Geriatrics Commons^™

An Electronic Health Record-Based Intervention To Increase Follow-Up Office Visits And Decrease Rehospitalization In Older Adults, Jerry Gurwitz, Terry Field, Jessica Ogarek, Jennifer Tjia, Sarah Cutrona, Leslie Harrold, Shawn Gagne, Peggy Preusse, Jennifer Donovan, Abir Kanaan, George Reed, Lawrence Garber

Jennifer Tjia

OBJECTIVES: To assess the effect of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital.

DESIGN: Randomized controlled trial.

SETTING: Large multispecialty group practice.

PARTICIPANTS: Individuals aged 65 and older discharged from hospital to home.

INTERVENTION: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule …

Knowledge Of And Perceived Need For Evidence-Based Education About Antipsychotic Medications Among Nursing Home Leadership And Staff, Celeste Lemay, Kathleen Mazor, Terry Field, Jennifer Donovan, Abir Kanaan, Becky Briesacher, Sarah Foy, Leslie Harrold, Jerry Gurwitz, Jennifer Tjia

Jennifer Tjia

BACKGROUND/OBJECTIVES: Antipsychotic use is common in US nursing homes, despite evidence of increased risk of morbidity and mortality, and limited efficacy in older adults with dementia. Knowledge, attitudes, and beliefs regarding antipsychotic use among nursing home staff are unclear. The study aim was to describe nursing home leadership and direct care staff members' knowledge of antipsychotic risks, beliefs and attitudes about the effectiveness of antipsychotics and nonpharmacologic management of dementia-related behaviors, and perceived need for evidence-based training about antipsychotic medication safety. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Survey of leadership and direct care staff of nursing homes in Connecticut was conducted …

Studies To Reduce Unnecessary Medication Use In Frail Older Adults: A Systematic Review, Jennifer Tjia, Sarah Velten, Carole Parsons, Sruthi Valluri, Becky Briesacher

Jennifer Tjia

BACKGROUND: Overuse of unnecessary medications in frail older adults with limited life expectancy remains an understudied challenge.

OBJECTIVE: To identify intervention studies that reduced use of unnecessary medications in frail older adults. A secondary goal was to identify and review studies focusing on patients approaching end of life. We examined criteria for identifying unnecessary medications, intervention processes for medication reduction, and intervention effectiveness.

METHODS: A systematic review of English articles using MEDLINE, EMBASE, and International Pharmaceutical Abstracts from January 1966 to September 2012. Additional studies were identified by searching bibliographies. Search terms included prescription drugs, drug utilization, hospice or palliative …

Technological Resources And Personnel Costs Required To Implement An Automated Alert System For Primary Care Physicians When Patients Transition From Hospitals To Home, Terry S. Field, Lawrence D. Garber, Shawn J. Gagne, Jennifer Tjia, Peggy Preusse, Jennifer L. Donovan, Abir O. Kanaan, Jerry H. Gurwitz

Jennifer Tjia

Background With the adoption of electronic medical records by medical group practices, there are opportunities to improve the quality of care for patients discharged from hospitals. However, there is little guidance for medical groups outside of integrated hospital systems to automate the flow of patient information during transitions in care.

Objective To describe the technological resources, expertise and time needed to develop an automated system providing information to primary care physicians when their patients transition from hospitals to home.

Development Within a medical group practice, we developed an automated alert system that provides notification of discharges, reminders of the need …

Predicting Nursing Home Adherence To A Clinical Trial Intervention: Lessons For The Conduct Of Cluster Randomized Trials, Jennifer Tjia, Kathleen Mazor, Terry Field, Peter Doherty, Ann Spenard, Jerry Gurwitz

Jennifer Tjia

OBJECTIVES: To describe factors predictive of nursing home (NH) adherence to a clinical trial intervention. DESIGN: Post hoc analysis of a cluster randomized trial (CRT) evaluating a structured communication intervention to improve nurse-physician telephone communication in NHs. SETTING: NH. PARTICIPANTS: All eligible licensed nursing staff in all participating NHs. MEASUREMENTS: Adherence was defined as active participation for at least 3 months of the 12-month trial. NH characteristics hypothesized to affect trial outcomes (profit status, bed size, nursing staff time, NH quality, and leadership turnover) were measured a priori. The association between intervention adherence, NH characteristics and preintervention questionnaire response rate …

Growth In Dementia-Associated Hospitalizations Among The Oldest Old In The United States: Implications For Ethical Health Services Planning, Marya Zilberberg, Jennifer Tjia

Jennifer Tjia

As the world population ages, an epidemic of neurologic diseases, such as Alzheimer-type dementia and Parkinson disease, is predicted. The most rapid population growth has been observed in the 85 years and older group ... Concurrent with this population growth, we have witnessed a vast expansion of health care utilization and expenditures, with the consequent close scrutiny and attempts to rein in this supply-driven juggernaut. ... We conducted this analysis to gain a better understanding of the current trends in dementia-associated hospitalizations among the 85 years and older population in the United States and its implications for future health care …

Challenge Of Changing Nursing Home Prescribing Culture, Jennifer Tjia, Jerry Gurwitz, Becky Briesacher

Jennifer Tjia

This article described a framework for improving prescribing in nursing homes (NH) by focusing on the whole facility as a system that has created a "prescribing culture." We offered this paradigm as an alternative to focused interventions that target prescribers only. We used the example of atypical antipsychotics to illustrate the approach. We also highlighted elements of the NH culture change movement that are germane to medication prescribing, and illustrated which elements of NH culture were shown to be associated with suboptimal quality of care. We concluded by describing current models, including our study funded by the Agency for Healthcare …

Daily Medication Use In Nursing Home Residents With Advanced Dementia, Jennifer Tjia, Margaret Rothman, Dan Kiely, Michele Shaffer, Holly Holmes, Greg Sachs, Susan Mitchell

Jennifer Tjia

OBJECTIVES: To describe the pattern and factors associated with daily medication use in nursing home (NH) residents with advanced dementia. DESIGN: Prospective cohort study. SETTING: Twenty-two Boston-area NHs. PARTICIPANTS: NH residents with advanced dementia (N=323). MEASUREMENTS: Data from residents' records were used to determine the number or daily medications, specific drugs prescribed, and use of drugs deemed "never appropriate" in patients with advanced dementia. Resident characteristics associated with the use of more daily medications and drugs deemed inappropriate were examined. RESULTS: Residents were prescribed a mean of 5.9 +/- 3.0 daily medications, and 37.5% received at least one medication considered …

Cholinesterase Inhibitor And Memantine Use In Newly Admitted Nursing Home Residents With Dementia, Carole Parsons, Becky Briesacher, Jane Givens, Yong Chen, Jennifer Tjia

Jennifer Tjia

OBJECTIVES: To quantify the use of cholinesterase inhibitors (ChEIs) and memantine in nursing home (NH) residents with dementia upon NH admission and 3 months later and to examine factors associated with reduction in therapy.

DESIGN: Retrospective cohort study.

SETTING: Nationwide sample of U.S. NHs.

PARTICIPANTS: Three thousand five hundred six NH residents with dementia newly admitted in 2006.

MEASUREMENTS: Data from pharmacy dispensing records were used to determine ChEI and memantine medication use upon NH admission and at 3-month follow-up. The Minimum Data Set was used to determine resident- and facility-level characteristics. Severity of dementia was defined using the Cognitive …

Medicare Part D And Changes In Prescription Drug Use And Cost Burden: National Estimates For The Medicare Population, 2000 To 2007, Becky Briesacher, Yanfang Zhao, Jeanne Madden, Fang Zhang, Alyce Adams, Jennifer Tjia, Dennis Ross-Degnan, Jerry Gurwitz, Stephen Soumerai

Jennifer Tjia

CONTEXT: The full effect of Medicare Part D, after the initial policy transition period and across the United States Medicare population, remains unclear.

OBJECTIVE: To estimate nationally representative changes in prescription drug use and out-of-pocket drug costs 2 years after implementation of Part D.

DESIGN, SETTING, AND PARTICIPANTS: We examined study outcomes over 8 years (2000 to 2007) and estimated changes after Part D, accounting for earlier trends. Our analyses used the community-dwelling sample of the Medicare Current Beneficiary Survey (unweighted unique n=38,798). Actual post-Part D outcomes were compared with projected values using 2000 to 2005 data. Subgroup analyses and …