PALTtalk

AMDA On-The-Go | An Approach to UTI Prevention, Management, and Treatment

David A. Nace, MD, MPH, CMD
Dr. Nace is an Associate Professor whose research focuses primarily on infectious disease in long-term care. His interest in antibiotic stewardship is funded by three AHRQ studies: two, for which he serves as co-investigator, are designing and testing a national antimicrobial stewardship toolkit for nursing facilities; the third, for which he serves as PI, will update guidelines for urinary tract infection (UTI) management and then implement a program to improve its management in 40 nursing homes in four states.
 
References:
Dr. Theresa Rowe, 2018 NHSN LTCF Training - Epidemiology and Prevention of UTI
Cohen CC, Choi YJ, Stone PW., Costs of Infection Prevention Practices in Long-Term Care Settings: A Systematic Review., Nursing Economics, 2016
Dr. David A. Nace, et. al. The Improving Outcomes of UTI Management in Long-Term Care..., JAMDA, 2018

AMDA On-The-Go | Opioids and Pain Management in PA/LTC

Jeffrey Nichols, MD, CMD
Dr. Jeffrey Nichols, CMD, is Chief Medical Officer of the Gouverneur Skilled Nursing Facility, a division of New York City Health + Hospitals. Dr. Nichols teaches both Geriatrics and Palliative Care fellows and is an Associate Professor at the NYU Langone Medical School as well as the Icahn Mount Sinai School of Medicine. Dr. Nichols is Board Certified in Hospice and Palliative Care as well as Geriatrics. A long time AMDA leader, he currently serves as AMDA's Treasurer and Finance Committee Chair and writes the Dear Dr. Jeff column for Caring for the Ages.
References:
M C Reid, et al. "Pain Management in Long-Term Care Communities: A Quality Improvement Initiative”, Annals of Long Term Care, 2015
Laura B. Farless, MD; Christine S. Ritchie, MD, MSPH / ”Challenges of Pain Management in Long-Term Care”, Annals of Long Term Care, 2012
Brat, GA, et al, “Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study”, British Medical Journal, 2018
“Aging and Addicted”: The Opioid Epidemic Affects Older Adults, Too”, Kaiser Health News, 2016
CMS Roadmap to Address the Opioid Epidemic, CMS.gov, June, 2018

AMDA On-The-Go | Optimistic Project

Kathleen Unroe, MD, MHA
Research Scientist, Regenstrief Institute Assistant Professor of Medicine, Indiana University School of Medicine Center Scientist, Indiana University Center for Aging Research Dr. Unroe is focused on health policy relevant research in long term care, including the use of palliative care and hospice in this setting, transitions of care, quality of medical care in nursing homes, and staffing models in long term care. She is co-PI of the Optimistic model project
 
References:
Unroe KT, Nazir A, Holtz LR et al. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services nursing facility demonstration project. J Am Geriatr Soc 2015;63:165-169.
Hickman, S. E., Unroe, K. T., Ersek, M. T., Buente, B., Nazir, A., & Sachs, G. A. (2016). An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting. Journal of the American Geriatrics Society, 64(11), 2385–2392.
Unroe, et. al., “Improving Nursing Facility Care Through an Innovative Payment Demonstration Project: Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care Phase 2”, Journal of the American Geriatrics Association, 2018

AMDA On-The-Go | Management of LTC Residents with Diabetes

Naushira Pandya, MD, CMD
Dr. Pandya is board certified in internal Medicine, Geriatrics, and Endocrinology. She is also a certified medical director of long-term care facilities, and a recognized authority in diabetes management in the elderly. In addition, she oversees the training of medical students, residents and fellows in Geriatrics, and is a research mentor students, residents and faculty. She has over 20 publications and is a national and international speaker. Dr.Pandya has held several state and national leadership positions, including the presidency of AMDA, Society for Post-Acute and Long-Term Care Medicine. She holds the distinction of being a Fulbright Senior Specialist Scholar in Geriatrics in Slovakia in 2009.
 
References:
Centers for Disease Control Diabetes Data, cdc.org
Munshi, M., et. al., Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association, Diabetes Care 2016 Feb; 39(2): 308-318.
Haas, Linda, Special Considerations for Older Adults With Diabetes Residing in Skilled Nursing Facilities, Diabetes Spectrum 2014 Feb; 27 (1): 37
McKnight’s Long Term Care News, August 5, 2015, profile on Naushira Pandya MD
Pandya N, et. al., Optimizing insulin delivery for patients with diabetes, Geriatric Nursing, 2018, 39:138

AMDA On-The-Go | Through the Eyes of an Administrator

“The world of long-term care is changing very quickly,” says Richard Bane, president of BaneCare Management. "We are not what people typically associate with a nursing home". This episode looks at the past, present, and future of Skilled Nursing Facilities through the eyes of an administrator with 35 years of experience.
References:
Code of Federal Regulations on Administration:  42 CFR 483.7, cms.gov
Code of Massachusetts regulations on Administration: 105 CMR 150, mass.gov
McKnights Long Term Care News, August, 2018–5 Star ratings and readmissions
“The Five-Star Rating System for Skilled Nursing: Perceptions and Effects”, www.lancasterpollard.com, June 10, 2017
“Skilled Nursing Facility Star Rating, Patient Outcomes, and Readmission Risk After Total Joint Arthroplasty”, Journal of Arthroplasty, June, 2018
American Health Care Association, ‘Quality Initiatives’, www.ahcancal.org

AMDA On-The-Go | Management of Sepsis

Episode 12: Sepsis with Dr. Bernardo Reyes Fernandez / Coming Soon!
Bernardo Reyes, MD., is a board-certified internist and geriatrician, he serves as Assistant Director of the Internal Medicine Residency Program and Associate Director of the Geriatric and Palliative Rotations and Assistant Professor of Clinical Biomedical Science in the Charles E. Schmidt College of Medicine at Florida Atlantic University (FAU).
References:
Fernandez, "Early Identification and Management of Sepsis", JAMDA, June 2018
Sloane, P, et al, “Can sepsis be detected in the Nursing Home Prior to the Need for Hospital Transfer?”, JAMDA, June, 2018
Dantes R and Epstein L, “Combatting Sepsis: A Public Health Perspective”, Clinical Infectious Diseases, May, 2018

AMDA On-The-Go | Predictive Models of Care

 
Dr. Burke is the first Director of Research for the Hospital Medicine Section at the University of Pennsylvania and an Assistant Professor of Medicine at the Perelman School of Medicine. Dr. Burke's research seeks to improve the outcomes associated with transitions from the hospital to post-acute care in vulnerable populations. 
 
References:
Burke et. al., "Predicting Potential Adverse Events During a Skilled Nursing Facility Stay: A Skilled Nursing Facility Prognosis Score" JAGS, 2018
Jencks, M.D., M.P.H., Williams, M.D., and Coleman, M.D., M.P.H., "Rehospitalizations among Patients in the Medicare Fee-for-Service Program" NEJM, April 2009
Burke et. al., "Hospital Readmission From Post-Acute Care Facilities: Risk Factors, Timing, and Outcomes", JAMDA, March 2016

AMDA On-The-Go | Innovation

AMDA On-The-Go launched in March of 2018. Since March, we have released ten episodes and would love to hear your feedback. Even if you haven't listened, please fill out this brief survey so we can improve this free benefit.
Innovations with Dr. Steven Buslovich and Adam Sobol
 
Dr. Steven Buslovich is Geriatrician and Medical Director for several post-acute/LTC facilities in Western NY and co-founder, CEO of Patient Pattern. Also, on faculty at University of Buffalo, School of Medicine. 
Learn more by visiting Patient Pattern’s website: patientpattern.com/
 
 
 
Adam Sobol is founder and CEO of CareBand, an innovative, patent-pending wearable technology for senior citizens that are experiencing a decline in their mental and physical health. CareBand aims to increase the safety and independence of senior citizens giving caregivers and family members peace of mind. 
Learn more by visiting Careband’s website: https://carebandremembers.com/

AMDA On-The-Go | Core Competencies

AMDA On-The-Go launched in March of 2018. Since March, we have released nine episodes and would love to hear your feedback. Even if you haven't listened, please fill out this brief survey so we can improve this free benefit.
Paul Katz, MD, CMD, is Professor of Medicine and Director of the Department of Geriatric Medicine, Florida State University, and a Past President of the American Medical Director's Association. He is the lead physician of the Working Committee of the Seniors Quality Leap Initiative, representing Baycrest Centre for Geriatric Care.
Reference:
Katz, “A Call to Action” JAMDA, 2010
Katz and Pfell, “Nursing home physicians and the credibility gap”, JAMDA, 2012
Katz, et. al., “Examining the rationale and processes behind the development of AMDA’s competencies for post-acute and long-term care", Annals of Long Term Care, 2014

AMDA On-The-Go | Public Policy

Dr. Karl Steinberg currently chairs AMDA's Public Policy Committee, serves on the AAHPM's Public Policy Committee, and is also immediate past chair of the Coalition for Compassionate Care of California. Dr. Steinberg has worked as a geriatrician, family physician and hospice physician in San Diego County since 1992. He is a Past President and current President-Elect of the California Association of Long Term Care Medicine (CALTCM), which is the state chapter of AMDA--The Society for Post-Acute and Long-Term Care Medicine (formerly the American Medical Directors Association). He also is editor-in-chief of AMDA's periodical, Caring for the Ages.
References:
 
“Why Health Care Policy is so Hard”, New York Times, 7/28/17
“The future of US health care”, RAND Health, 2017
"Nursing home reform act of 2017"