Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations

Huckfeldt, Peter J.; Kane, Robert L; Yang, Zhiyou; Engström, Gabriella; Tappen, Ruth M.; Rojido, Carolina; Newman, D. L.; Reyes, Bernardo; Ouslander, Joseph G.

doi:10.1111/jgs.15476

Cited by 43 publications

(42 citation statements)

References 21 publications

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“…The authors contend this null result could reflect the challenges of implementing a complex, resource-intensive intervention in the nursing home setting, something noted in pre-trial studies where drop-out of nursing homes was a concern 31. A subsequent per-protocol analysis found that nursing homes able to implement the intervention saw reductions in hospitalisations, but only a minority were able to do so 32. Enlisting external support to assist nursing homes with quality improvement—such as that funded by the Centers for Medicare and Medicaid Services through the Quality Improvement Organizations (QIO) programme—may be helpful, though evaluation of the effect of QIOs remains surprisingly limited 33 34…”

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confidence: 99%

Quality measurement and nursing homes: measuring what matters

Burke

Werner

2019

BMJ Qual Saf

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confidence: 99%

Quality measurement and nursing homes: measuring what matters

Burke

Werner

2019

BMJ Qual Saf

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“…Only 73 (50%) of the 145 intervention patients discharged to SNF, ALF, or home with home health went to one of the participating organizations, and their use of INTERACT was variable. In one study, increasing use of core INTERACT tools was associated with lower rates for potentially avoidable hospitalizations, although this result could also reflect facilities' motivation to reduce hospitalizations as opposed to INTERACT use itself …”

Section: Discussionmentioning

confidence: 99%

“…First, it targeted patients aged 75 years and older who were at high risk for readmission and other complications of hospitalization because focusing resources on high‐risk patients enhances the potential for cost‐effectiveness. Second, it included multiple components of previously tested interventions to address the multifactorial nature of hospital readmissions in the older adult population, and it incorporated elements of programs that have demonstrated some success in older populations, including the Care Transitions Intervention, the Transitional Care Model, and Interventions to Reduce Acute Care Transfers …”

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confidence: 99%

Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults

Huckfeldt

Reyes

Engström

et al. 2019

J American Geriatrics Society

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OBJECTIVES To test the effectiveness of a multicomponent care transition intervention targeted at hospitalized patients, aged 75 years and older, at high risk for hospital readmissions, return emergency department (ED) visits, and related complications. DESIGN Implementation as a quality improvement program with propensity‐matched preintervention and concurrent comparison groups over a 12‐month period. SETTING A 400‐bed community teaching hospital. PARTICIPANTS Patients, aged 75 years and older, admitted to non–intensive care unit beds who met specific high‐risk criteria. The intervention group included 202 patients, and the concurrent and preintervention comparison groups included 4142 and 4592 patients, respectively. MEASUREMENTS Primary outcomes were 30‐day hospital readmissions and returns to the ED; 7‐day readmissions and ED visits were secondary measures. RESULTS Among the 202 patients enrolled in the “Safe Transitions for At‐Risk Patients” (“STAR”) program, 37 (18.3%) were readmitted within 30 days, in contrast to 14.3% and 14.6% in the concurrent and preintervention comparison groups, respectively. Rates for 30‐day return ED visits that did not result in hospitalization were 10.9% in the intervention group, and 7.2% and 7.9% in the comparison groups. STAR patients had greater 30‐day ED use than patients in the preintervention comparison group (5.0 percentage points; 95% confidence interval = 0.8‐9.3 percentage points; P = .020). Implementation challenges included suboptimal involvement of the participating hospital and post–acute care organizations and a relatively high proportion of patients who did not receive the intervention as planned, despite agreeing to participate before leaving the hospital. CONCLUSION A multicomponent care transitions intervention targeting high‐risk patients, aged 75 years and older, admitted to a community teaching hospital was not effective in reducing 30‐ or 7‐day readmissions or return ED visits. Our implementation experience offers many lessons for future programs for similar high‐risk geriatric populations. J Am Geriatr Soc 67:2634–2642, 2019

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“…This is a secondary analysis of data from a randomized, controlled implementation trial of the Interventions to Reduce Acute Care Transfers (INTERACT) program. The main results of the trial and root cause analyses on transfers to the hospital have been reported . The Florida Atlantic University institutional review board approved the trial as a quality improvement project.…”

Section: Methodsmentioning

confidence: 99%

“…The main results of the trial and root cause analyses on transfers to the hospital have been reported. [10][11][12]31,32 The Florida Atlantic University institutional review board approved the trial as a quality improvement project. Six hundred thirteen SNFs recruited in collaboration with national organizations expressed interest in participation, 391 were screened for eligibility in online surveys and telephone interviews, and 264 eligible SNFs were randomly assigned to 1 intervention and 2 control groups.…”

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Management of Acute Changes in Condition in Skilled Nursing Facilities

Ouslander

Engström

Reyes

et al. 2018

J American Geriatrics Society

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OBJECTIVES To describe the presentation and management of acute changes in condition in skilled nursing facilities (SNFs) during implementation of a program designed to reduce unnecessary emergency department visits and hospitalizations. DESIGN Secondary analysis of data from a randomized controlled trial involving 264 SNFs. PARTICIPANTS One hundred thirty‐three of the 264 participating SNFs that provided data on acute changes in condition: 55 in the intervention group, 78 in the control group. INTERVENTIONS During a 12‐month period, intervention SNFs received training and support for implementation of the Interventions to Reduce Acute Care Transfers program. Control SNFs were offered training and implementation support after the end of the 12‐month trial. MEASURES Project champions used a structured online tool to describe acute changes in condition that did not result in a hospital transfer within 72 hours of the change. RESULTS Most of the 7,689 episodes of acute change in condition reported involved multiple changes that were not disease specific. Ten percent resulted in hospital transfer between 72 hours and 7 days after the change. Five acute changes had odds ratios for transfer greater than 2 (mental status change, abnormal vital signs, bleeding, shortness of breath, and unresponsiveness). Most transfers were for reasons other than the initial change in condition. CONCLUSIONS A wide variety of acute changes in condition can be managed in SNFs without hospital transfer. Most of these changes are nonspecific and multiple, and when they are associated with hospital transfer, the reasons for the transfer are most often different from the initial acute change in condition. These data highlight the multifactorial nature of acute changes in condition in the SNF population and suggest that disease‐specific protocols and assessment tools may not be the most appropriate approach to managing acute changes in condition in the SNF setting. J Am Geriatr Soc 66:2259–2266, 2018.

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Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations

Cited by 43 publications

References 21 publications

Quality measurement and nursing homes: measuring what matters

Quality measurement and nursing homes: measuring what matters

Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults

Management of Acute Changes in Condition in Skilled Nursing Facilities

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