There is an increased interest from policy makers into the emergency admissions and
hospitalisation of individuals in nursing homes. A study was conducted to examine the
hospitalization rate of nursing homes after the implementation of the INTERACT program.
The Interventions to Reduce Acute Care Transfers, INTERACT program, aims to increase the availability and quality of care at nursing homes, thus reducing the number of hospital admissions. The INTERACT program does this based on improved implementation, evaluation, and management of its three core principles with the goal of preventing hospitalisation.
The first principle is recognising and managing acute conditions before they progress in severity, enough to require hospitalisation. The second aspect the program focuses on opening channels of communication, improving documentation, and providing supportive tools for safe and efficient decision making without the requirement of hospitalisation. Thirdly, the program stresses advanced care planning, including hospice, and palliative care to encourage goals of care discussions. This program will ultimately lead to an improvement in treating the needs of patients with end-stage disease and provide them with medical care within the comfort of their homes.
The inclusion criteria for the study, published in JAMA Internal Medicine, required that a nursing home was capable of managing acute conditions on site and had the necessary technology to document and send patient data. The nursing homes had to have had no prior training using the INTERACT program to minimise error or bias. It was also required that they had a medical health professional, medical services, a place to perform laboratory tests, and pharmacy services. If the nursing home was participating in other programs that reduced hospitalisation, they were not included in the study. If patients went to the emergency, they were identified using the outpatient claim files and the evaluation data recorded from Medicare services.
The results showed that the nursing homes using INTERACT exhibited no significant reduction in overall hospital admissions relative to control nursing homes. The INTERACT program also showed no reduction in emergency department visits. These results differed significantly from those of the pilot study and may indicate that motivation was a large factor. The nursing homes who participated in the pilot study did so voluntarily, whereas those who participated in the full study were randomly assigned.
Other programs introduced such as the Hospital Readmissions Reductions program, having similar goals as the INTERACT program showed more promise and were started before the implementation of the INTERACT program. Results also showed that the participating nursing homes did not take full advantage of their training, attending only a 60-70% of the modules provided. Other obstacles that were noted by the researchers were staff resistance, competing demands, and volatile changing leadership at the nursing homes.
This research points to a few observations that must be made by hospitals and policy makers when trying to implement a new program. The lack of the understanding of the management of nursing homes, the schedules and responsibilities of its staff, and the inability of the implementers to merge the contents of the program with the nursing home staff roster hindered the progress of the program. Addressing these areas could impact the results of a further study. In addition, providing more individualized training may increase staff participation.
Written by Dr. Apollina Sharma, MBBS, GradDip EXMD
Kane, Robert L., et al. “Effects of an Intervention to Reduce Hospitalizations from Nursing Homes: A Randomized Implementation Trial of the INTERACT Program.” JAMA Internal Medicine (2017).