Volume 59, Issue 4 p. 745-753

Interventions to Reduce Hospitalizations from Nursing Homes: Evaluation of the INTERACT II Collaborative Quality Improvement Project

Joseph G. Ouslander MD

Joseph G. Ouslander MD

From the * Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; Geriatrics Institute, Miller School of Medicine, University of Miami, Miami, Florida; Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida; § College of Nursing and Healthcare Innovation, Arizona State University, Tucson, Arizona; Massachusetts Senior Care Foundation, Boston, Massachusetts; # Geriatric Research, Education, and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida; ** Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida; †† Harvard Medical School, Boston, Massachusetts; and ‡‡ Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts.

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Gerri Lamb PhD, RN, FAAN

Gerri Lamb PhD, RN, FAAN

From the * Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; Geriatrics Institute, Miller School of Medicine, University of Miami, Miami, Florida; Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida; § College of Nursing and Healthcare Innovation, Arizona State University, Tucson, Arizona; Massachusetts Senior Care Foundation, Boston, Massachusetts; # Geriatric Research, Education, and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida; ** Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida; †† Harvard Medical School, Boston, Massachusetts; and ‡‡ Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts.

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Ruth Tappen EdD, FAAN

Ruth Tappen EdD, FAAN

From the * Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; Geriatrics Institute, Miller School of Medicine, University of Miami, Miami, Florida; Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida; § College of Nursing and Healthcare Innovation, Arizona State University, Tucson, Arizona; Massachusetts Senior Care Foundation, Boston, Massachusetts; # Geriatric Research, Education, and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida; ** Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida; †† Harvard Medical School, Boston, Massachusetts; and ‡‡ Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts.

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Laurie Herndon MSN, GNP

Laurie Herndon MSN, GNP

From the * Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; Geriatrics Institute, Miller School of Medicine, University of Miami, Miami, Florida; Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida; § College of Nursing and Healthcare Innovation, Arizona State University, Tucson, Arizona; Massachusetts Senior Care Foundation, Boston, Massachusetts; # Geriatric Research, Education, and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida; ** Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida; †† Harvard Medical School, Boston, Massachusetts; and ‡‡ Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts.

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Sanya Diaz MD

Sanya Diaz MD

From the * Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; Geriatrics Institute, Miller School of Medicine, University of Miami, Miami, Florida; Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida; § College of Nursing and Healthcare Innovation, Arizona State University, Tucson, Arizona; Massachusetts Senior Care Foundation, Boston, Massachusetts; # Geriatric Research, Education, and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida; ** Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida; †† Harvard Medical School, Boston, Massachusetts; and ‡‡ Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts.

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Bernard A. Roos MD

Bernard A. Roos MD

From the * Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; Geriatrics Institute, Miller School of Medicine, University of Miami, Miami, Florida; Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida; § College of Nursing and Healthcare Innovation, Arizona State University, Tucson, Arizona; Massachusetts Senior Care Foundation, Boston, Massachusetts; # Geriatric Research, Education, and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida; ** Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida; †† Harvard Medical School, Boston, Massachusetts; and ‡‡ Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts.

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David C. Grabowski PhD

David C. Grabowski PhD

From the * Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; Geriatrics Institute, Miller School of Medicine, University of Miami, Miami, Florida; Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida; § College of Nursing and Healthcare Innovation, Arizona State University, Tucson, Arizona; Massachusetts Senior Care Foundation, Boston, Massachusetts; # Geriatric Research, Education, and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida; ** Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida; †† Harvard Medical School, Boston, Massachusetts; and ‡‡ Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts.

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Alice Bonner PhD, RN

Alice Bonner PhD, RN

From the * Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; Geriatrics Institute, Miller School of Medicine, University of Miami, Miami, Florida; Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida; § College of Nursing and Healthcare Innovation, Arizona State University, Tucson, Arizona; Massachusetts Senior Care Foundation, Boston, Massachusetts; # Geriatric Research, Education, and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida; ** Stein Gerontological Institute, Miami Jewish Health Systems, Miami, Florida; †† Harvard Medical School, Boston, Massachusetts; and ‡‡ Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts.

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First published: 15 March 2011
Citations: 260
Address correspondence to Joseph G. Ouslander, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd., Bldg. 71, Boca Raton, FL 33431-0991. E-mail: [email protected]

Abstract

A substantial proportion of hospitalizations of nursing home (NH) residents may be avoidable. Medicare payment reforms, such as bundled payments for episodes of care and value-based purchasing, will change incentives that favor hospitalization but could result in care quality problems if NHs lack the resources and training to identify and manage acute conditions proactively. Interventions to Reduce Acute Care Transfers (INTERACT) II is a quality improvement intervention that includes a set of tools and strategies designed to assist NH staff in early identification, assessment, communication, and documentation about changes in resident status. INTERACT II was evaluated in 25 NHs in three states in a 6-month quality improvement initiative that provided tools, on-site education, and teleconferences every 2 weeks facilitated by an experienced nurse practitioner. There was a 17% reduction in self-reported hospital admissions in these 25 NHs from the same 6-month period in the previous year. The group of 17 NHs rated as engaged in the initiative had a 24% reduction, compared with 6% in the group of eight NHs rated as not engaged and 3% in a comparison group of 11 NHs. The average cost of the 6-month implementation was $7,700 per NH. The projected savings to Medicare in a 100-bed NH were approximately $125,000 per year. Despite challenges in implementation and caveats about the accuracy of self-reported hospitalization rates and the characteristics of the participating NHs, the trends in these results suggest that INTERACT II should be further evaluated in randomized controlled trials to determine its effect on avoidable hospitalizations and their related morbidity and cost.