Poster Abstracts / JAMDA 14 (2013) B3eB26B14

discussions or focus groups. Evaluation: A primary measure of change isthe proportion of residents receiving antipsychotic medications at 6months and at 12 months when compared to the beginning of theprogram. Additionally, we are utilizing a pre-post survey to assess self-efficacy for managing behavior problems and knowledge of conditionsthat contribute to BPSD.Conclusion: Behavioral case-conference is a means to enhance knowledgeand skills for the identification andmanagement of BPSD and to encourageadoption of a patient-centered approach to care. Although, it is nota comprehensive approach to managing antipsychotic use, we anticipateimproved implementation of nonpharmacologic techniques and a reducedneed for antipsychotic drugs.Author Disclosures: All authors have stated there are no financialdisclosures to be made that are pertinent to this abstract.

Cardiac Rehabilitation Program in a Skilled Nursing Facility

Presenting Author: Arvind Modawal, MB BCH, MD, MPH, IPC: TheHospitalist CompanyAuthor(s): Arvind Modawal, MB BCH, MD, MPH

Background: The majority of Cardiac Rehabilitation (CR) programs arehospital or outpatient-based, it is a new growth area for SNF. Meta-analysisfound CR reduced recurrentmyocardial infarction by 17% at 12months andmortality by 47% at 2 years (Clark 2005).Objective/Aim: AIMS: The new CR program is a partnership at Oak HillsNursing and Rehabilitation utilizes the services of the Oak Hills Nursingand Rehabilitation staff with integrated EMR, Medical Director providingonsite physician supervision and Paragon Rehabilitation providing Rehabservices to improve care of patients with stable cardiac conditions.Quality Improvement Methods: Setting: 75 bed skilled nursing facility inCincinnati, OH. Core Components: A CR program is defined as a physician-supervised program that provides the following in both inpatient residentsand in outpatient: Patient assessment; lipid management; hypertensionmanagement; smoking cessation; diabetes management; nutritionalcounseling; weight management; physical activity counseling; psychoso-cial management; and exercise training. Cardiac therapy may include:Flexibility exercises; breathing exercise; Aerobic exercise; ADLs; strengthtraining; balance exercises; gait training to promote independence; andwalking programs. Participants eligible for program: Medically stable orcan be stabilized. They include the following: Stable myocardial infarc-tions; coronary artery bypass graft surgery (CABG); angioplasty; postcardiac transplant surgery; stable CHF; and cardiac risk factors with co-morbidity. Participants with unstable medical condition are excluded fromthe program: Unstable angina - i.e. - refractory to pharmacologicalmanagement; acute congestive heart failure; uncontrolled dysrhythmias ;resting BP’s >200/100 mm Hg; moderate to severe aortic stenosis; thirddegree AV block; acute pericarditis; acutely treated for recent embolicevents; resting ST segment depression greater than 3-4 mm; uncontrolledDiabetes Mellitus; moderate to severe cardiomyopathies; and orthopedicproblems which preclude them from exercise.Conclusion: CR program can be successful in improving quality of life,increasing independence for participants and financially beneficial for thefacility, physician and mid-level providers and therapy company.Author Disclosures: Arvind Modawal, MB BCH, MD, MPH has stated thereare no financial disclosures to be made that are pertinent to this abstract.

Dedicated Providers of Long Term Care Medicine Can Lower Rates ofAdmissions to the Hospital

Presenting Author: Vanessa Sturgill Fant, MD, Mid-Atlantic EldercareAuthor(s): Vanessa Sturgill Fant, MD

Background: New guidelines implemented by CMS in October 2012 placea financial penalty on hospitals for 30 day readmission rates.Objective/Aim: To incorporate a provider system into the long term careenvironment to lower rates of admissions to the hospital setting.

Quality Improvement Methods: Long term care facilities have imple-mented a medical group who focus on long term care medicine and usea model to provide intensive acute care to reduce hospitalization rates.The setting includes six long term care facilities which also provideskilled nursing care. Data was collected from admissions for the monthsJanuary-June 2012 of each facility. Interventions include increasedaverage availability of a medical provider ranging from 2-5 times perweek as well as phone call coverage 24 hours/day. This level of care wasimplemented to try to improve quality of acute care changes in the longterm care environment to reduce hospitalizations.Conclusion: Providers who practice primarily in long term care medicineand who provide intensive weekly rounds and coverage can lowerhospitalization rates. Lowered hospitalization rates can lower nationalhealth care costs as well as financial penalties to hospitals for elevatedreadmission rates.Author Disclosures: Vanessa Sturgill Fant, MD has stated there are nofinancial disclosures to be made that are pertinent to this abstract.

Defining, Measuring and Improving Person Centered Care in NursingHomes

Presenting Author: Howard B. Degenholtz, PhD, University of PittsburghHealth Policy and ManagementAuthor(s): Howard B. Degenholtz, PhD

Background: Person Centered Care (PCC) is a philosophy, embraced mostpopularly by the culture changemovement that attempts to shift the focusof caregivers to the resident as a whole person. The goal is to address theindividual’s needs, goals and preferences in a way that respects theiridentity and autonomy. While resident decision making and autonomyhave long been part of the regulatory and clinical framework for nursinghomes, the concept and embrace of PCC as a way to organize the daily livesof residents is relatively new.Objective/Aim: The Advancing Excellence Campaign, in 2012, has adoptedPCC as a goal area, and convened a working group to develop an approachfor participating nursing homes to adopt PCC practices as part of theirbroader quality improvement activities. The working group has developedan Enhanced Resident Interview for PCC and associated tools for imple-menting the new interview.Quality Improvement Methods: After a review of the peer review andgrey literature, the working group decided to focus on resident quality oflife (QOL) as the primary outcome of PCC. In addition, the working groupfelt that PCC needed to be a routine part of resident assessment and careplanning. Therefore, the group developed an approach which ‘enhances’the sections of the Minimum Data Set 3.0 (MDS) that capture residentpreferences for daily living and activities. For each of the 16 items inSection F of the MDS, the enhanced interview measures how often theresident’s preferences are met. A set of open-ended probes can be used tolearn resident’s preferences for each activity or preference area. A simplered-yellow-green algorithm was developed to triage the 16 questions bycomparing the standardMDS assessment item that rates the importance ofeach issue and the enhanced items that rate frequency. For example, ifa resident indicates than an issue is important but does not occur, this willbe coded as ‘red’. For individual care planning, staff is directed to focus onthe red zone issues. At the facility level, it is straightforward to track theproportion of residents with one or more issues in the red zone. A RootCause Analysis tool was developed to help facilities identify barriers tomeeting residents’ preferences. The Advancing Excellence Campaign willmake the tools available to participating facilities as well as a spreadsheetthat automatically calculates red-yellow-green and facilitates uploadingthe data for benchmarking purposes.Conclusion: The Advancing Excellence Campaign is an important forumfor bringing together experts in long term care to develop state of the arttools for quality improvement. The Enhanced Resident Interview for PCC isan example of the ways that the Campaign is helping the industry improvequality.Author Disclosures: Howard B. Degenholtz, PhD has stated there are nofinancial disclosures to be made that are pertinent to this abstract.