Session 1d Overview of the INTERACT Program This session is designed for: Administrators Social...
Transcript of Session 1d Overview of the INTERACT Program This session is designed for: Administrators Social...
Session 1d
Overview of the INTERACT Program
This session is designed for:
•Administrators•Social Workers
•Therapists (PT, OT, RT)•Other Direct Care Staff
The development and evaluation of the INTERACT quality improvement program and curriculum have been supported by grants from The Commonwealth Fund and the Retirement Research Foundation.
The INTERACT Interdisciplinary Team
Joseph Ouslander, MD Florida Atlantic UniversityRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversityJill Shutes, GNP Florida Atlantic UniversityNancy Henry, PhD, GNP Florida Atlantic UniversityMaria Rojido, MD Florida Atlantic UniversitySanya Diaz, MD Florida Atlantic UniversityLaurie Herndon, MSN, GNP-BC Mass Senior Care FoundationJo Taylor, RN, MPH The Carolinas Center for Medical ExcellenceGerri Lamb, PhD, RN, FAAN Arizona State UniversityAnnie Rahman, PhD, MSW USC Davis School of GerontologyDan Osterweil, MD California Association of Long Term Care MedicineMary Perloe, GNP Georgia Medical Care FoundationJohn Schnelle, PhD Vanderbilt UniversitySandra Simmons, PhD Vanderbilt UniversityAlice Bonner, PhD, GNP Center for Medicare and Medicaid Services
In collaboration with participating nursing homes
Overview of the INTERACT Program
Definition and goals of the INTERACT Program
Why it matters to you and your organization
An overview of the INTERACT Program and tools
What This Module Will Cover
Overview of the INTERACT Program
(“Interventions to Reduce Acute Care Transfers”)
Is a quality improvement program designed to improve the care of nursing home residents
with acute changes in condition
Overview of the INTERACT Program
The INTERACT program includes evidence and expert-recommended clinical practice tools, strategies to implement them, and related educational resources
The basic program is located on the internet:
http://interact2.net
Overview of the INTERACT Program
Acknowledgement
When using the INTERACT Program and tools, an appropriate acknowledgement should be included, and permission should be obtained to use the INTERACT trademark and copyrighted tools.
The INTERACT Program and tools were initially developed by Joseph G. Ouslander, MD and Mary Perloe, MS, GNP at the Georgia Medical Care Foundation with the support of a contract from the Center for Medicare and Medicaid Services. The current version of the INTERACT Program was designed by the INTERACT team, with input from many direct care providers and national experts in a project based at Florida Atlantic University and supported by The Commonwealth Fund. The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.
The INTERACTTM trademark and copyrighted materials may be used with the permission of Florida Atlantic University, which can be obtained via the “Contact Us” section of the INTERACT website (http://interact2.net )
Permission must be obtained for the use of any aspects of the INTERACT program for profit, or for incorporation of INTERACT tools into an electronic health record.
Overview of the INTERACT Program
#5. INTERACT responds to a real problem that is now receiving national and state attention.
Top 5…….Reasons to like INTERACT
Overview of the INTERACT Program
The Problem…
Emergency room visits, observation stays hospitalizations, and readmissions of nursing home residents are:
Common
Costly Complicated Often avoidable
Overview of the INTERACT Program
Mor et al. Health Affairs 29: 57-64, 2010
1 in 4 patients admitted to a SNF are re-admitted to the hospital within 30 days at a cost of $4.3 billion
Overview of the INTERACT Program
Common and costly….
Video Clip
Patient who suffers a complication during an unnecessary hospitalization
Overview of the INTERACT Program
Often Avoidable…
Some hospital transfers, ER visits, observation stays, hospital admissions, and readmissions are rated by expert clinicians as “avoidable”, “preventable”, or “unnecessary”
Studies in which clinical experts have reviewed medical records suggest that between 1/4 and 2/3 of hospitalizations might be unnecessary
Overview of the INTERACT Program
Now Receiving National and State Attention…
Financial and regulatory incentives are changing
The INTERACT Program:What is It and Why Does It Matter?Overview of the INTERACT Program
Pay-for-Performance Incentives for improved quality
No payment for certain complications; disincentives for
avoidable hospitalizations
Bundling of payments for episodes of care
Accountable Care Organizations that include
hospitals, physicians, home health agencies, and SNFs that
are responsible for the care of a defined group of patients
Other (e.g. Patient Centered Medical Homes, state programs
for Medicare/Medicaid dually eligible beneficiaries)
Changes in Medicare Financing
Overview of the INTERACT Program
Improve quality of care for your residents Share in savings to Medicare by reducing
unnecessary ER visits, observation stays, hospital admissions, and readmissions
Your facility can take advantage of the opportunities in health care reform
Overview of the INTERACT Program
Why Does This Matter to You and Your Facility?
The health care reform law also mandates that each facility
have a Quality Assurance and Performance Improvement program (“QAPI”)
The regulation and related surveyor guidance are being written
Improving the management of acute change in condition and reducing unnecessary hospital transfers through the use of INTERACT is one potential focus of your QAPI work
In addition, “Reducing Hospitalizations Safely” is a new goal for the Advancing Excellence in America’s Nursing Homes campaign
(see http://www.nhqualitycampaign.org)
Overview of the INTERACT Program
Why Does This Matter to You and Your Facility?
# 4: INTERACT can be implemented in any nursing home, drawing on its existing resources.
Top Reasons to like INTERACT…
Overview of the INTERACT Program
INTERACT tools:
•are available online at no charge.•are appropriate for use with both long-term and rehab residents.•integrate well with IT programs.•are rapidly becoming the standard of practice in many communities.•can increase referrals to your nursing home.
Overview of the INTERACT Program
# 3: INTERACT promotes best practice.
Top reasons to like INTERACT…
Overview of the INTERACT Program
1. Preventing conditions from becoming severe enough to require hospitalization through early identification and assessment of changes in resident condition
2. Managing some conditions in the NH without transfer when this is feasible and safe
3. Improving advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents
The INTERACT program uses 3 basic strategies:
Overview of the INTERACT Program
The goal of INTERACT is to improve care, not to prevent all hospital transfers In fact, INTERACT can help with more rapid
transfer of residents who need hospital care The goal of INTERACT is to improve the
management of residents with a change in condition
Overview of the INTERACT Program
Sadie Sara Sam
A Tale of Three Siblings
Overview of the INTERACT Program
Hospitalized for UTI and dehydration Discharged back to the NH after 4 days Re-hospitalized 7 days later for
dehydration and recurrent UTI
SadieA 96 year old long-stay NH resident
Preventable?
INTERACT strategy: Prevent conditions from becoming severe enough to require
hospitalization through early detection and evaluation
Overview of the INTERACT Program
Hospitalized for a lower respiratory infection, but had normal vital signs and oxygen saturation
Developed delirium in the hospital, fell, fractured her pubis, and developed a pressure ulcer
Sara (Sadie’s younger sister)A 92 year old long-stay NH resident
Preventable?
INTERACT strategy: Manage some conditions in the NH without transfer
Overview of the INTERACT Program
Hospitalized for the 4th time in 2 months for aspiration pneumonia related to end-stage Alzheimer’s disease
Transferred to hospice on the day of admission
Sam (Sara and Sadie’s older brother)A 101 year old long-stay NH resident
Preventable?
INTERACT strategy: Improve advance care planning and the use of palliative care
plans when appropriate as an alternative to hospitalization
Overview of the INTERACT Program
What are your experiences?
What do you think are the major causes of unnecessary hospitalizations of residents from the facility or facilities that you work in?
Overview of the INTERACT Program
# 2: INTERACT is evidence-based and by design, user-friendly and practical to implement.
Top reasons to like INTERACT…
Overview of the INTERACT Program
Originally developed in a project supported by the Center for Medicare and Medicaid Services (CMS)
Revised based on input from staff from several nursing homes and national experts in a project supported by The Commonwealth Fund
Overview of the INTERACT Program
Communication Tools
Decision Support Tools
Advance Care Planning Tools
Quality Improvement Tools
Overview of the INTERACT Program
Overview of the INTERACT Program
Easy to use by design. A case in point:
Stop & Watch: If you have identified an important change while caring for a resident today, please circle the change (from a list of possible changes on the form) and discuss it with the charge nurse before the end of your shift.
The INTERACT II tools are meant to be used together in your daily work in the nursing home
http://interact2.net
Overview of the INTERACT Program
Not all staff members will use all INTERACT II tools, but most will use at least some.
Overview of the INTERACT Program
Stop & Watch: CNAs, therapists, social workers, nurses, even family members
Care Paths, Acute Change in Condition File Cards: Nurses, physicians
Advance Care Planning Tools: Social workers, nurses, physicians
SBAR: Nurses
Transfer Checklist, Resident Transfer Form: Discharge planners, admissions staff, nurses
QI tools: QA staff, administrators, medical directors
# 1: INTERACT delivers.
Top reasons to like INTERACT…
Overview of the INTERACT Program
30 NHs – 10 in FL, 10 in Mass, 10 in NY On site training (part of one day)
Facility-based champion Phone calls with up to 10 facility champions twice
monthly facilitated by an experienced nurse practitioner
Completion and faxing of Quality Improvement Review tools monthly for 6 months
Evidence of INTERACT Effectiveness: The Commonwealth Fund Grant Collaborative
Overview of the INTERACT Program
Ouslander et al, J Am Geriatr Soc 59:745–753, 2011
Commonwealth Fund Project Results
Facilities
Mean Hospitalization Rate per 1000 resident days (SD)
Mean Change (SD)
95% Confidence Interval
p value Relative Reduction in
All-Cause Hospitalizations
Pre intervention
During Intervention
All INTERACT facilities (N = 25) 3.99 (2.30) 3.32 (2.04) - 0.69 (1.47) -0.08 to -1.30 0.02
17%
Engaged facilities (N = 17) 4.01 (2.56) 3.13 (2.27) - 0.90 (1.28) -0.23 to -1.56
0.0124%
Not engaged facilities (N = 8) 3.96 (1.79) 3.71 (1.53) - 0.26 (1.83) -1.79 to 1.27
0.696%
Comparison facilities (N = 11) 2.69 (2.23) 2.61 (1.82) - 0.08 (0.74) - 0.41 to 0.58
0.723%
Ouslander et al, J Am Geriatr Soc 59:745–753, 2011
Overview of the INTERACT Program
Commonwealth Fund Project Results: Implications
1. For a 100-bed NH, the average decrease would result in about 25 fewer hospitalizations per year, or about 2 fewer per month
2. This would result in $125,000 in savings to Medicare Part A using an average hospital DRG payment of $5,000
3. The INTERACT program as implemented in this project cost of about $7,700 per facility
4. Overall, this would result in $117,000 in savings per facility per year
Medicare could share these savings to support NHs to further improve care
Ouslander et al, J Am Geriatr Soc 59:745–753, 2011
Overview of the INTERACT Program
$ Costs HIGHLOW
Qu
alit
y
LOW
HIGH
Medicare Savings$
$ Shared Savings for
Providers
Improved Quality,Reduced Costs
Reduce UnnecessaryHospitalizations
Opportunities for You and Your Facility to Benefit from Shared Savings
Overview of the INTERACT Program
Safe Reduction in Unnecessary Acute Care Transfers
• Infrastructure (trained staff, lab support)
• Adequate reimbursement and financial incentives
• Quality improvement programs
• Educational resources• Clinical practice tools
Morbidity
Costs Quality
What Do You and Your Facility Need to Take Advantage of These Opportunities?
Overview of the INTERACT Program
Medline University INTERACT curriculum
The INTERACT website (http://interact2.net)
Other Resources
Overview of the INTERACT Program
Educational Resources
Please complete the Quiz and Evaluation If you do not complete them:
You will not receive continuing education credit If your facility is tracking who completes specific
modules, you will not be counted
Quiz and Evaluation
Overview of the INTERACT Program