pragmatic-focused criteria in a RAND-modified Delphi process. Phase 2 involved specifying 37 QMs for collection (4 QMs were dropped during pilot testing). We created an abstraction manual and data collection tool for all QMs. Phase 3 involved a retrospective chart review in 7 LTC homes on 33 QMs with trained data abstractors. Data were sufficient to analyze performance for 26 QMs. Lastly, in phase 4 results and psychometric properties were reviewed with an expert panel. They ranked the tested measures for validity and feasibility for use by a nonphysician auditor to evaluate medical provider performance based on medical record review. In total, we examined data from 343 resident charts from 7 LTC homes and 49 providers. Our process yielded 10 QMs as being specified for measurement, feasible to collect, and had good test performance. This is the only study to systematically identify a subset of QMs for feasible collection from the medical record by various data collectors. This pragmatic approach to measuring practice-based quality and quantifying select medical provider competencies allows for the evaluation of individual and facility-level performance and facilitates quality improvement initiatives. Future work should perform broader testing and validate and refine operationalized QMs.
MeSH term(s)	Humans ; Long-Term Care ; Nursing Homes ; Quality Indicators, Health Care ; Retrospective Studies ; Pilot Projects ; Feasibility Studies ; Consensus ; Primary Health Care
Language	English
Publishing date	2023-12-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2023.10.024
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Risk Factors, Presentation, and Course of Coronavirus Disease 2019 in a Large, Academic Long-Term Care Facility.

Shi, Sandra M / Bakaev, Innokentiy / Chen, Helen / Travison, Thomas G / Berry, Sarah D

Journal of the American Medical Directors Association

2020 Volume 21, Issue 10, Page(s) 1378–1383.e1

Abstract: Objective: To describe clinical characteristics and risk factors associated with coronavirus disease 2019 (COVID-19) in long-stay nursing home residents.: Design and participants: Retrospective cohort study (March 16, 2020 to May 8, 2020).: Setting! ...

Abstract	Objective: To describe clinical characteristics and risk factors associated with coronavirus disease 2019 (COVID-19) in long-stay nursing home residents. Design and participants: Retrospective cohort study (March 16, 2020 to May 8, 2020). Setting: Academic long-term chronic care facility (Boston, MA). Participants: Long-term care residents. Methods: Patient characteristics and clinical symptoms were obtained via electronic medical records and Minimum Data Set. Staff residence was inferred by zip codes. COVID-19 infection was confirmed by polymerase chain reaction testing using nasopharyngeal swabs. Residents were followed until discharge from facility, death, or up to 21 days. Risks of COVID-19 infection were modeled by generalized estimating equation to estimate the relative risk (RR) and 95% confidence intervals (CI) of patient characteristics and staff community of residence. Results: Overall 146 of 389 (37.5%) long-stay residents tested positive for COVID-19. At the time of positive test, 66 of 146 (45.5%) residents were asymptomatic. In the subsequent illness course, the most common symptom was anorexia (70.8%), followed by delirium (57.6%). During follow-up, 44 (30.1%) of residents with COVID-19 died. Mortality increased with frailty (16.7% in pre-frail, 22.2% in moderately frail, and 50.0% in frail; P < .001). The proportion of residents infected with COVID-19 varied across the long-term care units (range: 0%‒90.5%). In adjusted models, male sex (RR 1.80, 95% CI 1.07, 3.05), bowel incontinence (RR 1.97, 95% CI 1.10, 3.52), and staff residence remained significant predictors of COVID-19. For every 10% increase in the proportion of staff living in a high prevalence community, the risk of testing positive increased by 6% (95% CI 1.04, 1.08). Conclusions and implications: Among long-term care residents diagnosed with COVID-19, nearly one-half were asymptomatic at the time of diagnosis. Predictors of COVID-19 infection included male sex, bowel incontinence, and staff residence in a community with a high burden of COVID-19. Universal testing of patients and staff in communities with high COVID-19 rates is essential to mitigate outbreaks.
MeSH term(s)	Age Factors ; Aged ; Betacoronavirus ; COVID-19 ; COVID-19 Testing ; Clinical Laboratory Techniques ; Coronavirus Infections/diagnosis ; Coronavirus Infections/mortality ; Coronavirus Infections/therapy ; Female ; Frail Elderly/statistics & numerical data ; Humans ; Long-Term Care/organization & administration ; Male ; Nursing Homes/organization & administration ; Pandemics ; Pneumonia, Viral/mortality ; Pneumonia, Viral/therapy ; Retrospective Studies ; Risk Factors ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-08-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2020.08.027
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Risk Factors, Presentation, and Course of COVID-19 in a Large, Academic Long-term Care Facility

Shi, Sandra M. / Bakaev, Innokentiy / Chen, Helen / Travison, Thomas G. / Berry, Sarah D.

Journal of the American Medical Directors Association

Abstract: Objective To describe clinical characteristics, and risk factors associated with COVID-19 in long-stay nursing home residents Design and Participants Retrospective cohort study (3/16/2020-5/8/2020) Setting Academic long-term chronic care facility (Boston, ...

Abstract	Objective To describe clinical characteristics, and risk factors associated with COVID-19 in long-stay nursing home residents Design and Participants Retrospective cohort study (3/16/2020-5/8/2020) Setting Academic long-term chronic care facility (Boston, MA) Participants Long-term care residents Methods Patient characteristics and clinical symptoms were obtained via electronic medical records and Minimum Data Set Staff residence was inferred by zip codes COVID-19 infection was confirmed by polymerase chain reaction testing using nasopharyngeal swabs Residents were followed until discharge from facility, death, or up to 21 days Risk of COVID-19 infection were modeled by generalized estimating equation to estimate the relative risk and 95% confidence intervals of patient characteristics and staff community of residence Results Overall 146 of 389 (37 5%) long-stay residents tested positive for COVID-19 At the time of positive test, 66 of 146 (45 5%) residents were asymptomatic In the subsequent illness course the most common symptom was anorexia (70 8%), followed by delirium (57 6%) During follow-up 44 (30 1%) of residents with COVID-19 died Mortality increased with frailty (16 7% in pre-frail, 22 2% in moderately frail, and 50 0% in frail;p<0 001) The proportion of residents infected with COVID-19 varied across the long-term care units (range: 0-90 5%) In adjusted models male sex (RR: 1 80, 95% CI, 1 07, 3 05), bowel incontinence (RR: 1 97, 95% CI 1 10, 3 52), and staff residence remained significant predictors of COVID-19 For every 10% increase in the proportion of staff living in a high prevalence community, the risk of testing positive increased by 6% (95% CI, 1 04, 1 08) Conclusions and Implications Among long-term care residents diagnosed with COVID-19, nearly half were asymptomatic at the time of diagnosis Predictors of COVID-19 infection included male sex, bowel incontinence and staff residence in a community with a high burden of COVID-19 Universal testing of patients and staff in communities with high COVID-19 rates is essential to mitigating outbreaks
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #728649
Database	COVID19

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Article: Risk Factors, Presentation, and Course of Coronavirus Disease 2019 in a Large, Academic Long-Term Care Facility

Shi, Sandra M / Bakaev, Innokentiy / Chen, Helen / Travison, Thomas G / Berry, Sarah D

J Am Med Dir Assoc

Abstract: OBJECTIVE: To describe clinical characteristics and risk factors associated with coronavirus disease 2019 (COVID-19) in long-stay nursing home residents. DESIGN AND PARTICIPANTS: Retrospective cohort study (March 16, 2020 to May 8, 2020). SETTING: ... ...

Abstract	OBJECTIVE: To describe clinical characteristics and risk factors associated with coronavirus disease 2019 (COVID-19) in long-stay nursing home residents. DESIGN AND PARTICIPANTS: Retrospective cohort study (March 16, 2020 to May 8, 2020). SETTING: Academic long-term chronic care facility (Boston, MA). PARTICIPANTS: Long-term care residents. METHODS: Patient characteristics and clinical symptoms were obtained via electronic medical records and Minimum Data Set. Staff residence was inferred by zip codes. COVID-19 infection was confirmed by polymerase chain reaction testing using nasopharyngeal swabs. Residents were followed until discharge from facility, death, or up to 21 days. Risks of COVID-19 infection were modeled by generalized estimating equation to estimate the relative risk (RR) and 95% confidence intervals (CI) of patient characteristics and staff community of residence. RESULTS: Overall 146 of 389 (37.5%) long-stay residents tested positive for COVID-19. At the time of positive test, 66 of 146 (45.5%) residents were asymptomatic. In the subsequent illness course, the most common symptom was anorexia (70.8%), followed by delirium (57.6%). During follow-up, 44 (30.1%) of residents with COVID-19 died. Mortality increased with frailty (16.7% in pre-frail, 22.2% in moderately frail, and 50.0% in frail; P < .001). The proportion of residents infected with COVID-19 varied across the long-term care units (range: 0%â90.5%). In adjusted models, male sex (RR 1.80, 95% CI 1.07, 3.05), bowel incontinence (RR 1.97, 95% CI 1.10, 3.52), and staff residence remained significant predictors of COVID-19. For every 10% increase in the proportion of staff living in a high prevalence community, the risk of testing positive increased by 6% (95% CI 1.04, 1.08). CONCLUSIONS AND IMPLICATIONS: Among long-term care residents diagnosed with COVID-19, nearly one-half were asymptomatic at the time of diagnosis. Predictors of COVID-19 infection included male sex, bowel incontinence, and staff residence in a community with a high burden of COVID-19. Universal testing of patients and staff in communities with high COVID-19 rates is essential to mitigate outbreaks.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #802898
Database	COVID19

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