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AMDA Long Term Care Medicine - 2014


222 - Reducing Avoidable Hospitalizations of Nursing Home Residents: Evaluating the Impact of INTERACT and Related Approaches in One State


Feb 28, 2014 4:00pm ‐ Feb 28, 2014 5:00pm

Standard: $24.00

Description

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 1.0 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
Avoidable hospitalizations among nursing home (NH) residents result in unnecessary costs, and disruption of resident routines. This session will present results from a study of 39 NHs that carried out projects to reduce avoidable hospitalizations. The projects were supported by the Minnesota Performance-based Incentive Payment Program (PIPP), a statewide program that incentivizes NHs to develop and implement grass-roots quality improvement efforts. Facilities followed the basic principles of the INTERACT program, however, they tailored the INTERACT tools or developed their own tools to fit their local care setting. These projects were studied using hospitalization rate analyses, surveys, and case study interviews with nursing facility staff and medical directors. Results showed that NHs had a significant reduction in their resident hospitalization rates, particularly re-hospitalizations within 30 days of nursing home admission. The session will provide an overview of our results including staff perceptions about facilitators and barriers to project success. Moreover, staff members’ impressions of roles physicians or medical directors play in supporting quality improvement will be discussed. Results of medical director interviews regarding their own role in these quality improvement programs also will be presented. The audience will be able to learn new strategies for successfully implementing INTERACT and similar programs in their own environments.

Learning Objective(s):

  • Describe the components of the Minnesota Performance-Based Incentive Payments Program (PIPP).
  • Recognize the perceived barriers and facilitators to INTERACT implementation by facility staff.
  • Recognize the role Medical Directors in INTERACT implementation in PIPP facilities.
  • Draw conclusions about the impact of INTERACT program on hospitalizations in PIPP facilities.

Speaker(s):
Kathleen Abrahamson, PhD, RN; Greg Arling, PhD; Arif Nazir, MD, CMD

Disclosure(s):
None

Reference(s):
Chan TC, Hung IF, Cheng VC, Luk JK, Chu LW, Chan FH. Is Nursing Home Residence an Independent Predictor of Recurrent Hospitalization in Older Adults? J Am Med Dir Assoc. 2013. Epub 2013/06/19.Rau J. Medicare To Penalize 2,211 Hospitals For Excess Readmissions Kaiser Health News [Internet]. 2012 October 2, 2012.Chen J, Ross JS, Carlson MD, Lin Z, Normand SL, Bernheim SM, et al. Skilled nursing facility referral and hospital readmission rates after heart failure or myocardial infarction. Am J Med. 2012;125(1):100Garcia-Perez L, Linertova R, Lorenzo-Riera A, Vazquez-Diaz JR, Duque-Gonzalez B, Sarria-Santamera A. Risk factors for hospital readmissions in elderly patients: a systematic review. QJM : monthly journal of the Association of Physicians. 2011;104(8):639-51. Epub 2011/05/12.Ouslander JG, Berenson RA. Reducing unnecessary hospitalizations of nursing home residents. N Engl J Med. 2011;365(13):1165-7. Epub 2011/10/14Ouslander JG, Lamb G, Tappen R, Herndon L, Diaz S, Roos BA, et al. Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project. J Am Geriatr Soc. 2011;59(4):745-53. Epub 2011/03/18.O'Malley AJ, Caudry DJ, Grabowski DC. Predictors of nursing home residents' time to hospitalization. Health Serv Res. 2011;46(1 Pt 1):82-104. Epub 2010/09/21.Cummings SM. Adequacy of discharge plans and rehospitalization among hospitalized dementia patients. Health & social work. 1999;24(4):249-59. Epub 1999/12/22Fried TR, Mor V. Frailty and hospitalization of long-term stay nursing home residents. J Am Geriatr Soc. 1997;45(3):265-9. Epub 1997/03/01Shipton S. Risk factors associated with multiple hospital readmissions. Home care provider. 1996;1(2):83-5.

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