Abstract

Advance directive (AD) completion can improve transitions between hospitals and skilled nursing facilities (SNF’s). One Centers for Medicare and Medicaid Services (CMS) Innovations Demonstration Project, The Missouri Quality Initiative (MOQI), focused on improving AD documentation and use in sixteen SNF’s. The intervention included education, training, consultation and improvements to discussion process, policy development, increased AD enactment, and increased community education and awareness activities. An analysis was conducted of data collected from annual chart inventories occurring over four years. Using a logistic mixed model, results indicated statistical significance (p < .001) for increased AD documentation. Greatest gains occurred at project mid-point. The relationship between having an AD and occurrence of transfer to a hospital was tested on a sample of 1,563 residents with length of stays more than 30 days. Residents who did not have an AD were 29% more likely to be transferred. A logistic regression was conducted, and the results were statistically significant (p < .02).

摘要

完成预先指示 (AD) 可以改善医院和专业护理机构 (SNF) 之间的过渡。一个医疗保险和医疗补助服务中心 (CMS) 创新示范项目，即密苏里州质量倡议 (MOQI)，专注于改进 AD 文档并在 16 个 SNF 中使用。干预措施包括教育、培训、咨询和改进讨论过程、政策制定、增加反倾销立法以及增加社区教育和意识活动。对从四年多的年度图表清单中收集的数据进行了分析。使用逻辑混合模型，结果表明统计显着性 ( p < .001) 用于增加 AD 文档。最大的收益发生在项目中点。对 1,563 名住院时间超过 30 天的居民样本进行了 AD 和转院之间的关系测试。没有 AD 的居民被转移的可能性要高 29%。进行了逻辑回归，结果具有统计学意义（p  < .02）。