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Original Investigation
September 2017

Effects of an Intervention to Reduce Hospitalizations From Nursing HomesA Randomized Implementation Trial of the INTERACT Program

Author Affiliations
  • 1University of Minnesota School of Public Health, Minneapolis
  • 2Florida Atlantic University, Christine E. Lynn College of Nursing, Boca Raton
  • 3Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton
JAMA Intern Med. 2017;177(9):1257-1264. doi:10.1001/jamainternmed.2017.2657
Key Points

Question  Did training and support for implementation of a nursing home (NH) quality improvement program (Interventions to Reduce Acute Care Transfers [INTERACT]) reduce hospitalizations and emergency department (ED) visits?

Findings  Among 85 NHs with no prior use of INTERACT, we compared preintervention and postintervention changes in hospitalization and ED visit rates for NHs randomly assigned to receive training and implementation support on INTERACT to changes in control NHs. We found no statistically significant effect on hospitalizations per 1000 NH residents.

Meaning  Training and support for INTERACT implementation as carried out in this study had no effect on hospitalization or ED visit rates in participating NHs.

Abstract

Importance  Medicare payment initiatives are spurring efforts to reduce potentially avoidable hospitalizations.

Objective  To determine whether training and support for implementation of a nursing home (NH) quality improvement program (Interventions to Reduce Acute Care Transfers [INTERACT]) reduced hospital admissions and emergency department (ED) visits.

Design, Setting, and Participants  This analysis compared changes in hospitalization and ED visit rates between the preintervention and postintervention periods for NHs randomly assigned to receive training and implementation support on INTERACT to changes in control NHs. The analysis focused on 85 NHs (36 717 NH residents) that reported no use of INTERACT during the preintervention period.

Interventions  The study team provided training and support for implementing INTERACT, which included tools that help NH staff identify and evaluate acute changes in NH resident condition and document communication between physicians; care paths to avoid hospitalization when safe and feasible; and advance care planning and quality improvement tools.

Main Outcomes and Measures  All-cause hospitalizations, hospitalizations considered potentially avoidable, 30-day hospital readmissions, and ED visits without admission. All-cause hospitalization rates were calculated for all resident-days, high-risk days (0-30 days after NH admission), and lower-risk days (≥31 days after NH admission).

Results  We found that of 85 NHs, those that received implementation training and support exhibited statistically nonsignificant reductions in hospitalization rates compared with control NHs (net difference, −0.13 per 1000 resident-days; P = .25), hospitalizations during the first 30 days after NH admission (net difference, −0.37 per 1000 resident-days; P = .48), hospitalizations during periods more than 30 days after NH admission (net difference, −0.09 per 1000 resident-days; P = .39), 30-day readmission rates (net change in rate among hospital discharges, −0.01; P = .36), and ED visits without admission (net difference, 0.02 per 1000 resident-days; P = .83). Intervention NHs exhibited a reduction in potentially avoidable hospitalizations overall (net difference, −0.18 per 1000 resident-days, P = .01); however, this effect was not robust to a Bonferroni correction for multiple comparisons.

Conclusions and Relevance  Training and support for INTERACT implementation as carried out in this study had no effect on hospitalization or ED visit rates in the overall population of residents in participating NHs. The results have several important implications for implementing quality improvement initiatives in NHs.

Trial Registration  clinicaltrials.gov Identifier: NCT02177058

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