CMS-funded program to reduce hospitalizations shows promise after year one, researchers say

Specially trained RNs could help reduce avoidable hospitalizations, results suggest.
Specially trained RNs could help reduce avoidable hospitalizations, results suggest.

A federally funded project to reduce avoidable hospitalizations of nursing home residents got off to a strong start in its first year, according to recently published findings

“Early experiences of clinical staff have yielded multiple stories of nursing facility staff, residents, and families affected by improved care,” the authors wrote in their update on the OPTIMISTIC project.

The project is one of seven Centers for Medicare & Medicaid Services-funded demonstrations meant to reduce avoidable hospitalizations among long-stay residents. OPTIMISTIC involves 19 nursing facilities in Indiana. Out of 900 acute care transfers recorded in the first year, 29% were flagged as avoidable. On a national basis, the avoidable hospitalization rate has been estimated to be as high as 50%, noted project Co-Director Kathleen T. Unroe, M.D.,  of the Regenstrief Institute and Indiana University.

A specially trained registered nurse has been placed in each OPTIMISTIC facility to spearhead quality improvements aimed at reducing hospitalizations, such as eliminating unnecessary medication. A nurse practitioner also supports each facility. Early efforts have focused largely on chronic disease management — particularly for dementia — and early detection and prevention of changes that could precipitate hospitalization.

Defining new clinical roles, integrating into the nursing home culture, data management and communication among stakeholders were among the most important lessons learned during the first year, the report states.

OPTIMISTIC stands for Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care. The initiative began in February 2013. The complete year-one report appears in the current issue of the Journal of the American Geriatrics Society.