INTERACT program can reduce unnecessary hospitalizations in SNFs

There are more than 1.6 million Americans currently living in nursing homes, and approximately 60 percent are sent to emergency rooms and 25 percent are admitted to a hospital in a year. Although hospitalizations are often required for medical reasons, experts suggest that 28 to 40 percent of these admissions could be avoided with enhanced care in the skilled nursing facility (SNF). According to the "Revolving Door of Rehospitalization from Skilled Nursing Facilities," a paper published in the January 2010 issue of Health Affairs, 23.5 percent of Medicare beneficiaries discharged from the hospital to an SNF were readmitted to the hospital within 30 days at a cost to Medicare of $4.34 billion in 2006. Reducing unnecessary hospitalizations can therefore both improve care and reduce Medicare and Medicaid expenditures.

To help address the national imperative for innovative strategies to improve care for Medicare beneficiaries and reduce healthcare costs, Dr. Joseph G. Ouslander, M.D., senior associate dean of geriatric programs, FAU's Charles E. Schmidt College of Medicine and Dr. Ruth Tappen, Ed.D., R.N., Christine E. Lynn Eminent Scholar, FAU's Christine E. Lynn College of Nursing, recently received $457,804 of a four-year grant with a cumulative total of $1.8 million from the National Institutes of Health (NIH), National Institute for Nursing Research for an innovative program they have developed titled "Implementing Interventions to Reduce Hospitalizations of Nursing Home Residents" or INTERACT.

INTERACT is a quality improvement program designed to facilitate the early identification, assessment, documentation and communication about changes in the status of residents in SNFs, and provide the necessary tools to manage conditions before they become serious enough to necessitate a hospital transfer. The tools target three key strategies to reduce potentially avoidable hospitalizations: preventing conditions from becoming severe enough to require acute hospital care; managing selected acute conditions in the nursing home; and improving advance care planning for residents among whom a palliative or comfort care plan, rather than acute hospitalization, may be appropriate.

The NIH funded project will involve an interdisciplinary team of experienced nursing home researchers conducting a randomized controlled trial to test the implementation of the INTERACT program.

"This NIH grant will enable us to further our research on avoiding unnecessary hospitalizations and improving care, and will provide us with the data that is needed to implement this program more widely," said Tappen. "We can make a real impact with INTERACT."

INTERACT was first designed as a project supported by the Centers for Medicare and Medicaid Services (CMS) and further tested in a project supported by the Commonwealth Fund under Ouslander's leadership. The program was initially implemented at 25 community-based nursing homes in Florida, Massachusetts and New York over a six-month period and resulted in a 17 percent reduction in hospital admissions among the residents. The reduction was even greater in homes that were most engaged in implementing the INTERACT intervention.

"The anticipated changes in Medicare reimbursement will reduce financial incentives that favor hospitalization, but could result in reduced quality of care if nursing home staff do not have the training and clinical tools they need in order to manage nursing home residents when acute changes occur," said Ouslander.

Using INTERACT's standardized protocol and working with an on-call nurse practitioner who visits the nursing home daily, the patient can be treated in the nursing home without any complications and only costing Medicare about $200 instead of $10,000 or more. Using such care in nursing homes nationwide could improve care, reduce complications from hospitalizations, and avoid hundreds of millions of dollars in Medicare expenditures annually.

Ouslander and Tappen emphasize that improving care and reducing complications in nursing homes will require multifaceted strategies to address the current incentives for hospitalization and a team effort among healthcare funders, regulators, healthcare professionals, nursing homes and hospitals.