title: Initiative To Reduce Avoidable Hospitalizations Among Nursing Facility Residents Shows Promising Results.
abstract: Nursing facility residents are frequently admitted to the hospital, and these hospital stays are often potentially avoidable. Such hospitalizations are detrimental to patients and costly to Medicare and Medicaid. In 2012 the Centers for Medicare and Medicaid Services launched the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, using evidence-based clinical and educational interventions among long-stay residents in 143 facilities in seven states. In state-specific analyses, we estimated net reductions in 2015 of 2.2-9.3 percentage points in the probability of an all-cause hospitalization and 1.4-7.2 percentage points in the probability of a potentially avoidable hospitalization for participating facility residents, relative to comparison-group members. In that year, average per resident Medicare expenditures were reduced by $60-$2,248 for all-cause hospitalizations and by $98-$577 for potentially avoidable hospitalizations. The effects for over half of the outcomes in these analyses were significant. Variability in implementation and engagement across the nursing facilities and organizations that customized and implemented the initiative helps explain the variability in the estimated effects. Initiative models that included registered nurses or nurse practitioners who provided consistent clinical care for residents demonstrated higher staff engagement and more positive outcomes, compared to models providing only education or intermittent clinical care. These results provide promising evidence of an effective approach for reducing avoidable hospitalizations among nursing facility residents.
authors.affiliation: Melvin J. Ingber (mingber@rti.org) is a principal scientist at RTI International in Washington, D.C.
authors.forename: Melvin J
authors.initials: MJ
authors.lastname: Ingber
authors.affiliation: Zhanlian Feng is a senior research public health analyst at RTI International in Waltham, Massachusetts.
authors.forename: Zhanlian
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Galina Khatutsky is a senior research public health analyst and program manager at RTI International in Waltham.
authors.forename: Galina
authors.initials: G
authors.lastname: Khatutsky
authors.affiliation: Joyce M. Wang is a research public health analyst at RTI International in Waltham.
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Wang
authors.affiliation: Lawren E. Bercaw is a research public health analyst at RTI International in Waltham.
authors.forename: Lawren E
authors.initials: LE
authors.lastname: Bercaw
authors.affiliation: Nan Tracy Zheng is a senior research public health analyst at RTI International in Waltham.
authors.forename: Nan Tracy
authors.initials: NT
authors.lastname: Zheng
authors.affiliation: Alison Vadnais is a research public health analyst at RTI International in Waltham.
authors.forename: Alison
authors.initials: A
authors.lastname: Vadnais
authors.affiliation: Nicole M. Coomer is a senior economist and program manager at RTI International in Research Triangle Park, North Carolina.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Coomer
authors.affiliation: Micah Segelman is a research public health analyst at RTI International in Washington, D.C.
authors.forename: Micah
authors.initials: M
authors.lastname: Segelman
mesh_terms: D017046:Cost Savings / Q000191:economics; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D009735:Nursing Homes / Q000458:organization & administration* / Q000639:trends; D009740:Nursing Staff / Q000193:education*; D036301:Qualitative Research; D011787:Quality of Health Care; D014481:United States
keywords: Health Spending; Long-Term Care; Organization and Delivery of Care