Connecticut still ranks high among states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 33 percent since 2011 – a bigger decline than the national average — new government data show. The data released in June by the Centers for Medicare & Medicaid Services (CMS), show that nursing home residents in Connecticut, many with dementia, are still more likely to be given antipsychotics than their counterparts in 31 other states. But the state’s usage has fallen in the last 4 ½ years at a greater rate than the average drop of 27 percent, and it is now about the same as the national average — 17.4 percent. That’s down from 26 percent in 2011. CMS has been working with states for the past five years to address the overuse of antipsychotic medications in nursing homes.
A state lawmaker who is pushing public health and hospital officials to make data on hospital infection rates available to consumers, in the wake of a C-HIT story, says he is “encouraged” by a new website on hospital quality launched by the Department of Public Health (DPH) Office of Health Care Access. But state Sen. Tony Hwang, R-Fairfield, said he still wants to work with DPH and state hospitals to make the infection rate information more easily accessible. DPH recently launched a website application, developed by the federal Department of Health and Human Services’ Agency for Healthcare Research and Quality, that provides information on quality and utilization measures, including hospital-acquired infections, for each Connecticut hospital. “I think it’s a very good start, and I appreciate (DPH Commissioner) Dr. Jewell Mullen recognizing that the data should be made available,” Hwang said. “But I still think we need to find ways to make that information more easily available,” possibly through disclosures on individual hospitals’ websites, he said.
State health inspectors visiting Stamford Hospital in late 2012 turned up several infection-control violations, including the improper drying and storage of endoscopes, instruments used to look inside the body. An inspection of Hartford Hospital in 2012 found an operating room with “dust and darkened debris” on top of pumps attached to IV poles, a container of syringes “overflowing” a protective cover, and brownish stains on the floor and underside of the operating table. These kinds of lapses, while not directly tied to patient infections, have contributed to Connecticut’s poor ratings on some federal measures of hospital-acquired infections. Newly released data show that more than 50 percent of the state’s hospitals had rates for at least one type of hospital-acquired infection that were worse than federal benchmarks, in late 2012 and 2013. No other state had a higher percentage of its hospitals exceeding the infection standards set by the U.S. Centers for Disease Control and Prevention, and most states had fewer than 20 percent, according to the data, compiled by Kaiser Health News.
Connecticut still ranks high among states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 21.6 percent since 2011 – more than the national average — new government data show. The data, released Friday by the Centers for Medicare & Medicaid Services (CMS), show that nursing home residents in Connecticut – many with dementia — are still more likely to be given antipsychotics than their counterparts in 33 other states. But the state’s usage rate has declined more than the national average drop of 17.1 percent. “While quality improvement in the area of reducing off-label antipsychotic drug usage needs to be an ongoing effort, Connecticut’s skilled nursing facilities have achieved very positive change,” said Matt Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes. He said the state’s homes are making ongoing changes in “behavioral and health care practice” to further reduce reliance on antipsychotics.
More than two-thirds of Americans have thought about their end-of-life preferences – yet fewer than a third have so-called living wills. Connecticut health care activists are hoping to help close that gap by joining in this year’s “National Healthcare Decisions Day” April 16, with a “call to action” event at the state Capitol. The national day is intended to stir people to choose a health care representative or proxy, and to make decisions about future healthcare treatment, in the event they cannot do so at the end of life. “It’s a difficult conversation – nobody wants to think about their mortality,” said Anne Elwell, a vice president of Qualidigm, the state’s Medicare consulting company, which is organizing the event. “It’s really about life planning — in the way that we think about what we want for our children or what happens to our possessions if something were to happen .
Connecticut still ranks among the top 20 states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 14 percent since 2011, new government data shows. The percentage of patients receiving antipsychotics in the state’s nursing homes fell from 25.72 percent in early 2011 to 22.38 percent this year, according to new data from the Centers for Medicare & Medicaid Services (CMS). The state now ranks the 18th highest in the country in antipsychotic use – down from 16th highest in 2011, and no longer ranked among the top four states, as it was from 2005-10. Antipsychotic drugs are an important treatment for patients with certain mental health conditions, such as schizophrenia. But the Food and Drug Administration has warned that the drugs have potentially fatal side effects when used in elderly patients with dementia.
‘Patient-centric care’ is one of those catch phrases that have little grounding in real-world patient-provider encounters. But later this month, hundreds of Connecticut health care consumers and clinicians will come together for a first-of-its-kind conference that aims to foster patient engagement in medical care. “Better Health: Everyone’s Responsibility,” set for Sept. 17 at the Connecticut Convention Center, Hartford, is a step in bringing patients and providers together to discuss joint decision-making in medical care – from medication management, to end-of-life care, to navigating provisions of the Affordable Care Act. The goal of the summit – open to the public – is to break down barriers between providers and the people they serve, by giving both sides a crash course in key health-care issues and effective ways of communicating.
In the 1970s, after investigators reported that more than 70 percent of air crashes involved human error, the aviation community worked with psychologists to develop a training protocol to improve teamwork, decision-making and safety. Since then, that core training has been adapted for use in other professions, including the military, firefighting and medicine. Now, health professionals in Connecticut have taken those basic lessons and drafted a training protocol for yet another high-risk setting: Nursing homes. The authors of the program, called TeamSTEPPS for Long-Term Care, say the simple training can save lives and money. They plan to pilot the program in Connecticut in the fall and promote it nationally.
When Florence Bolella, director of nursing at Kimberly Hall South nursing home in Windsor, told her staff to remove all the alarms from patients, fear and panic set in. Not among the residents, who were relieved to be free of the annoying beeps and squawks that sounded every time someone with mobility problems moved, but among the nurses’ aides. “The CNAs were so afraid they were going to get in trouble if a patient fell,” Bolella recalled. “It took us almost a year to remove 33 alarms. I eventually had to lock up the alarms, so the staff would stop using them.”
In the two years that the nursing home has stopped using both alarms and restraints, it has seen a decline in the number of falls. Bolella isn’t surprised: “I never felt the alarms were effective.”
Kimberly Hall South is among a handful of nursing homes in Connecticut that have gone “alarm-free,” meaning residents at risk of injury, usually from falls, are no longer outfitted with detectors on their mattresses, chair pads and clothing that emit a warning signal when they try to get up and move around.
Connecticut has saved an estimated $5.4 million in Medicare costs since 2010 by reducing re-hospitalizations of patients through a collaborative “communities of care” model in place in 14 regions around the state, including Hartford, New Haven, Milford, Meriden and Torrington. The estimate by Qualidigm, the state’s Medicare quality improvement organization, coincides with a study in the Journal of the American Medical Association (JAMA) that showed a marked decrease in both hospitalizations and readmissions of Medicare patients in regions where quality improvement organizations (QIOs) coordinate interventions that engage community partners to improve care after discharge. Hospital clinicians and their community partners in the 14 regions of Connecticut have stepped up “to find solutions (so that) patients are benefitting from enhanced coordination among providers across the care continuum,” said Dr. Mary Cooper, vice president and chief quality officer of the Connecticut Hospital Association, which is working with Qualidigm on the “communities of care” model. Readmitting Medicare patients to the hospital within a month of discharge is a frequent—and expensive — occurrence. A new report published this week by the Robert Wood Johnson Foundation shows that hospitals and their community allies made little progress from 2008 to 2010 at reducing readmissions for elderly patients.