Increased Focus on Nursing Home Hospitalizations
Study Overview
Recent attention from policymakers has turned to emergency admissions and hospitalizations among nursing home residents. A study was conducted to evaluate the hospitalization rates in nursing homes following the implementation of the INTERACT program.
INTERACT Program Goals
The INTERACT program, which stands for Interventions to Reduce Acute Care Transfers, aims to enhance the availability and quality of care within nursing homes. Its primary objective is to decrease hospital admissions through improved implementation, evaluation, and management of three core principles designed to prevent unnecessary hospitalizations.
Core Principles of INTERACT
The first principle focuses on recognizing and managing acute conditions early, preventing their progression to a stage that necessitates hospitalization. The second principle emphasizes enhancing communication channels, improving documentation, and providing tools that support safe and efficient decision-making without relying on hospitalization. Lastly, the program advocates for advanced care planning, including hospice and palliative care, to facilitate discussions about care goals. This approach ultimately seeks to meet the needs of patients with end-stage diseases, allowing them to receive medical care in the comfort of their homes.
Study Inclusion Criteria
The study, published in JAMA Internal Medicine, established specific criteria for nursing homes to participate. Eligible nursing homes needed to demonstrate the capacity to manage acute conditions on-site and possess the technology required for documenting and transmitting patient data. Furthermore, they should not have received prior training in the INTERACT program to avoid biases in the results. The nursing homes were also required to have a qualified medical professional, medical services, laboratory testing capabilities, and pharmacy services. Nursing homes engaged in other programs aimed at reducing hospitalizations were excluded from the study. Emergency visits were identified through outpatient claims files and evaluation data from Medicare services.
Study Findings
The findings indicated that nursing homes implementing INTERACT did not experience a significant reduction in overall hospital admissions when compared to control nursing homes. Additionally, the INTERACT program did not lead to a decrease in emergency department visits. These results contrast with those from the pilot study and suggest that motivation may have played a critical role. In the pilot study, nursing homes volunteered to participate, while the full study involved randomly assigned participants.
Comparison with Other Programs
Other initiatives, such as the Hospital Readmissions Reduction program, which share similar goals with INTERACT, demonstrated more promising outcomes and were initiated prior to the INTERACT program’s implementation. The study also revealed that participating nursing homes did not fully capitalize on their training, attending only 60-70% of the available modules. Researchers identified additional challenges, including staff resistance, competing demands, and unstable leadership within the nursing homes.
Implications for Future Research
This research highlights several considerations for hospitals and policymakers when introducing new programs. A lack of understanding regarding nursing home management, staff schedules, and responsibilities, along with difficulties in integrating program content with staff routines, hindered the program’s progress. Addressing these issues could significantly influence the outcomes of future studies. Furthermore, providing more tailored training may enhance staff engagement and participation.
Author Information
Written by Dr. Apollina Sharma, MBBS, GradDip EXMD. Reference: Kane, Robert L., et al. “Effects of an Intervention to Reduce Hospitalizations from Nursing Homes: A Randomized Implementation Trial of the INTERACT Program.” JAMA Internal Medicine (2017).