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DVT Prophylaxis on Transfer from Hospital to Nursing Home
DVT Prophylaxis on Transfer from Hospital to Nursing Home Presenting Author: Jignesh Patel, MD, William Beaumont Hospital Author(s): Jignesh Patel, MD; and John Voytas, MD Introduction/Objective: Current ACCP guideline suggests a grade (1A) recommendation for high risk medically ill patients, but its use in clinical practice is unknown. Several studies show a large gap between ideal and real-world practice, despite the theoretical possibility that physician awareness might increase use of VTE prophylaxis. Design/Methodology: N 5 50 medically ill elderly Patients with highest risk VTE were selected based on our inclusion criteria which include .3 established risk factor. INCLUSION CRITERIA: In addition to Age . 65 [elderly] 1 Acute Hospitalization for . 3 days, we included other high risk medical conditions like: CHF, COPD, CKD, Morbid obesity, malignancy, rheumatologic/inflammatory disease, respiratory/non-respiratory infection, Immobilization or immobilization with bathroom prevalence or ICU admission. EXCLUSION CRITERIA: Patient already on long term anticoagulation because of A. fib or preexisting DVT/PE or mechanical valve, high risk for bleeding including recent gastrointestinal bleeding, bleeding disorder, intracranial hemorrhage, documented uncontrolled hypertension [.200/120 on .3days], thrombocytopenia [ platelets \100,000], coagulopathy, age \ 65, hospice enrolled, H/O multiple falls, clinically relevant hepatic/renal impairment, who underwent surgery/orthopedic procedure. Results:
Variable
N Mean SD Median 25thPctl 75thPctl Mini Max
Age 50 Hosp Stay 50
84 8
7 4
85 7
80 6
89 9
65 3
97 20
35/50 (70%) were not given prophylaxis on discharge. 33/50 (66%) were not given prophylaxis by NH physician. VTE Prophylaxis Frequency Percent Prophylaxis received on Discharge 15 30% Prophylaxis not given on Discharge 35 70% Prophylaxis by NH Physician [including 2 new] 17 34% Prophylaxis not given by NH Physician. 33 66% Conclusion/Discussion: Compared with ENDORSE study where 39.5% at risk medically ill patients, received ACCP-recommended VTE prophylaxis during their acute hospitalization, this study shows 30% of at risk patients discharged to sub-acute rehabilitation with ACCP-recommended VTE prophylaxis and 34% of at risk patients where placed on VTE prophylaxis by NH physicians upon NH admission. This study shows a need for an improvement in screening VTE risk and prophylaxis, which may be achieved by implementing reminder systems for physicians or by automatically screening patients upon admission with standardized form. Similar reviews should be performed in other settings to determine underuse of VTE prophylaxis if suspected in medical patients. Limitation: This study was not able to determine VTE prophylaxes during acute hospitalization as patients were transferred from several different hospitals and all MAR were not available. Disclosures: All authors have stated there are no disclosures to be made that are pertinent to this abstract.
Economic Evaluation of a Handheld Charge Capture Application for Long Term Care Providers Presenting Author: Steven Handler, MD, MS, University of Pittsburgh, University of Pittsburgh Author(s): Steven M. Handler, MD, MS; and David A. Nace, MD, MPH Introduction/Objective: Previous research has shown that a point-of-care handheld charge capture program can improve coding accuracy and satisfaction for long-term care providers. The objective of this quality improvement project was to determine the impact of a point-of-care handheld charge capture program on the number of charges submitted, payments received, charge lag, and return on investment in a group of long-term care providers. Design/Methodology: We conducted a pre-test/post-test study of 10 physicians and 5 advanced practitioners who provided nursing facility,
POSTER ABSTRACTS
domiciliary/rest home/custodial care, or home visit services for a period of 12 months. During the first 6 months, providers submitted charges using paper-based forms and then for the subsequent 6 months, they were required to submit all charges using a point-of-care handheld charge capture program. The point-of-care handheld charge capture application was custom-built to run on a Palm Operating System device and included security software to ensure HIPAA compliance. For each time-period, the following were compared using unpaired t-tests: charges submitted, payments received, and charge lag. We also conducted a return on investment analysis accounting for software development and licenses, hardware, provider training, and administrative costs. Results: The total number of charges submitted increased 26.3%, from 2,706 to 3,673 (P \ 0.001) after switching from a paper-based to an electronicbased claims submission process. The majority of increased charges were associated with domiciliary/rest home/custodial care codes. Payments increased nearly fifty percent, from $92,080 to $182,363 (P\0.001) following the transition from paper to electronic claims submission. During the study period, the average charge lag decreased from 11.4 days to 5.6 days (P \ 0.001). The six-month return on investment ($90,283 increase in revenue, minus $85,176 in development costs) was 1.06 fold (106%). Conclusion/Discussion: Long term care clinicians that switched from a paper-based to a point-of-care handheld charge capture program submitted significantly more charges, increased payments, and reduced charge lag. Despite a significant investment in developing a handheld charge capture program, the results also suggest that the total development costs were recouped within 6 months. Disclosures: All authors have stated there are no disclosures to be made that are pertinent to this abstract.
Effect of an Interdisciplinary Team Approach to Psychotropic Drug Reduction and Elimination on Quality Measures and other Clinical Outcomes in Skilled Nursing Facilities (SNFs): The Medication Evaluation Trial (MET trial) Presenting Author: Mark Coggins, PharmD, Golden Living Centers Author(s): Mark Coggins, PharmD, Mary P. Evans, MD, CMD; and Camille Bruce, LNHA Introduction/Objective: To evaluate the feasibility and efficacy of incorporating a consultant pharmacist (CP) into an IDT approach to psychotropic medication reduction and comprehensive care planning for SNF residents receiving psychotropic medications, exhibiting disruptive behaviors, or identified as ’at risk’ for undesirable clinical outcomes. All residents of a 150 bed SNF in Hendersonville, NC, receiving psychotropic drugs or identified by facility staff as having or exhibiting weight loss, psychotropic drug use, disruptive behaviors, pressure ulcers, or falls between January 1 and June 30, 2009 had their medical records and care plans reviewed by facility staff in an IDT meeting comprised of a CP, nurse, social worker, dietician, therapy staff and activity staff. The team met twice a week and reviewed each individual resident’s chart every four weeks. Recommendations were communicated to the attending physician and primarily consisted of pain management, depression treatment, therapy referrals, individualized activities, gradual dose reduction of psychotropic drugs, and nutrition interventions. Outcomes of interest: rates of psychotropic drug use and other quality measures, as well as fall related and psychiatric discharges to hospital. Design/Methodology: Prospective Clinical Trial. Results: During the 6 month study period, antipsychotic drug use was reduced by 54%, and anxiolytic drug use was reduced by 59%. Hypnotic drug use decreased by 64%. Antidepressant and analgesic use increased. Among other quality measures, pressure ulcer rates decreased by 66%, falls decreased by 25% in those at risk for falls, and fractures decreased by 17%. Psychiatric discharges to hospital fell by 72%. Hospitalizations for falls were reduced by 23%. Conclusion/Discussion: An interdisciplinary approach including a consultant pharmacist is feasible and effective in reducing antipsychotic, sedative hypnotic and anxiolytic drug use, enhancing treatment of pain and depression, and in improving quality measures and clinical outcomes. Disclosures: All authors have stated there are no disclosures to be made that are pertinent to this abstract.
B9
Variable
N Mean SD Median 25thPctl 75thPctl Mini Max
Age 50 Hosp Stay 50
84 8
7 4
85 7
80 6
89 9
65 3
97 20
35/50 (70%) were not given prophylaxis on discharge. 33/50 (66%) were not given prophylaxis by NH physician. VTE Prophylaxis Frequency Percent Prophylaxis received on Discharge 15 30% Prophylaxis not given on Discharge 35 70% Prophylaxis by NH Physician [including 2 new] 17 34% Prophylaxis not given by NH Physician. 33 66% Conclusion/Discussion: Compared with ENDORSE study where 39.5% at risk medically ill patients, received ACCP-recommended VTE prophylaxis during their acute hospitalization, this study shows 30% of at risk patients discharged to sub-acute rehabilitation with ACCP-recommended VTE prophylaxis and 34% of at risk patients where placed on VTE prophylaxis by NH physicians upon NH admission. This study shows a need for an improvement in screening VTE risk and prophylaxis, which may be achieved by implementing reminder systems for physicians or by automatically screening patients upon admission with standardized form. Similar reviews should be performed in other settings to determine underuse of VTE prophylaxis if suspected in medical patients. Limitation: This study was not able to determine VTE prophylaxes during acute hospitalization as patients were transferred from several different hospitals and all MAR were not available. Disclosures: All authors have stated there are no disclosures to be made that are pertinent to this abstract.
Economic Evaluation of a Handheld Charge Capture Application for Long Term Care Providers Presenting Author: Steven Handler, MD, MS, University of Pittsburgh, University of Pittsburgh Author(s): Steven M. Handler, MD, MS; and David A. Nace, MD, MPH Introduction/Objective: Previous research has shown that a point-of-care handheld charge capture program can improve coding accuracy and satisfaction for long-term care providers. The objective of this quality improvement project was to determine the impact of a point-of-care handheld charge capture program on the number of charges submitted, payments received, charge lag, and return on investment in a group of long-term care providers. Design/Methodology: We conducted a pre-test/post-test study of 10 physicians and 5 advanced practitioners who provided nursing facility,
POSTER ABSTRACTS
domiciliary/rest home/custodial care, or home visit services for a period of 12 months. During the first 6 months, providers submitted charges using paper-based forms and then for the subsequent 6 months, they were required to submit all charges using a point-of-care handheld charge capture program. The point-of-care handheld charge capture application was custom-built to run on a Palm Operating System device and included security software to ensure HIPAA compliance. For each time-period, the following were compared using unpaired t-tests: charges submitted, payments received, and charge lag. We also conducted a return on investment analysis accounting for software development and licenses, hardware, provider training, and administrative costs. Results: The total number of charges submitted increased 26.3%, from 2,706 to 3,673 (P \ 0.001) after switching from a paper-based to an electronicbased claims submission process. The majority of increased charges were associated with domiciliary/rest home/custodial care codes. Payments increased nearly fifty percent, from $92,080 to $182,363 (P\0.001) following the transition from paper to electronic claims submission. During the study period, the average charge lag decreased from 11.4 days to 5.6 days (P \ 0.001). The six-month return on investment ($90,283 increase in revenue, minus $85,176 in development costs) was 1.06 fold (106%). Conclusion/Discussion: Long term care clinicians that switched from a paper-based to a point-of-care handheld charge capture program submitted significantly more charges, increased payments, and reduced charge lag. Despite a significant investment in developing a handheld charge capture program, the results also suggest that the total development costs were recouped within 6 months. Disclosures: All authors have stated there are no disclosures to be made that are pertinent to this abstract.
Effect of an Interdisciplinary Team Approach to Psychotropic Drug Reduction and Elimination on Quality Measures and other Clinical Outcomes in Skilled Nursing Facilities (SNFs): The Medication Evaluation Trial (MET trial) Presenting Author: Mark Coggins, PharmD, Golden Living Centers Author(s): Mark Coggins, PharmD, Mary P. Evans, MD, CMD; and Camille Bruce, LNHA Introduction/Objective: To evaluate the feasibility and efficacy of incorporating a consultant pharmacist (CP) into an IDT approach to psychotropic medication reduction and comprehensive care planning for SNF residents receiving psychotropic medications, exhibiting disruptive behaviors, or identified as ’at risk’ for undesirable clinical outcomes. All residents of a 150 bed SNF in Hendersonville, NC, receiving psychotropic drugs or identified by facility staff as having or exhibiting weight loss, psychotropic drug use, disruptive behaviors, pressure ulcers, or falls between January 1 and June 30, 2009 had their medical records and care plans reviewed by facility staff in an IDT meeting comprised of a CP, nurse, social worker, dietician, therapy staff and activity staff. The team met twice a week and reviewed each individual resident’s chart every four weeks. Recommendations were communicated to the attending physician and primarily consisted of pain management, depression treatment, therapy referrals, individualized activities, gradual dose reduction of psychotropic drugs, and nutrition interventions. Outcomes of interest: rates of psychotropic drug use and other quality measures, as well as fall related and psychiatric discharges to hospital. Design/Methodology: Prospective Clinical Trial. Results: During the 6 month study period, antipsychotic drug use was reduced by 54%, and anxiolytic drug use was reduced by 59%. Hypnotic drug use decreased by 64%. Antidepressant and analgesic use increased. Among other quality measures, pressure ulcer rates decreased by 66%, falls decreased by 25% in those at risk for falls, and fractures decreased by 17%. Psychiatric discharges to hospital fell by 72%. Hospitalizations for falls were reduced by 23%. Conclusion/Discussion: An interdisciplinary approach including a consultant pharmacist is feasible and effective in reducing antipsychotic, sedative hypnotic and anxiolytic drug use, enhancing treatment of pain and depression, and in improving quality measures and clinical outcomes. Disclosures: All authors have stated there are no disclosures to be made that are pertinent to this abstract.
B9