Strategies to Reduce Avoidable Hospitalization Among the Elderly
Orlando, FL—Nursing home residents often experience avoidable inpatient hospitalizations. These events are expensive, disruptive, and disorienting for frail elderly individuals and people with disabilities, according to the Centers for Medicare & Medicaid Services. Evidence-based interventions that improve care and costs are needed. During a session at NAMCP, Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD, chief medical officer, The Access Group, discussed the importance of reducing avoidable hospitalizations and outlined 3 programs to help combat this trend.
INTERACT (Intervention to Reduce Acute Transfers) is designed to improve the care of nursing home residents by identifying situations that commonly result in transfers to the hospital—and working together to manage them effectively and safely without transfer whenever possible. The program is 1 of several evidence-based care transition interventions, explained Dr Stefanacci, who is also on the faculty at Thomas Jefferson University, Jefferson School of Population Health. INTERACT provides clinical practice tools, communication strategies, and documentation standards that enhance the nursing home’s ability to identify, evaluate, and manage conditions before they become serious enough to necessitate hospital transfer. It also addresses advanced care planning [N Engl J Med. 2011;365(13):1165-1167].
He said that INTERACT can help a nursing home facility safely reduce hospital transfers by:
• Preventing conditions from becoming severe by identifying and assessing changes in resident condition early
• Managing conditions in the nursing home without transfer when feasible
• Improving advance care planning and using palliative care plans
Dr Stefanacci highlighted a study from the INTERACT II quality improvement project [J Am Geriatr Soc. 2011;59(4):745-753]. It was evaluated in 25 nursing homes in 3 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. This 6-month project resulted in 17% reduction in self-reported hospital admissions. The projected savings to Medicare in a 100-bed nursing home was ~$125,000.
The Program for All-Inclusive Care (PACE) is another program that allows older adults to stay in their homes and communities. PACE was authorized as a permanent Medicare provider in 1997. Currently, there are 114 programs in 32 states. PACE employs interdisciplinary teams to deliver and coordinate care. The program bundles Medicare and Medicaid payments to provide a full range of health care services.
Dr Stefanacci reviewed the 6 PACE areas of focus most effective in reducing avoidable emergency department visits/hospitalizations: (1) management of red flags; (2) end-of-life management; (3) caregiver support; (4) care coordina- tion; (5) medication management, and (6) participant and caregiver health care system literacy.
The final program he discussed was a partnership with hospital emergency rooms (ERs) to provide rapid assessment and initial treatment to transfer patients back to a skilled nursing facility (SNF) with a care plan. In addition to establishing a proactive process, it requires a continuous quality improvement process between the ER and SNF to access performance. The program also assesses impact on hospitalization rate.
Reducing avoidable hospitalizations of nursing home residents represents an opportunity to decrease emotional trauma to the resident and family, decrease complications of hospitalization, and reduce overall health care costs, Dr Stefanacci said.—Eileen Koutnik-Fotopoulos
