Journal of the American Medical Directors Association最新文献

{"title":"Resource Factors Associated With Avoidable Transfers in Nursing Homes","authors":"Matthew S. Farmer PhD, RN,&nbsp;Alisha H. Johnson PhD, RN,&nbsp;Kimberly R. Powell PhD, RN","doi":"10.1016/j.jamda.2025.106040","DOIUrl":"10.1016/j.jamda.2025.106040","url":null,"abstract":"<div><h3>Objectives</h3><div>Reducing avoidable hospital transfers among nursing home (NH) residents remains a critical priority, with 20% to 67% of transfers potentially preventable. Despite evidence that embedded advanced practice registered nurses (APRNs) and enhanced resources reduce transfers, chronic underinvestment leaves NHs with inadequate staffing and limited diagnostic capabilities. This study examined which resource constraints contributed to avoidable transfers among NH residents with dementia.</div></div><div><h3>Design</h3><div>Cross-sectional analysis of transfer events collected during the Missouri Quality Initiative, a Centers for Medicare and Medicaid Services–funded intervention (2016–2020) that embedded APRNs, implemented INTERACT tools, and enhanced health information technology to reduce avoidable hospitalizations.</div></div><div><h3>Setting and Participants</h3><div>Sixteen Missouri NHs participated, encompassing 3683 hospital transfer events from long-term residents. APRNs completed INTERACT surveys documenting resource availability and transfer context.</div></div><div><h3>Methods</h3><div>Eleven resource indicators were extracted from APRN surveys. Exploratory factor analysis identified latent resource domains. Factor scores were analyzed using Bayesian generalized linear mixed models to assess associations with avoidable transfers, accounting for facility-level variation.</div></div><div><h3>Results</h3><div>Half (50.2%) of transfers were avoidable. Four resource domains emerged: Delayed Diagnostics, Lack of Expertise/Staffing, APRN and Registered Nurse (RN) Availability, and On-site Clinical Resources. Limited APRN availability and staff discomfort (factors 2 and 3) significantly increased the odds of avoidable transfers (OR ≈1.7), whereas the lack of on-site clinicians and equipment (factor 4) were associated with nonavoidable transfers (OR ≈0.37). In addition, facility-level differences contributed meaningfully to transfer decisions, suggesting that unmeasured organizational factors influence outcomes.</div></div><div><h3>Conclusions and Implications</h3><div>Avoidable transfers are driven by staff discomfort and limited APRN availability, revealing gaps in nursing jurisdiction and decision-making capacity. Practice and policy reforms should expand APRN access, strengthen diagnostic partnerships, leverage telehealth, and support closed provider models. These interventions are urgently needed to reduce costly, traumatic transfers and improve resident-centered care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 2","pages":"Article 106040"},"PeriodicalIF":3.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Vaccination and Impact on Morbidity Among Nursing Home Residents, October 2024–January 2025: An Ecological Analysis","authors":"Farid L. Khan MPH,&nbsp;Jenny Boucher PharmD,&nbsp;Timothy L. Wiemken PhD,&nbsp;Angela D. Cook MS,&nbsp;Tobias Bergroth PhD,&nbsp;Alon Yehoshua PharmD,&nbsp;Evan J. Zasowski PharmD,&nbsp;Santiago M.C. Lopez MD,&nbsp;Laura A. Puzniak PhD","doi":"10.1016/j.jamda.2025.106029","DOIUrl":"10.1016/j.jamda.2025.106029","url":null,"abstract":"<div><h3>Objectives</h3><div>US nursing home residents experience a disproportionate burden of COVID-19–associated cases and hospitalizations. COVID-19 vaccination may reduce the burden in this population; however, data on the association between vaccine uptake and outcomes for this vulnerable population are lacking.</div></div><div><h3>Design</h3><div>Retrospective, observational ecological study.</div></div><div><h3>Setting and Participants</h3><div>Facility-level nursing home resident information from the Centers for Disease Control and Prevention's National Healthcare Safety Network Long-Term Care Facility COVID-19 Module database from October 5, 2024, to January 5, 2025.</div></div><div><h3>Methods</h3><div>Facility-level COVID-19 vaccination uptake and COVID-19 outcomes were linked with sociodemographic, economic, and facility characteristics. Generalized estimating equations were used to assess associations between vaccination uptake and COVID-19 cases and hospitalizations, controlling for potential confounders.</div></div><div><h3>Results</h3><div>The study included up to 13 weeks of data from 12,665 facilities (168,278 facility-weeks total). COVID-19 vaccination uptake increased from 14.8% to 40.0% over the study period. A 10% increase in vaccination uptake was associated with a significant reduction in COVID-19 cases [adjusted incidence rate ratio (ARR), 0.94; 95% CI, 0.91–0.97] and hospitalizations (ARR, 0.91; 95% CI, 0.86–0.95) among up-to-date residents. Facilities with higher vaccination rates experienced fewer weekly COVID-19 cases and hospitalizations.</div></div><div><h3>Conclusions and Implications</h3><div>Increased COVID-19 vaccination rates among nursing home residents are associated with reduced cases and hospitalizations, underscoring the importance of vaccination as a public health strategy in this vulnerable population. Efforts to improve COVID-19 vaccine uptake are warranted and could include revision of quality measures ratings to align COVID-19 vaccination with flu vaccination requirements.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 3","pages":"Article 106029"},"PeriodicalIF":3.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription Patterns and Associated Factors of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors Use Among Patients Worldwide: A Systematic Review and Meta-Analysis of Real-World Studies","authors":"Man Xu MSc,&nbsp;Quanzhi Li MSc,&nbsp;Ning Chen MSc,&nbsp;Xi Zhang PhD,&nbsp;Wei Zhang PhD","doi":"10.1016/j.jamda.2025.106036","DOIUrl":"10.1016/j.jamda.2025.106036","url":null,"abstract":"<div><h3>Objectives</h3><div>The prescribing patterns of sodium-glucose cotransporter 2 (SGLT2) inhibitors in real-world clinical practice remain inadequately characterized. To address this gap, this meta-analysis aims to synthesize evidence on the prescription trends and clinical factors associated with SGLT2 inhibitor use.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting and Participants</h3><div>Patients with type 2 diabetes, chronic kidney disease, or cardiovascular disease.</div></div><div><h3>Methods</h3><div>Studies that were conducted to assess SGLT2 inhibitor use among patients were screened. From its inception until November 4, 2024, searches were conducted in PubMed, Web of Science, and Embase. Statistical analyses were performed with Review Manager (RevMan) version 5.4 and Stata 18.0.</div></div><div><h3>Results</h3><div>The study examined data from 102 studies, revealing a compelling global prevalence of SGLT2 inhibitors of 12% (95% CI, 11%-13%). The pooled prevalence of SGLT2 inhibitor use was 13% (95% CI, 11%-14%) in patients with cardiovascular disease, followed by type 2 diabetes at 12% (95% CI, 11%-13%) and chronic kidney disease at 11% (95% CI, 9%-13%). The use of SGLT2 inhibitors was significantly higher in patients who were enrolled after December 2020 compared with those enrolled before that date (20% vs 9%). The prescribing of SGLT2 inhibitors is significantly related to age, sex, body mass index, Medicare, and endocrinology visits.</div></div><div><h3>Conclusions and Implications</h3><div>The meta-analysis indicates that the real-world use of SGLT2 inhibitors increased gradually up to 2020. The synthesized evidence revealed variations in usage across different patient subgroups, which require addressing the identified barriers in the future to ensure optimal prescribing.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 2","pages":"Article 106036"},"PeriodicalIF":3.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healing at Home: Receipt of Home Health Care and Patient-Centered Outcomes Among Older Adults After Acute Myocardial Infarction.","authors":"Alexandra M Hajduk, Jason R Falvey, Jingjing Shang, Lisa M Kern, Madeline Sterling, Sui Tsang, Jeph Herrin, Sarwat I Chaudhry","doi":"10.1016/j.jamda.2025.106063","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.106063","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of receipt of home health care (HHC) on the patient-centered outcomes of days not at home (DNAH) and risk of decline in physical and mental health status among older adults hospitalized with acute myocardial infarction (AMI).</p><p><strong>Design: </strong>Secondary analysis of data from a national prospective cohort study.</p><p><strong>Setting and participants: </strong>Adults age ≥75 years discharged home after an AMI hospitalization and linked to Medicare data.</p><p><strong>Methods: </strong>The primary exposure was receipt of HHC by 14 days postdischarge. DNAH within 180 days after discharge was defined as the count of days spent deceased or in a hospital, skilled nursing facility, or inpatient rehab facility. Health status decline was defined as a decrease ≥5 points on the SF-12 from baseline to 180 days. Inverse probability of treatment-weighted generalized linear models was used to evaluate associations between receipt of HHC and these outcomes.</p><p><strong>Results: </strong>A total of 491 of 1846 (26.6%) participants received HHC within 14 days; HHC recipients were older and had greater clinical and functional comorbidity. HHC was not associated with DNAH (incidence rate ratio [IRR], 1.24; 95% CI, 0.99-1.56) nor risk of decline in mental health status (odds ratio [OR], 0.83; 95% CI, 0.64-1.07), but was associated with substantially reduced risk of decline in physical health status (OR, 0.70; 95% CI, 0.56-0.89).</p><p><strong>Conclusions and implications: </strong>More than one-quarter of patients with AMI age ≥75 discharged home received HHC. Patients who received HHC, who were older and sicker on average, were less likely to experience clinically significant declines in physical health status but had similar rates of mental health status decline and DNAH as those who did not receive HHC. This work suggests that providers consider the health outcome goals of older AMI patients and prescribe HHC to those who prioritize preservation of physical health status.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"106063"},"PeriodicalIF":3.8,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Directions & Connections","authors":"","doi":"10.1016/S1525-8610(25)00616-4","DOIUrl":"10.1016/S1525-8610(25)00616-4","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 1","pages":"Article 106099"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient- Versus Provider-Centered Care","authors":"Barbara Resnick PhD, CRNP ,&nbsp;Paul Katz MD","doi":"10.1016/j.jamda.2025.106009","DOIUrl":"10.1016/j.jamda.2025.106009","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 1","pages":"Article 106009"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nonpharmacological Approach to Skin Picking in a Patient With Alzheimer's Dementia: A Case Report","authors":"Ujunwa Ebili MD,&nbsp;Esther S. Oh MD, PhD,&nbsp;Mfon E. Umoh MD, PhD","doi":"10.1016/j.jamda.2025.105951","DOIUrl":"10.1016/j.jamda.2025.105951","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 1","pages":"Article 105951"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning in Sarcopenia Diagnosis: Promising but Requires Caution in Clinical Translation","authors":"Huan Luo MSc,&nbsp;Lei Pu PhD","doi":"10.1016/j.jamda.2025.105958","DOIUrl":"10.1016/j.jamda.2025.105958","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 1","pages":"Article 105958"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Patient Medical Complexity After Skilled Nursing Facility Payment Reform: A Qualitative Study","authors":"Natalie E. Leland PhD, OTR/L ,&nbsp;Rachel A. Prusynski DPT, PhD ,&nbsp;Amanda Shore COTA/L ,&nbsp;Harsha Amaravadi MPH ,&nbsp;Tracy Mroz PhD, OTR/L ,&nbsp;Debra Saliba MD, MPH","doi":"10.1016/j.jamda.2025.106019","DOIUrl":"10.1016/j.jamda.2025.106019","url":null,"abstract":"<div><h3>Objectives</h3><div>The skilled nursing facility (SNF) patient-driven payment model (PDPM) is intended to align payment with patient clinical characteristics to more accurately compensate complex and resource intensive care. However, it is unclear whether and how SNFs shifted their admission practices to align PDPM's financial incentives. This study examined SNF leaders’ perspectives on changes in admission practices and patient case mix in order to understand variation in responses to PDPM implementation.</div></div><div><h3>Design</h3><div>A qualitative study.</div></div><div><h3>Setting and Participants</h3><div>A purposive sample of SNF leaders from across the United States [eg, average to high (3–5 stars) and below-average (1–2 stars) care quality].</div></div><div><h3>Methods</h3><div>Ninety-four SNF leaders participated in one-on-one semistructured interviews between January 2021 and December 2022. Thematic analysis examined leaders’ perspectives of their organization’s response to PDPM, including changes in admission practices and patient case mix, as well as contextual factors contributing to their response. We then examined patterns by SNF quality rating and admission practice changes.</div></div><div><h3>Results</h3><div>Descriptions of whether and why SNF case mix change differed based on their history of caring for a medically complex patient population. Leaders of SNFs that historically cared for rehabilitation patients frequently described strategic changes in their admission practices (eg, enhanced preadmission screening) after PDPM to prioritize the admission of medically complex patients, including those with higher nursing-related care needs (eg, tracheostomy, wounds, peritoneal dialysis). These leaders tended to represent average or high-quality SNFs, whereas leaders from below-average quality SNFs more frequently reported minimal or no case mix changes, in part reflecting a history of admitting medically complex patients before PDPM.</div></div><div><h3>Conclusions and Implications</h3><div>Results suggest that PDPM’s intended effect of shifting SNF admissions to more medically complex patients varied by baseline SNF admission patterns and characteristics. These findings can inform longitudinal national evaluations of organizational responses to PDPM implementation.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 1","pages":"Article 106019"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PALTmed Events and Product","authors":"","doi":"10.1016/S1525-8610(25)00617-6","DOIUrl":"10.1016/S1525-8610(25)00617-6","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"27 1","pages":"Article 106100"},"PeriodicalIF":3.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}