Implementing Interventions to Reduce Hospitalizations of Nursing Home Residents

描述（由申请人提供）：该提案直接解决了国家迫切需要的创新战略，以改善医疗保险受益人的护理和降低医疗保健成本。拟议项目的总体目标是改善居住在养老院（NH）的老年人的护理，同时减少不必要的医疗保险支出。这一目标将通过测试一个质量改进计划来实现，该计划旨在减少NH居民在随机对照试验中可避免的住院次数。 NH居民的住院治疗是频繁的，并与许多并发症和增加的医疗保健费用。先前的研究表明，多达三分之二的此类住院可能是可以避免的。医疗保险报销的预期变化将减少有利于住院的经济激励，但如果NH工作人员没有培训和临床工具来管理NH的居民，当发生急性变化时，可能会导致护理质量下降。INTERACT（减少急性护理转移的干预措施）是一项质量改进计划，利用基于既定临床指南的工具。这些工具针对三个关键战略，以减少可能可避免的住院： 1)防止病情变得严重到需要急性住院治疗; 2）管理NH中选定的急性病情;以及3）改善居民的预先护理计划，其中姑息或舒适护理计划，而不是急性住院治疗，可能是合适的。涉及30个国家卫生机构的初步研究表明，与去年同期相比，住院人数减少了17%。干预的成本为7,700美元;预计从100张病床的NH减少住院的医疗保险节省125,000美元/年。虽然这些结果是有希望的，但INTERACT在减少住院治疗方面的有效性仍有待于对照试验的检验。因此，拟议的项目将涉及经验丰富的NH研究人员的跨学科团队进行随机对照试验，以测试INTERACT计划的实施。被随机分配到INTERACT实施组的NH将参加3个月的培训，然后是12个月的实施期，在此期间，他们将通过定期电话会议和根据需要的电话或电子邮件通信获得经验丰富的执业护士的支持。实施INTERACT计划对住院率的影响将与随机分配的常规护理对照组和仅自我监测住院率的组进行比较。待检验的假设为：1）与12个月基线期相比，在12个月实施期内，实施INTERACT的NHS的住院率将比对照和仅监测的NHS有更大的降低; 2）INTERACT NHS住院医疗保险支出的降低将超过实施该计划的估计成本。 公共卫生相关性：改善医疗保险受益人的护理，同时降低医疗保健成本的战略对我们国家的健康和为后代保留医疗保险至关重要。拟议的项目旨在通过测试一项创新的质量改进计划“INTERACT”（减少急性护理转移的干预措施）来帮助实现这一目标，该计划旨在减少疗养院居民可避免的住院人数。如果成功，这种干预有可能改善养老院居民的护理，并在未来几十年内节省数十亿美元的医疗保险支出。

DESCRIPTION (provided by applicant): This proposal directly addresses the national imperative for innovative strategies to improve care for Medicare beneficiaries and reduce health care costs. The overall objective of the proposed project is to improve the care of older individuals who reside in nursing homes (NHs), and at the same time reduce unnecessary Medicare expenditures. This goal will be accomplished by testing a quality improvement program designed to reduce the number of avoidable hospitalizations of NH residents in a randomized controlled trial. Hospitalizations of NH residents are frequent and associated with numerous complications and increased health care costs. Previous research suggests that as many as two-thirds of such hospitalizations may be avoidable. Anticipated changes in Medicare reimbursement will reduce financial incentives that favor hospitalization, but could result in reduced care quality if NH staff does not have the training and clinical tools to manage residents in the NH when acute changes occur. INTERACT (Interventions to Reduce Acute Care Transfers) is a quality improvement program that utilizes tools based on established clinical guidelines. The tools target three key strategies to reduce potentially avoidable hospitalizations: 1) preventing conditions from becoming severe enough to require acute hospital care; 2) managing selected acute conditions in the NH; and 3) improving advance care planning for residents among whom a palliative or comfort care plan, rather than acute hospitalization, may be appropriate. Preliminary research involving 30 NHs demonstrated a 17% reduction in hospitalizations compared to the same six-month period in the previous year. The cost of the intervention was $7,700; projected savings to Medicare of reduced hospital admissions from a 100-bed NH were $125,000/year. While these results are promising, the effectiveness of INTERACT in reducing hospitalizations remains to be tested in a controlled trial. The proposed project will therefore involve an interdisciplinary team of experienced NH researchers in conducting a randomized controlled trial to test the implementation of the INTERACT program. NHs randomized to INTERACT implementation will participate in 3- months of training followed by a 12-month implementation period during which they will be supported by an experienced nurse practitioner through regular teleconference calls and as-needed telephonic or email communication. The effects of implementing the INTERACT program on hospitalization rates will be compared to a randomly assigned group of usual care control NHs and a group that will self-monitor hospitalization rates only. The hypotheses to be tested are: 1) INTERACT implementation NHs will have a greater reduction in hospitalization rate than the control and monitoring only NHs during the 12-month implementation period compared to a 12-month baseline period; and 2) reductions in Medicare expenditures for hospitalizations in the INTERACT NHs will exceed the estimated costs of implementing the program. PUBLIC HEALTH RELEVANCE: Project Narrative Strategies to improve care for Medicare beneficiaries that also reduce health care costs are critical to the health of our nation and the preservation of Medicare for future generations. The proposed project strives to help accomplish this goal by testing an innovative quality improvement program "INTERACT" (Interventions to Reduce Acute Care Transfers)) designed to reduce the number of avoidable hospitalizations of nursing home residents. If successful, this intervention has the potential to improve care of nursing home residents and save billions of dollars in Medicare expenditures over the next several decades.