Dataset Information

Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations.

ABSTRACT:

Objectives

To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents.

Design

Secondary analysis from a randomized controlled trial.

Setting

SNFs from across the United States (N=264).

Participants

Two hundred of the SNFs from the randomized trial that provided baseline and intervention data on INTERACT use.

Interventions

During a 12-month period, intervention SNFs received remote training and support for INTERACT implementation; control SNFs did not, although most control facilities were using various components of the INTERACT program before and during the trial on their own.

Measurements

INTERACT use data were based on monthly self-reports for SNFs randomized to the intervention group and pre- and postintervention surveys for control SNFs. Primary outcomes were rates of all-cause hospitalizations, potentially avoidable hospitalizations (PAHs), ED visits without admission, and 30-day hospital readmissions.

Results

The 65 SNFs (32 intervention, 33 control) that reported increases in INTERACT use had reductions in all-cause hospitalizations (0.427 per 1,000 resident-days; 11.2% relative reduction from baseline, p<.001) and PAHs (0.221 per 1,000 resident-days; 18.9% relative reduction, p<.001). The 34 SNFs (12 intervention, 22 control) that reported consistently low or moderate INTERACT use had statistically insignificant changes in hospitalizations and ED visit rates.

Conclusion

Increased reported use of core INTERACT tools was associated with significantly greater reductions in all-cause hospitalizations and PAHs in both intervention and control SNFs, suggesting that motivation and incentives to reduce hospitalizations were more important than the training and support provided in the trial in improving outcomes. Further research is needed to better understand the most effective strategies to motivate SNFs to implement and sustain quality improvement programs such as INTERACT.

SUBMITTER: Huckfeldt PJ

PROVIDER: S-EPMC6156928 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Publications

Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations.

Huckfeldt Peter J PJ Kane Robert L RL Yang Zhiyou Z Engstrom Gabriella G Tappen Ruth R Rojido Carolina C Newman David D Reyes Bernardo B Ouslander Joseph G JG

Journal of the American Geriatrics Society 20180810 9

<h4>Objectives</h4>To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents.<h4>Design</h4>Secondary analysis from a randomized controlled trial.<h4>Setting</h4>SNFs from across the United States (N=264).<h4>Participants</h4>Two hundred of the SNFs from the randomized trial that provided baseline and interventio ...[more]

PMID: 30094818

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Project description:Importance:Medicare payment initiatives are spurring efforts to reduce potentially avoidable hospitalizations. Objective:To determine whether training and support for implementation of a nursing home (NH) quality improvement program (Interventions to Reduce Acute Care Transfers [INTERACT]) reduced hospital admissions and emergency department (ED) visits. Design, Setting, and Participants:This analysis compared changes in hospitalization and ED visit rates between the preintervention and postintervention periods for NHs randomly assigned to receive training and implementation support on INTERACT to changes in control NHs. The analysis focused on 85 NHs (36?717 NH residents) that reported no use of INTERACT during the preintervention period. Interventions:The study team provided training and support for implementing INTERACT, which included tools that help NH staff identify and evaluate acute changes in NH resident condition and document communication between physicians; care paths to avoid hospitalization when safe and feasible; and advance care planning and quality improvement tools. Main Outcomes and Measures:All-cause hospitalizations, hospitalizations considered potentially avoidable, 30-day hospital readmissions, and ED visits without admission. All-cause hospitalization rates were calculated for all resident-days, high-risk days (0-30 days after NH admission), and lower-risk days (?31 days after NH admission). Results:We found that of 85 NHs, those that received implementation training and support exhibited statistically nonsignificant reductions in hospitalization rates compared with control NHs (net difference, -0.13 per 1000 resident-days; P?=?.25), hospitalizations during the first 30 days after NH admission (net difference, -0.37 per 1000 resident-days; P?=?.48), hospitalizations during periods more than 30 days after NH admission (net difference, -0.09 per 1000 resident-days; P?=?.39), 30-day readmission rates (net change in rate among hospital discharges, -0.01; P?=?.36), and ED visits without admission (net difference, 0.02 per 1000 resident-days; P?=?.83). Intervention NHs exhibited a reduction in potentially avoidable hospitalizations overall (net difference, -0.18 per 1000 resident-days, P?=?.01); however, this effect was not robust to a Bonferroni correction for multiple comparisons. Conclusions and Relevance:Training and support for INTERACT implementation as carried out in this study had no effect on hospitalization or ED visit rates in the overall population of residents in participating NHs. The results have several important implications for implementing quality improvement initiatives in NHs. Trial Registration:clinicaltrials.gov Identifier: NCT02177058.

Project description:BackgroundAdmission hypothermia (AH, < 36.5℃) remains a major challenge for global neonatal survival, especially in developing countries. Baseline research shows nearly 89.3% of very low birth weight (VLBW, < 1500 g) infants suffer from AH in China. Therefore, a prospective multicentric quality improvement (QI) initiative to reduce regional AH and improve outcomes among VLBW neonates was implemented.MethodsThe study used a sequential Plan-Do-Study-Act (PDSA) approach. Clinical data were collected prospectively from 5 NICUs within the Sino-Northern Neonatal Network (SNN) in China. The hypothermia prevention bundle came into practice on January 1, 2019. The clinical characteristics and outcomes data in the pre-QI phase (January 1, 2018- December 31, 2018) were compared with that from the post-QI phase (January 1, 2019-December 31, 2020). Clinical characteristics and outcomes data were analyzed.ResultsA total of 750 in-born VLBW infants were enrolled in the study, 270 in the pre-QI period and 480 in the post- QI period, respectively. There were no significant differences in clinical characteristics of infants between these two phases. Compared with pre-QI period, the incidence of AH was decreased significantly after the QI initiative implementation in the post-QI period (95.9% vs. 71.3%, P < 0.01). Incidence of admission moderate-to-severe hypothermia (AMSH, < 36℃) also decreased significantly, manifesting a reduction to 38.5% in the post-QI (68.5% vs 30%, P < 0.01). Average admission temperature improved from after QI (35.5 [Formula: see text] 0.7℃ vs. 36.0 [Formula: see text] 0.6℃, P < 0.01). There was no increase in proportion the number of infants with a temperature of > 37.5 °C or thermal burns between the two groups. The risk ratio of mortality in infants during the post-QI period was significantly lower in the post-QI period as compared to the pre-QI period [adjusted risk ratio (aRR): 0.26, 95% confidence interval (CI): 0.13-0.50]. The risk ratio of late-onset neonatal sepsis (LOS) also significantly lowered in the post-QI period (aRR: 0.66, 95% CI: 0.50-0.87).ConclusionImplementation of multicentric thermoregulatory QI resulted in a significant reduction in AH and AMSH in VLBW neonates with associated reduction in mortality. We gained a lot from the QI, and successfully aroused the attention of perinatal medical staff to neonatal AH. This provided a premise for continuous quality improvement of AH in the future, and might provide a reference for implementation of similar interventions in developing countries.Trial registrationTrial registration number: ChiCTR1900020861 . Date of registration: 21 January 2019(21/01/2019). Prospectively registered.

Project description:BACKGROUND | OBJECTIVE: To evaluate the implementation of three intervention elements to reduce hospitalizations in nursing home residents.DesignConvergent mixed-method design within a hybrid type-2 effectiveness-implementation study.SettingEleven nursing homes in the German-speaking region of Switzerland.ParticipantsQuantitative data were collected from 573 care workers; qualitative data were collected from 108 care workers and the leadership from 11 nursing homes.InterventionThree intervention elements targeting care workers were implemented to reduce unplanned hospitalizations: (1) the STOP&WATCH instrument for early recognition of changes in resident condition; (2) the ISBAR instrument for structured communication; and (3) specially-trained INTERCARE nurses providing on-site geriatric support. Multifaceted implementation strategies focusing both on the overall nursing home organization and on the care workers were used.MethodsThe quantitative part comprised surveys of care workers six- and twelve-months post-intervention. The intervention's acceptability, feasibility and uptake were assessed using validated and self-developed scales. Qualitative data were collected in 22 focus groups with care workers, then analyzed using thematic analysis methodology. Data on implementation processes were collected during implementation meetings with nursing home leadership and were analyzed via content analysis. Findings were integrated using a complementary approach.ResultsThe ISBAR instrument and the INTERCARE nurse role were considered acceptable, feasible, and taken up by > 70% of care workers. The STOP&WATCH instrument showed the lowest acceptance (mean: 68%), ranging from 24 to 100% across eleven nursing homes. A combination of factors, including the amount of information received, the amount of support provided in daily practice, the users' perceived ease of using the intervention and its adaptations, and the intervention's usefulness, appeared to influence the implementation's success. Two exemplary nursing homes illustrated context-specific implementation processes that serve as either barriers or facilitators to implementation.ConclusionsOur findings suggest that, alongside the provision of information shortly before intervention start, constant daily support is crucial for implementation success. Ideally, this support is provided by designated and trained individuals who oversee implementation at the organizational and unit levels. Leaders who seek to implement interventions in nursing homes should consider their complexity and their consequences for workflow to optimize implementation processes accordingly.Trial registrationThis study was registered at clinicaltrials.gov ( NCT03590470 ) on the 18/06/2018.

Project description:GoalAdministrative burden is one of many potential root causes of physician burnout. Scribe documentation assistance can reduce this burden. However, traditional in-person scribe services are challenged by consistent staffing because the model requires the physical presence of a scribe and limits the team to a single individual. In addition, in-person scribes cannot provide the flexible support required for virtual care encounters, which can now pivot geographically and temporally. To respond to these challenges, our health network implemented an asynchronous virtual scribe model and evaluated the program's impact on clinician perceptions of burnout across multiple outpatient specialties.MethodsUsing a mixed-methods, pre-/postdesign, this evaluation measured the impact of an asynchronous virtual scribe program on physician burnout. Physicians were given the Professional Fulfillment Index tool (to self-assess their mental state) and free-text comment surveys before virtual scribe initiation and again at 3-, 6-, and 12-month intervals after program implementation. Descriptive statistics of survey results and qualitative review of free-text entries were analyzed for themes of facilitation and barriers to virtual scribe use.Principal findingsOf 50 physician participants in this study, 42 (84%) completed the preintervention survey and 15 (36%) completed all 4 surveys; 25 participants (50%) discontinued scribe use after 12 months. Burnout levels-as defined by dread, exhaustion, lack of enthusiasm, decrease in empathy, and decrease in colleague connection-all trended toward improvement during this study. Importantly, quality, time savings, burnout, and productivity moved in positive directions as well.Practical applicationThe cost burden to physicians and the COVID-19 pandemic inhibited the continued use of asynchronous virtual medical scribes. Nevertheless, those who continued in the program have reported positive outcomes, which indicates that the service can be a viable and effective tool to reduce physician burnout.

Project description:Background: Although understanding implementation context is essential, there is a dearth of research on how to systematically explore it in quality improvement (QI) programs. Therefore, in this study, we used the consolidated framework for implementation research (CFIR) to guide a systematic evaluation of the implementation context of an ongoing QI program in order to generate rapid site-specific feedback that can be used to improve subsequent plan-do-study-act (PDSA) cycles.Methods: Formative cross-case evaluation was conducted using convergent mixed methods design. The study was conducted in five primary health care (PHC) facilities (PHC 1, PHC 3, PHC 5, PHC 9 and PHC 10) implementing the QI program. Health workers in those facilities formed the study population. Quantitative data were collected using a self-administered, Likert-based rating tool, while qualitative data collection was guided by an interview guide. The interviews were transcribed verbatim, and thematic analysis was performed. Raw median score and factor scores were computed. Methodological integration occurred at the design, analysis and reporting stage.Results: A total of 165 health workers were included in this study with a mean age of 33.43 years (standard deviation of 7.15). Majority were females and they all had post-secondary education. Health workers in two facilities; PHC 1 and PHC 5, reported higher score for the QI program across all five domains of CFIR. Implementation facilitators included intervention flexibility, relative advantage, self-efficacy among health workers, health workers confidence in the intervention, services integration. While implementation barriers included vaccine stock out, faulty cold chain infrastructure, lack of incentives, and socio-cultural beliefs.Conclusion: This study demonstrated that theory-driven formative evaluation can be integrated in QI programs in a low resource setting. It buttressed the value in conducting such assessment as they can be used to generate rapid feedback on factors that influence implementation success which can then be addressed in subsequent cycles.

Dataset Information

Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations.

Objectives

Design

Setting

Participants

Interventions

Measurements

Results

Conclusion

Publications

Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations.

Similar Datasets

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