Colleen Galambos

Automated Technology to Speed Recognition of Signs of Illness in Older Adults

Our team has developed a technological innovation that detects changes in health status that indicate impending acute illness or exacerbation of chronic illness before usual assessment methods or self-reports of illness. We successfully used this information in a 1-year prospective study to alert health care providers so they could readily assess the situation and initiate early treatment to improve functional independence. Intervention participants showed significant improvements (as compared with the control group) for the Short Physical Performance Battery gait speed score at Quarter 3 (p = 0.03), hand grip-left at Quarter 2 (p = 0.02), hand grip-right at Quarter 4 (p = 0.05), and the GAITRite functional ambulation profile score at Quarter 2 (p = 0.05). Technological methods such as these could be widely adopted in older adult housing, long-term care settings, and in private homes where older adults wish to remain independent for as long as possible.

Cost, staffing and quality impact of bedside electronic medical record (EMR) in nursing homes.

OBJECTIVE There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes. METHODS Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither. Intervention sites (Groups 1 and 2) received substantial, partial financial support from CMS to implement EMR. Costs and staffing were measured from Medicaid cost reports, and staff retention from primary data collection; resident outcomes were measured by MDS-based quality indicators and quality measures. RESULTS Total costs increased in both intervention groups that implemented technology; staffing and staff retention remained constant. Improvement trends were detected in resident outcomes of ADLs, range of motion, and high-risk pressure sores for both intervention groups but not in comparison groups. DISCUSSION Implementation of bedside EMR is not cost neutral. There were increased total costs for all intervention facilities. These costs were not a result of increased direct care staffing or increased staff turnover. CONCLUSIONS Nursing home leaders and policy makers need to be aware of on-going hardware and software costs as well as costs of continual technical support for the EMR and constant staff orientation to use the system. EMR can contribute to the quality of nursing home care and can be enhanced by on-site consultation by nurses with graduate education in nursing and expertise in gerontology.

A Review of Discharge Planning Research of Older Adults 1990-2008

This integrative review of the literature analyzed the research about hospital discharge planning within the historical timeline of public policy changes that affected service utilization. There were 36 articles reviewed that represented a variety of disciplines, nursing (n = 21), social work (n = 6), medicine (n = 5), and sociology (n = 4). The review revealed several interesting findings. Though the family is the first line of defense against problems, little work done has been done that focuses on building partnerships between patients, families, and health care providers. The costs of care drive the health care system; yet costs of interventions were rarely described. Intensive case management of at-risk populations has neither been widely adopted nor is it reimbursed through public funding, even though it has been found to be cost effective.

Improving Nurse Care Coordination With Technology

Technology offers potential solutions to the pending crisis of healthcare for older adults, while healthcare workers are in short supply. Technology can enable remote monitoring of individuals and early detection of potential problems, so that early interventions can help older adults remain as healthy and independent as possible. Research is under way with passive monitoring technology in senior housing that is finding patterns in the data that can enhance nurse care coordination through early illness detection. With early detection, interventions can be more effective and reduce hospitalization and other healthcare expenses. Case studies are presented, and implications are discussed.

Radar walking speed measurements of seniors in their apartments: Technology for fall prevention

Falls are a significant cause of injury and accidental death among persons over the age of 65. Gait velocity is one of the parameters which have been correlated to the risk of falling. We aim to build a system which monitors gait in seniors and reports any changes to caregivers, who can then perform a clinical assessment and perform corrective and preventative actions to reduce the likelihood of falls. In this paper, we deploy a Doppler radar-based gait measurement system into the apartments of thirteen seniors. In scripted walks, we show the system measures gait velocity with a mean error of 14.5% compared to the time recorded by a clinician. With a calibration factor, the mean error is reduced to 10.5%. The radar is a promising sensing technology for gait velocity in a day-to-day senior living environment.

The use of bedside electronic medical record to improve quality of care in nursing facilities: a qualitative analysis

It appears that the implementation and use of a bedside electronic medical record in nursing homes can be a strategy to improve quality of care. Staff like using the bedside electronic medical record and believe it is beneficial. Information gleaned from this qualitative evaluation of four nursing homes that implemented complete electronic medical records and participated in a larger evaluation of the use of an electronic medical record will be useful to other nursing homes as they consider implementing bedside computing technology. Nursing home owners and administrators must be prepared to undertake a major change requiring many months of planning to successfully implement. Direct care staff will need support as they learn to use the equipment, especially for thefirst 6 to 12 months after implementation. There should be a careful plan for continuing education opportunities so that staff learn to properly use the software and can benefit from the technology. After 12 to 24 months, almost no one wants to return to the era of paper charting.

Initiative to test a multidisciplinary model with advanced practice nurses to reduce avoidable hospitalizations among nursing facility residents.

Author Affiliations: Sinclair School of Nursing (Drs Rantz, Alexander, Vogelsmeier, Popejoy, Flesner, and Crecelius and Ms Lueckenotte), School of Social Work, College of Human and Environmental Sciences (Dr Galambos), and Curtis W. and Ann H. Long Department of Family and Community Medicine (Dr Koopman), University of Missouri, Columbia; and College of Nursing and Health Sciences, University of Wisconsin–Eau Claire (Dr Zwygart-Stauffacher).

A Competency Approach to Curriculum Building: A Social Work Mission

Summary This article discusses The John A. Hartford Foundation CSWE SAGE-SW Project through an historical reflection of curriculum development within the profession. The projects relationship to several curriculum building models is also explored. A curriculum development tool for combining the Hartford Competencies with the CSWE EPAS requirements is provided.

FROM THE EDITOR: POLITICAL TOLERANCE, SOCIAL WORK VALUES, AND SOCIAL WORK EDUCATION

as a profession, we do a fair share of talking about diversity— diversity of culture, ethnicity, nationalism, race, sexual orientation, religion, even geographical diversity. There is one form of diversity that we are almost silent about, and that is diversity of political ideology. in the last 5 years one article was published on the topic—“exploring the political Diversity of social Workers” by Mitchell rosenwald. in this article rosenwald (2006) systematically examines the concept of political ideology among social workers. He defines political ideology as an “individual’s support of policy positions that reflect their attitudes on society’s relationship with technology, power distribution, dependency, and nationalism” (p. 121). His study divided political ideology into five categories— radical left, liberal, moderate, conservative, and radical right. although the study’s sample was obtained from only one state, the results give us cause to reflect on our inherent assumptions about the profession. in particular, the results of the study indicated that no single political ideology was held by the majority of participants. furthermore, in terms of individual opinion items, social workers ranked as more liberal on social issues and moderate to conservative on economic welfare issues.

Preparing Nursing Homes for the Future of Health Information Exchange

OBJECTIVE Our purpose was to describe how we prepared 16 nursing homes (NHs) for health information exchange (HIE) implementation. BACKGROUND NH HIE connecting internal and external stakeholders are in their infancy. U.S. initiatives are demonstrating HIE use to increase access and securely exchange personal health information to improve patient outcomes. METHOD To achieve our objectives we conducted readiness assessments, performed 32 hours of clinical observation and developed 6 use cases, and conducted semi-structured interviews with 230 participants during 68 site visits to validate use cases and explore HIE. RESULTS All 16 NHs had technology available to support resident care. Resident care technologies were integrated much more with internal than external stakeholders. A wide range of technologies were accessible only during administrative office hours. Six non-emergent use cases most commonly communicated by NH staff were: 1) scheduling appointments, 2) Laboratory specimen drawing, 3) pharmacy orders and reconciliation, 4) social work discharge planning, 5) admissions and pre-admissions, and 6) pharmacy-medication reconciliation. Emerging themes from semi-structured interviews about use cases included: availability of information technology in clinical settings, accessibility of HIE at the point of care, and policies/procedures for sending/receiving secure personal health information. CONCLUSION We learned that every facility needed additional technological and human resources to build an HIE network. Also, use cases help clinical staff apply theoretical problems of HIE implementation and helps them think through the implications of using HIE to communicate about clinical care.