Annals of Long Term Care

Increasing Influenza Immunization for Long-Term Care Facility Staff Using Quality Improvement

Kelly L. Sand, MPP, Joanne Lynn, MD, MA, MS, Barbara Bardenheier, MPH, MA, Hsien Seow, BS, and David A. Nace, MD, MPH

OBJECTIVES: To improve staff immunization rates for influenza in long-term care facilities (LTCFs).

DESIGN: A quality improvement project

SETTING: LTCFs ranging in size from 50 to 2,000 beds.

PARTICIPANTS: Staff members at facilities.

MEASUREMENTS: Change in staff influenza immunization rate.
RESULTS: Of the 13 nursing homes involved, 11 improved their staff influenza immunization rates; nine improved more than 10%, and six improved to a rate greater than 55%, a level that corresponds to substantial protection against outbreaks. Staff education was essential but insufficient. Direct encouragement and dramatic informative endeavors helped, as did financial incentives, competitions, and requiring unambiguously worded consents for refusals. Paying staff members $150 each achieved improvement rapidly.

CONCLUSION: Quality improvement increased staff immunization rates at LTCFs, which reduces the risk of an influenza outbreak. Based on the insights learned about effective changes, the project developed a change package for use by other LTCFs. J Am Geriatr Soc 2007; 55(11):1741-1747.

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Delivering Effective Primary Care to Older Adults: A Randomized, Controlled Trial of the Senior Resource Team at Group Health Cooperative

Elizabeth A. Phelan, MD, MS, Benjamin Balderson, PhD, Martin Levine, MD, Janet H. Erro, RN, MN, PNP, Luesa Jordan, BA, Lou Grothaus, MS, Nirmala Sandhu, MPH, Patrick J. Perrault, James P. LoGerfo, MD, MPH, and Edward H. Wagner, MD, MPH

OBJECTIVES: To assess the effect of a team of geriatrics specialists on the practice style of primary care providers (PCPs) and the functioning of their patients aged 75 and older.

DESIGN: Randomized, controlled trial.

SETTING: Two primary care clinics in the Seattle, Washington, area.

PARTICIPANTS: Thirty-one PCPs and 874 patients aged 75 and older.

INTERVENTION: An interdisciplinary team of geriatrics specialists worked with patients and providers to enhance the geriatric focus of care.

MEASUREMENTS: Main outcomes were a practice style reflecting a geriatric orientation and patient scores on the physical and affect subscales of the Arthritis Impact Measurement Scale 2—Short Form. Secondary outcomes were hospitalizations, incident disability in activities of daily living (ADLs), and PCP perceptions of the intervention. Death rates were also assessed.

RESULTS: Intervention providers screened significantly more for geriatric syndromes at 12 months, but this finding did not persist at 24 months. There were no significant differences in adequate hypertension control or high-risk prescribing at 12 or 24 months of follow-up. There were no significant differences in patient functioning or significant differences in hospitalization rates at either time point. Meaningful differences were observed in ADL disability at 12 but not 24 months. PCPs viewed the intervention favorably. Seventy-eight participants died over the 24 months of follow-up; the proportion dying was higher in the intervention group (11.4% in intervention group vs 7.1% of controls, P=.03).

CONCLUSION: The addition of an interdisciplinary geriatric team was acceptable to PCPs and had some effect on care of geriatric conditions but little effect on patient function or the use of inpatient care and was associated with greater mortality. J Am Geriatr Soc 2007; 55(11):1748-1756.

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The Effect of Age on Outcomes of Sling Surgery for Urinary Incontinence

Jennifer T. Anger, MD, MPH, Mark S. Litwin, MD, MPH, Qin Wang, MA, Chris L.