MU project to reduce avoidable re-hospitalizations among nursing home residents

The University of Missouri Sinclair School of Nursing today announced a nearly $15 million grant from the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS). Led by Curators' Professor of Nursing Marilyn Rantz, MU researchers will use the funds, distributed over four years, to implement a project aimed at reducing avoidable re-hospitalizations among nursing home residents. Insights gained from this project could provide a nationwide model for senior care and significantly reduce national health care spending.

"The term, 'ecstatic,' does not capture my current sentiment," said Judith Fitzgerald Miller, dean of the Sinclair School of Nursing. "This is a transformational grant for the university and is congruent with our passion for excellence in health care. The care of older adults will be improved as a result of this work."

The majority of nursing home residents are enrolled in Medicaid and most also participate in Medicare, CMS reports. Previous research suggests that nearly half of hospitalizations among nursing home residents enrolled in Medicare or Medicaid could have been avoided. These potentially avoidable hospitalizations amounted to more than $7 billion in 2011.

MU will partner with CMS and state Medicaid programs to improve care for residents at 16 nursing facilities in St. Louis. The MU researchers will oversee the project, and using grant funds, the team will recruit and place one advanced practice registered nurse (APRN) at each of the nursing homes. APRNs receive specialized post-graduate educations in nursing. The APRNs will work with nursing facility staff and residents' health providers to coordinate patient care and improve the recognition, assessment and management of conditions that are common causes of hospitalizations for aging adults.

"Previous research has shown that every time patients move from nursing homes to hospitals and back to nursing facilities, their conditions deteriorate," said Rantz, who has spent more than three decades conducting research to improve seniors' quality of life. "Older adults have subtle changes in their behaviors and in their health statuses. In nursing homes, improving the observation and assessment processes by advanced practiced nurses can help residents receive treatment earlier and avoid unnecessarily going back to hospitals."

The APRNs at each facility will work with a traveling interdisciplinary team consisting of a master's-trained social worker, an information technology specialist, a medical director and an APRN with specialized knowledge of INTERACT II, a quality improvement program designed to monitor and improve aging adults' health.

"Transitioning between hospitals and nursing homes is a complicated process because the exchange of accurate, complete and timely information often is convoluted," Rantz said. "The interdisciplinary team will put the infrastructure in place to support good communication, which will help improve the patients' care."

Rantz has dedicated most of her career to studying ways health care professionals can facilitate healthy aging processes. She views this grant as the culmination of her work and an opportunity to put her research into practice.

"From my perspective as a researcher, clinician and former nursing home administrator, this award is exciting because, for years, I have measured the benefits of APRNs in nursing homes," Rantz said. "Putting APRNs in nursing homes is the right solution, and if you combine these nurses with the INTERACT II tools, we've really got a shot at improving the quality of care and health outcomes of nursing home residents."

Rantz recently was recognized for her outstanding professional achievements and commitment to service when she was admitted to the Institute of Medicine. Admittance into the institute is one of the most prestigious honors for health and medical researchers.