title: The Optimizing Patient Transfers, Impacting Medical Quality, andImproving Symptoms:Transforming Institutional Care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services nursing facility demonstration project.
abstract: The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project aims to reduce avoidable hospitalizations of long-stay residents enrolled in 19 central Indiana nursing facilities. This clinical demonstration project, funded by the Centers for Medicare and Medicaid Services Innovations Center, places a registered nurse in each nursing facility to implement an evidence-based quality improvement program with clinical support from nurse practitioners. A description of the model is presented, and early implementation experiences during the first year of the project are reported. Important elements include better medical care through implementation of Interventions to Reduce Acute Care Transfers tools and chronic care management, enhanced transitional care, and better palliative care with a focus on systematic advance care planning. There were 4,035 long-stay residents in 19 facilities enrolled in OPTIMISTIC between February 2013 and January 2014. Root-cause analyses were performed for all 910 acute transfers of these long stay residents. Of these transfers, the project RN evaluated 29% as avoidable (57% were not avoidable and 15% were missing), and opportunities for quality improvement were identified in 54% of transfers. Lessons learned in early implementation included defining new clinical roles, integrating into nursing facility culture, managing competing facility priorities, communicating with multiple stakeholders, and developing a system for collecting and managing data. The success of the overall initiative will be measured primarily according to reduction in avoidable hospitalizations of long-stay nursing facility residents.
authors.affiliation: Center for Aging Research, Indiana University Indianapolis, Indianapolis, Indiana; School of Medicine, Indiana University Indianapolis, Indianapolis, Indiana; Regenstrief Institute, Inc., Indianapolis, Indiana; Research in Palliative and End-of-Life Communication and Training Signature Center, Indiana University - Purdue University Indianapolis, Indianapolis, Indiana.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Unroe
authors.forename: Arif
authors.initials: A
authors.lastname: Nazir
authors.forename: Laura R
authors.initials: LR
authors.lastname: Holtz
authors.forename: Helen
authors.initials: H
authors.lastname: Maurer
authors.forename: Ellen
authors.initials: E
authors.lastname: Miller
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hickman
authors.forename: Michael A
authors.initials: MA
authors.lastname: La Mantia
authors.forename: Merih
authors.initials: M
authors.lastname: Bennett
authors.forename: Greg
authors.initials: G
authors.lastname: Arling
authors.forename: Greg A
authors.initials: GA
authors.lastname: Sachs
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007196:Indiana; D008484:Medicaid; D006278:Medicare; D017146:Models, Organizational; D009722:Nurse Practitioners; D009735:Nursing Homes / Q000458:organization & administration*; D010360:Patient Transfer; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D014481:United States
keywords: hospitalizations; nursing facilities