دانلود کتاب Post-Acute and Long-Term Care Medicine: A Guide for Practitioners (Current Clinical Practice)

فهرست مطالب :

Preface
Contents
Contributors
Post-Acute Care and Long-Term Services: Evolution to Value-Based Care
Introduction
Long-Term Services and Supports
Skilled Nursing Facility: LT
Post-acute Facility-Based Care
Home Health Services
Inpatient Rehabilitation Facilities (IRF)
Long-Term Acute Care Hospital (LTACH)
Subacute/SNF-ST
Direct Subacute Admissions
Subacute/SNF-ST Reimbursement
Preferred SNF Network
Special Needs Plans
Learnings from COVID-19
The Interdisciplinary Team
Summary
References
Home Health Care
Introduction
Home Care
The Physician House Call
Preparing for the House Call
Billing for Services
Agency Home Health Care
Members of the Team
Skilled Nursing
Physical Therapist
Speech Therapist
Occupational Therapist
Social Worker
Home Care Aide
Requirements for Agency Home Health Care
Physician Reimbursement for Home Health Care Services
Certification/Recertification Codes
Care Plan Oversight Code
Summary: The Future of Home Health Care
References
Assisted Living and Residential Care
Introduction
Assisted Living
History
Definition
Community Characteristics
Staffing
Resident Characteristics
Residents’ Rights
Financing
Staff Training
Disaster Preparedness and COVID-19
Medical Care
Medication Management
Clinician’s Role and Models of Care
Communication and Care Coordination
Care Coordination and Care Transitions
Care Coordination and Technology
Care Coordination and Accountable Care Organizations
Clinical Direction (i.e., Medical Director or Not!)
Clinical Direction and Hospice
Practitioner Billing E/M Codes
The Future of Assisted Living
Clinical Suggestions for Practitioners
Adapt Already Established and Evidence-Based Policies and Procedures for AL
Meet Regularly with the ALC Administrator
Provide In-Service Training to Staff, Residents, and Family Members
Ensure Effective Communication
Focus on High-Risk Medications and Medical Problems
Initiate Discussions on Advance Directives for Healthcare
Encourage Preventive Medicine and Person-Centered Care
Urge Hiring of a Medical Director
Guide Families and Colleagues to Available Resources
Champion State “Mini-AL Workgroups”
Clinical Leadership in Quality Assurance/Performance Improvement (QAPI)
Summary
References
PACE
Introduction
Pace History
Financing
Outcomes
A Day at the PACE Day Health Center (DHC)
PACE Model Practice
Role of the Medical Director in PACE
PACE in the Nursing Home
The Future of PACE
References
Department of Veterans Affairs Options for Long-Term Care
Introduction
Community-Based Care
Hospital in Home
Home-Based Primary Care
Clinical Video Telehealth (CVT)
Telehealth
Homemaker Home Health Aide Care
Nursing Facility Care
Community Nursing Facilities and Community Living Center
End-of-Life Care
References
The Role of Practitioners and the Medical Director
Introduction
The Role of the Medical Practitioner
Clinical Reasoning and Diagnostic Quality
The Role of the Medical Director
Medical Director Characteristics
Origins of the Medical Director Role
Key Medical Director Responsibilities
Regulatory Foundation
Professional Organizations and the Medical Director Role
Medical Director Relationship with Practitioners
Practitioner Responsibilities
The Medical Director’s Relationship with the Facility
The Medical Director’s Role in Facility Quality
References
Team-Based Care: Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants
Introduction
Partnering with a Nurse Practitioner Nurse or Physician Assistant
Clinical Nurse Specialists
Physician Assistants
Prescribing Privileges of PAs and NPs
Collaborative Practice
References
Common Clinical Conditions in Post-Acute and Long-Term Care
Introduction
Hypertension
Benefits and Risks of Treatment
Evaluation
Treatment Goals
Resistant Hypertension
Implications for Long-Term Care
Anemia
Definition and Prevalence of Anemia
Signs and Symptoms
Causes of Anemia
Anemia of CKD
Acute or Chronic Immune Activation (ACI)
Blood Loss
Treatment
Heart Failure
Causes of Heart Failure
Evaluation
Common Precipitants of Heart Failure
Disease Management and Care Considerations in HF
Management
Rehospitalization for HF
Refractory HF
Chronic Obstructive Pulmonary Disease
Identification of COPD
Diagnosis of COPD
Management of COPD
Acute Exacerbations
Diabetes
Type 1 Diabetes in PALTC
Key Recommendations for Managing Diabetes in PALTC Settings
Treatment Selection
Insulin
Sliding-Scale Insulin
Suggestions for Adjusting Insulin Therapy Based on Glucose Patterns
Goals of Treatment
Medication Management: Focus on Safety and Simplification
Hypoglycemia
Monitoring
Assessment of Glycemic Control
Improving Interprofessional Communication and Facility Care Processes
Optimizing Transitions of Care
Thyroid Disorders
Pathophysiology and Epidemiology of Thyroid Disorders in Older Adults
Screening for Thyroid Dysfunction
Interpretation of Thyroid Function Tests
Hypothyroidism
Causes of Hypothyroidism
Clinical Evaluation
Treatment of Clinical Hypothyroidism
Subclinical Hypothyroidism
Management of Subclinical Hypothyroidism
Hyperthyroidism
Diagnosis of Hyperthyroidism
Thyroid Nodules and Thyroid Cancer
Follow-Up of Patients with a History of Thyroid Cancer
Vitamin B12 Deficiency
Diagnosis
Treatment
Skin Disorders
Scabies
Transmission and Diagnosis
Controlling the Outbreak
Treatment of Scabies [41, 42]
Herpes Zoster
General Measures
Vaccination
Treatment
Clostridioides difficile Infection
Clinical Features
Management
Acute Kidney Injury
Conclusion
References
Hypertension
Anemia
Heart Failure
COPD
Diabetes
Thyroid Disease
Vitamin B12 Deficiency
Scabies
Herpes Zoster
Clostridium difficile
Acute Kidney Injury
Preventing Hospital Admissions and Readmissions
Introduction
Transitions of Care
Effective Communication
PCP Fax Transitional Care Summary: SNF to Home
Accountable Care Organizations (ACO)
Acute Changes in Condition
Change in Mental Status
Chest Pain
Congestive Heart Failure (CHF)
Dehydration
Behavioral Problems
Acute Onset of Fever
Asymptomatic Bacteriuria and Urinary Tract Infections
Nursing Home Acquired Pneumonia
Physician Order for Life Sustaining Treatment (POLST) and Advance Directives
Summary
References
Goals of Care and Prevention
Introduction
Goals of Care
Fall Prevention
Immunizations
Influenza
Pneumococcus
Shingles (Herpes Zoster)
COVID-19 Vaccination
Nutrition and Vitamin and Mineral Supplementation
Screening Tests
Screening for Osteoporosis
Tuberculosis Screening
Cancer Screening
Exercise
References
Integrating Palliative Care into Long-Term Care
Introduction
Guiding Principles of Palliative Care
Illness Trajectories and Prognostication
General Indicators and Clinical Parameters of Serious Illness
Symptom Assessment and Management
Anorexia/Cachexia
Dyspnea
Nausea and Vomiting
Constipation
Delirium
Fatigue/Weakness/Lack of Energy
Depression/Anxiety
Pain Management
Opioid Analgesics
Eligibility Guidelines for Hospice
End of Life Care
References
Weight and Nutrition in Post-Acute and Long-Term Care
Introduction
Risk Factors
Medication
Disease
Assessment of Nutritional Status
Weight Management
Nutritional Interventions
Fluids
Supplements
Appetite Stimulants
Indications and Use (or Not) of Feeding Tubes
Ethical and Legal Issues Related to Feeding
Updated Regulations Related to Nutrition and Tube Feeding
Summary
References
Wound Assessment and Management
Introduction
Risk Assessment
Wound Assessment
Types of Wounds
Pressure Injury
Diabetic Wounds
Ischemic Wounds
Venous Wounds
Prevention of Wounds
Unavoidable Pressure Ulcers/Injuries
Staging of Pressure Ulcers/Injuries
Management of Wounds
Treatment of Wounds
Complications of Wounds
IDT Member Roles/Responsibilities for Wound Management
CMS Wound Management Guidance (F686)
Summary
References
Dementia, Delirium, and Depression
Introduction
Dementia
Differential Diagnosis
Diagnosing Dementia
Screening for Dementia
Evaluation of the Resident with Cognitive Impairment
Prognosis
Pharmacologic Treatment
Alzheimer’s Disease (DAT)
Non-DAT Dementias
Challenging Behaviors in Dementia
Treatment of Behaviors in Dementia
Non-Pharmacologic Treatment
Pharmacologic Treatment
Medication Management in Cognitive Impairment
Delirium
Identification
Assessment of Delirium
Prevention
Treatment
COVID-19 and Delirium
Depression
Symptoms and Risk Factors
Differentiating Depression from Dementia
Diagnosis
Screening Tools
Treatment
Pharmacotherapy
Psychotherapy
COVID-19
Summary
References
Ethical and Legal Issues in Post-Acute and Long-Term Care
Introduction
Principles of Health Care Ethics
Resident Rights
Elder Abuse, Neglect, and Exploitation
Racial Disparity in Quality of Care/Patient Outcomes
Mental Capacity, Competence, and Surrogate Decision-Making
Evaluation of Capacity
End-of-Life Issues
Ethical and Legal Aspects of Research in Long-Term Care
Liability in Long-Term Care
Summary
References
Working with Families and Person-Centered Care
Introduction
Person-Centered Care: Impact on Patient/Resident Assessment and Care Planning
Attitudes
Knowledge
Skills
Selection of a Family Spokesperson
Responding to a Phone Call from an Unhappy Family Member
Convening and Conducting a Family Meeting (Refer to Table 1)
Convening and Conducting a Person-Centered Care Plan Meeting (CPM) (Refer to Table 2)
Empowering the Patient/Resident and the Resident’s Representative
During the Care Plan Meeting
When There Are Cultural Differences
Summary
References
Documentation and Coding
Introduction
Documenting the Visit
History
Physical Examination
Medical Decision Making
Visit Time
Coding and Billing for Skilled Nursing and Non-Skilled Nursing Facility Visits
Other Coding Issues in Nursing Facilities
Consultations
Hospice Care
Physicians in Group Practice
Multi-Site Same Day Visits
Split or Shared Visits
“Incident To” Services
Prolonged Face-to-Face Service Codes (99417, 993X0)
Prolonged Non-Face-to-Face Service Codes (99358, 99359)
Chronic Care Management Services
Annual Nursing Facility Resident Assessment (AWVs): (G0438, G0439)
Telehealth Services
Visits by Qualified Nonphysician Practitioners
Services Provided in the NF or SNF That Are Not Reimbursable by Medicare
Coding and Billing for Assisted Living Facilities
Coding and Billing for Home Visits
Summary
References
Medication Management in Long-Term Care
Introduction
Physiologic Changes in the Elderly
Absorption
Distribution
Metabolism
Renal Elimination and Clearance
Pharmacodynamics
Medication Selection in the Elderly
Preventing Adverse Drug Events
Issues in Medication Management
Anticholinergic Burden
“Deprescribing” and Gradual Dose Reduction (GDR)
Transitions in Care and Medication Errors
Use of Psychoactive Medication
Overprescribing of Antibiotics
Overprescribing of Proton Pump Inhibitors
Selection of Diabetic Medication
Choice and Use of Analgesics
Medication Treatment Goals for Hypertension
Beta-Blocker Use in Post-Myocardial Infarction
Choice of Anticoagulants in Non-Valvular Atrial Fibrillation
Treatment of Subclinical Hypothyroidism
Choosing Wisely® and Medication Management
Pharmacogenomics
Summary
Appendix A: Unnecessary Drugs in the NF/SNF
Appendix B: Choosing Wisely® and Medication Management in PA/LTC
References
Rehabilitation and Maximizing Function in Long-Term Care
Introduction
Background
Types of Therapy Services
Payment for Rehabilitation Therapy
Multi-Morbidities and Frailty
Prevention During Rehabilitation
Pressure Ulcer/Injury Prevention
Prevention of Venous Thromboembolism (VTE)
Rehabilitation Approaches for Specific Conditions
Stroke
Fracture Care
Joint Replacement
Amputation and Orthotics
Deconditioned State
Maximizing Function
Pain Management
Depression
Care Transitions
Outcomes Related to Site of Rehab Care
Summary
References
COVID-19 in Post-Acute and Long-Term Care: Challenges and Opportunities
Introduction
Demographics and the scope of COVID-19 in LTC Facilities
Clinical Presentation of COVID-19 in Older Adults
Symptoms of COVID-19 Versus Other Viral Infections
Infection Prevention and Control Strategies in LTC Facilities
Quarantine
Infection Control Program (ICP) Recommendations for LTC Facilities
Visitation
Precautions when Providing Patient Care
Patient Monitoring and COVID-19 Testing in Facilities
Return to Work Criteria for LTC Facility Healthcare Workers “Infected” with COVID-19
Return to Work Criteria for Healthcare Workers “Exposed” to Confirmed COVID-19
Patient Assessment and Management
Management of COVID-19 Infection
Medications Not Recommended, or Only in the Context of a Clinical Trial
Long-Term Consequences of COVID-19 Infection
Long COVID-19
Summary
References
Further Reading
Index