Nursing Facilities Can Reduce Avoidable Hospitalizations Without Increasing Mortality Risk For Residents

Feng, Zhanlian; Ingber, Melvin J.; Segelman, Micah; Zheng, Nan; Wang, Joyce M.; Vadnais, Alison; Coomer, Nicole; Khatutsky, Galina

doi:10.1377/hlthaff.2018.0379

Cited by 10 publications

(15 citation statements)

References 12 publications

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“…Prior research has examined hospitalizations for potentially preventable conditions among older adults with dementia transferred from nursing facilities. 18,30 The modest decline in transfers from nursing homes to hospitals observed in the current study is consistent with this prior research and may reflect the targeting of nursing home transfers to hospitals by both CMS policy initiatives 16,17 and quality improvement programs. 31 Although promising, these findings must be interpreted with the context that most older adults with dementia reside in the community, supported by family caregivers.…”

Section: Discussionsupporting

confidence: 87%

“…We next examined national trends in all‐cause hospitalizations and hospitalizations for potentially preventable conditions, overall and by admission source. Multiple recent national health policy interventions have sought to reduce hospital transfers from nursing homes for ACSCs 16‐18 . Thus we hypothesized that across the same conditions, admissions from non‐acute care facilities would decline more than admissions from the community.…”

Section: Methodsmentioning

confidence: 99%

“…15,23 To address this gap, the present study uses nationally representative hospital discharge data from 2012 to 2016 to examine national trends in all-cause and potentially preventable hospitalizations of older adults with diagnosed dementia. Given recent evidence documenting a decline in hospital transfers among nursing home residents, [16][17][18] we further examined hospitalization trends by older adults' residence before hospitalization.…”

mentioning

confidence: 99%

“…Injury prevention efforts have been led by the Centers for Disease Control and Prevention through programs such as Stopping Elderly Accidents, Deaths, and Injuries (STEADI) introduced in 2013 14 . As part of the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) launched several health policy initiatives targeted at reducing preventable hospitalizations including the Hospital Readmissions Reduction Program 15 and Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents 16‐18 . However, despite the unique challenges in communication and care coordination faced by older adults with dementia, no national policy or programmatic initiatives have focused specifically on reducing preventable hospitalizations in this population, most of whom reside at home.…”

mentioning

confidence: 99%

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National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia

Anderson

Marcantonio

McCarthy

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES: Dementia is associated with higher healthcare expenditures, in large part due to increased hospitalization rates relative to patients without dementia. Data on contemporary trends in the incidence and outcomes of potentially preventable hospitalizations of patients with dementia are lacking. DESIGN: Retrospective cohort study using the National Inpatient Sample from 2012 to 2016. SETTING: U.S. acute care hospitals. PARTICIPANTS: A total of 1,843,632 unique hospitalizations of older adults (aged ≥65 years) with diagnosed dementia. MEASUREMENTS: Annual trends in the incidence of hospitalizations for all causes and for potentially preventable conditions including acute ambulatory care sensitive conditions (ACSCs), chronic ACSCs, and injuries. In-hospital outcomes including mortality, discharge disposition, and hospital costs. RESULTS: The survey weighted sample represented an estimated 9.27 million hospitalizations for patients with diagnosed dementia (mean [standard deviation] age = 82.6 [6.7] years; 61.4% female). In total, 3.72 million hospitalizations were for potentially preventable conditions (40.1%), 2.07 million for acute ACSCs, .76 million for chronic ACSCs, and .89 million for injuries. Between 2012 and 2016, the incidence of all-cause hospitalizations declined from 1.87 million to 1.85 million per year (P = .04) while the incidence of potentially preventable hospitalizations increased from .75 million to .87 million per year (P < .001), driven by an increased number of hospitalizations of community-dwelling older adults. Among patients with dementia hospitalized for potentially preventable conditions, inpatient mortality declined from 6.4% to 6.1%

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Section: Discussionsupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia

Anderson

Marcantonio

McCarthy

et al. 2020

J American Geriatrics Society

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“…In an external evaluation of Phase I (2012-2016), OPTIMISTIC was found to significantly reduce both potentially avoidable hospitalizations and all-cause hospitalizations with no negative effects on quality 18 or mortality. 19 The role of the clinical staff in OPTIMISTIC has continued in a Phase II of the demonstration project (2016-3 2020), which has added novel Medicare billing codes to the clinical model to increase motivation and ability to care for acutely ill residents in place by allowing facilities to bill an additional amount when caring for residents with specific clinical issues (e.g., urinary tract infections). 15,17 There are a total of 40 facilities in Phase II of the project; the full clinical model, including PCRN support, is available in 17 facilities in central Indiana.…”

Section: Optimistic (Optimizing Patient Transfers Impacting Medical mentioning

confidence: 99%

The Role of the Palliative Care Registered Nurse in the Nursing Facility Setting

Hickman

Parks

Unroe

et al. 2020

J Hosp Palliat Nurs

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There is a growing recognition of significant, unmet palliative care needs in nursing facilities, yet limitations in the workforce limit access to palliative care services. Attention to palliation is particularly important when there are efforts to reduce hospitalizations to help ensure there are no unintended harms associated with treating residents in place. A specialized palliative care Registered Nurse (PCRN) role was developed as part of the OPTIMISTIC program, a federally funded project to reduce potentially avoidable hospitalizations. Working in collaboration with existing clinical staff and medical providers, the PCRN focuses on managing symptoms, advance care planning, achieving goal concordant care, and promoting quality of life. The PCRN serves as a resource for families through education and support. The PCRN also provides education and mentorship to staff to increase their comfort, knowledge, and skills with end-of life care. The goal of this article is to provide an overview of the PCRN role and its implementation in nursing facilities, and describe core functions that are transferrable to other contexts.

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Hospital Transfer Rates Among US Nursing Home Residents With Advanced Illness Before and After Initiatives to Reduce Hospitalizations

Loomer

et al. 2020

JAMA Intern Med

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Hospital transfers among nursing home residents in the United States who have been diagnosed with advanced illnesses and have limited life expectancy are often burdensome, costly, and of little clinical benefit. National initiatives, introduced since 2012, have focused on reducing such hospitalizations, but little is known about the consequences of these initiatives in this population.OBJECTIVE To investigate the change in hospital transfer rates among nursing home residents with advanced illnesses, such as dementia, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD), from 2011 to 2017-before and after the introduction of national initiatives to reduce hospitalizations. DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, nationwide Minimum Data Set (MDS) assessments from January 1, 2011, to December 31, 2016 (with the follow-up for transfer rates until December 31, 2017), were used to identify annual inception cohorts of long-stay (>100 days) nursing home residents who had recently progressed to the advanced stages of dementia, CHF, or COPD. The data were analyzed from October 24, 2018, to October 3, 2019. MAIN OUTCOMES AND MEASURESThe number of hospital transfers (hospitalizations, observation stays, and emergency department visits) per person-year alive was calculated from the MDS assessment from the date when residents first met the criteria for advanced illness up to 12 months afterward using Medicare claims from 2011 to 2017. Transfer rates for all causes, potentially avoidable conditions (sepsis, pneumonia, dehydration, urinary tract infections, CHF, and COPD), and serious bone fractures (pelvis, hip, wrist, ankle, and long bones of arms or legs) were investigated. Hospice enrollment and mortality were also ascertained. RESULTSThe proportions of residents in the 2011 and 2016 cohorts who underwent any hospital transfer were 56.1% and 45.4% of those with advanced dementia, 77.6% and 69.5% of those with CHF, and 76.2% and 67.2% of those with COPD. The mean (SD) number of transfers per person-year alive for potentially avoidable conditions was higher in the 2011 cohort vs 2016 cohort: advanced dementia, 2.4 (14.0) vs 1.6 (11.2) (adjusted risk ratio [aRR], 0.73; 95% CI, 0.65-0.81); CHF, 8.5 (32.0) vs 6.7 (26.8) (aRR, 0.72; 95% CI, 0.65-0.81); and COPD, 7.8 (30.9) vs 5.5 (24.8) (aRR, 0.64; 95% CI, 0.57-0.72). Transfers for bone fractures remained unchanged, and mortality did not increase. Hospice enrollment was low across all illness groups and years (range, 23%-30%). CONCLUSIONS AND RELEVANCEThe findings of this study suggest that concurrent with new initiatives aimed at reducing hospitalizations, hospital transfers declined between 2011 and 2017 among nursing home residents with advanced illnesses without increased mortality rates. Opportunities remain to further reduce unnecessary hospital transfers in this population and improve goal-directed care for those residents who opt to forgo hospitalization.

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Nursing Facilities Can Reduce Avoidable Hospitalizations Without Increasing Mortality Risk For Residents

Cited by 10 publications

References 12 publications

National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia

National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia

The Role of the Palliative Care Registered Nurse in the Nursing Facility Setting

Hospital Transfer Rates Among US Nursing Home Residents With Advanced Illness Before and After Initiatives to Reduce Hospitalizations

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