Journal of the American Medical Directors Association
Project ECHO-AGE and Nursing Home Quality of Care
Section snippets
Introduction/Objective
US nursing homes (NHs) care for increasing numbers of elderly residents with a diagnosis of dementia and related behavioral difficulties. However, many lack access to specialized expertise and often resort to antipsychotic medications or physical restraints, which can compromise residents' safety, dignity, and autonomy. Project ECHO-AGE aims to increase NH staffs' capacity to provide appropriate care through bi-weekly video-conferences with a multidisciplinary BIDMC geriatric medical team,
Design/Methodology
This matched-cohort study compared quality of care measures (QMs) between facilities participating in ECHO-AGE and controls for the period July 2012-December 2013. Participants: ECHO-AGE NHs (n=11) were matched 1:2 to controls (n=22) on region, size, ownership, Medicare/Medicaid certification, and staffing using the Centers for Medicare and Medicaid Services NH Compare database. Exclusion criteria included minimal participation (n=5) and insufficient data (n=2). Methods: The main outcomes are
Results
NHs were located in Maine and Massachusetts, with average 122.7 beds (SD=56.4). AGE facilities reported greater proportions of residents with increased need for ADL assistance than controls (MAGE=18.2% , SDAGE=4.4%; MControl=12.7%, SDControl=4.7%; t(30)=-3.5; p=0.002) at baseline, while other differences were not significant. Both group (β=-0.6, P=0.02) and baseline (β=0.08, P=0.03) were significant predictors of physical restraint usage. AGE NHs (LS Mean=0.4, SE=0.4) reported lower restraint
Conclusion/Discussion
Preliminary evidence suggests Project ECHO-AGE may reduce rates of physical restraint usage among long-term NH residents. Larger samples and patient-level data might be helpful in further clarifying Project ECHO-AGE's impact on quality of care.
Author Disclosures
The ECHO-AGE Project at Beth Israel Deaconess Medical Center is funded through a grant from the RX Foundation. Research on the impact of ECHO-AGE is funded by a grant from the Donahue Foundation.