Abstract
Objectives
The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms:
Transforming Institutional Care (OPTIMISTIC) project led to significant decreases
in potentially avoidable hospitalizations of long-stay nursing facility residents
in external evaluation. The purpose of this study was to quantify hospitalization
risk from the start of the project and describe the heterogeneity of the enrolled
facilities in order to better understand the context for successful implementation.
Design
Pre-post analysis design of a prospective intervention within a single group.
Setting and Participants
A total of 4320 residents in the 19 facilities were included from admission until
time to the first hospitalization.
Measures
Data were extracted from Minimum Data Set assessments and linked with facility-level
covariates from the LTCFocus.org data set. Kaplan-Meier and Cox proportional hazards regression were used to assess
risk of hospitalization during the preintervention period (2011-2012), a “ramp-up”
period (2013-2014), and an intervention period (2015-2016).
Results
The cohort consisted of 4230 long-stay nursing facility residents. Compared with the
preintervention period, residents during the intervention period had an increased
probability of having no hospitalizations within 1 year, increasing from 0.51 to 0.57,
which was statistically significant (P < .001). In adjusted Cox models, the risk of hospitalization was lower in the ramp-up
period compared to the pre-period [hazard ratio (HR) 0.85, 95% confidence interval
(CI) 0.75-0.95] and decreased further during the intervention period (HR 0.74, 95%
CI 0.65-0.84).
Conclusions and Implications
As part of a large multisite demonstration project, OPTIMISTIC has successfully reduced
hospitalizations. However, this study highlights the magnitude and extent to which
results differ across facilities. Implementing the OPTIMISTIC program was associated
with a 16% risk reduction after the first 18 months and continued to a final risk
reduction of 26% after 5½ years. Although this model of care reduces hospitalizations
overall, facility variation should be expected.
Keywords
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Article info
Footnotes
Funding sources: This work was supported by the US Department of Health and Human Services, Centers for Medicare & Medicaid Services (Funding Opportunity 1E1CMS331488) and an internal grant from the Regenstrief Institute. The opinions expressed in this article are the authors' own and do not reflect the view of the US Department of Health and Human Services, Centers for Medicare & Medicaid Services.
Conflicts of Interest: K.U. is CEO and Founder of Probari, Inc, a program to train nurses to reduce nursing home hospital transfers.
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
