Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative

Rantz, Marilyn; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Crecelius, Charles; Ge, Bin; Petroski, Gregory F.

doi:10.1016/j.jamda.2017.05.027

Cited by 82 publications

(121 citation statements)

References 24 publications

Supporting

Mentioning

115

Contrasting

Unclassified

Order By: Relevance

“…The absence of a relationship between directed exchange and readmissions in this study was unexpected. Prior studies based on strong research designs have identified specific directed exchange tools as a beneficial intervention to reduce readmissions in select populations . This discrepancy with previous research may be attributable to our study's focus on unplanned readmissions, ACSHs, and nonemergent ED visits.…”

Section: Discussioncontrasting

confidence: 71%

See 1 more Smart Citation

The associations between query‐based and directed health information exchange with potentially avoidable use of health care services

Vest

Unruh

Shapiro

et al. 2019

Health Services Research

View full text Add to dashboard Cite

Objective To quantify the impact of two approaches (directed and query‐based) to health information exchange (HIE) on potentially avoidable use of health care services. Data Sources/Study Setting Data on ambulatory care providers’ adoption of HIE were merged with Medicare fee‐for‐service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO). Study Design Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query‐based HIE compared with beneficiaries attributed to providers who had not adopted HIE. Data Collection Providers’ HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers. Principal Findings Query‐based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome. Conclusions The Centers for Medicare & Medicaid Services’ (CMS) EHR certification criteria includes requirements for directed HIE, but not query‐based HIE. Pending further research, certification criteria should place equal weight on facilitating query‐based and directed exchange.

show abstract

Section: Discussioncontrasting

confidence: 71%

“…A standard use case for directed exchange is support for care transitions . Overall, directed exchange has been associated with reductions in avoidable utilization and higher quality of care in high‐risk ambulatory care and long‐term care populations …”

Section: Introductionmentioning

confidence: 99%

The associations between query‐based and directed health information exchange with potentially avoidable use of health care services

Vest

Unruh

Shapiro

et al. 2019

Health Services Research

View full text Add to dashboard Cite

show abstract

“…All of these sites used components of the INTERACT program and provided on‐site training and implementation support using advanced practice nurses and nurse practitioners. One site that used nurse practitioners to support INTERACT implementation achieved a 30% reduction in all‐cause hospitalizations . Telemedicine is another strategy that can enhance the ability to implement quality improvement and clinical programs in SNFs, providing in‐person assessment and recommendations through live interactions with staff, residents, and families .…”

Section: Discussionmentioning

confidence: 99%

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

Huckfeldt

Kane

Yang

et al. 2018

J American Geriatrics Society

View full text Add to dashboard Cite

Increased reported use of core INTERACT tools was associated with significantly greater reductions in all-cause hospitalizations and PAHs in both intervention and control SNFs, suggesting that motivation and incentives to reduce hospitalizations were more important than the training and support provided in the trial in improving outcomes. Further research is needed to better understand the most effective strategies to motivate SNFs to implement and sustain quality improvement programs such as INTERACT.

show abstract

“…The Centers for Medicare and Medicaid Services (CMS) has defined diagnoses for which they consider hospital transfers from SNFs potentially avoidable . Several types of interventions hold promise for reducing potentially avoidable hospitalizations for changes in condition related to these diagnoses …”

mentioning

confidence: 99%

“…We therefore believe these data will be helpful to health professionals in SNFs in their efforts to improve care by identifying the most common acute changes in condition that were managed without hospital transfer and addressing them with educational and quality improvement activities. Understanding the nature of acute changes in condition that can be successfully managed without hospital transfer may also be helpful in developing clinical criteria and quality measures for programs such as those that CMS is testing to reduce hospitalizations of long‐stay SNF residents …”

mentioning

confidence: 99%

Management of Acute Changes in Condition in Skilled Nursing Facilities

Ouslander

Engström

Reyes

et al. 2018

J American Geriatrics Society

View full text Add to dashboard Cite

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.

show abstract

Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative

Cited by 82 publications

References 24 publications

The associations between query‐based and directed health information exchange with potentially avoidable use of health care services

The associations between query‐based and directed health information exchange with potentially avoidable use of health care services

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

Management of Acute Changes in Condition in Skilled Nursing Facilities

Contact Info

Product

Resources

About