Male doctor using stethoscope to examine coughing patient in hospital gown.
Credit: Science Photo Library/Getty Images

On-site acute care in the nursing home did not result in any harm, and may have benefited long-stay residents, according to outcomes following a large-scale, multi-state initiative from the Centers for Medicare & Medicaid Services. Investigators are urging nursing home medical directors to take note.

The Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents examined whether on-site treatment of six medical conditions would help to reduce avoidable hospitalizations in this population. 

Investigators compared care trajectories in nearly 17,000 episodes of on-site treatment and 5,907 in-hospital treatment episodes. Conditions studied included congestive heart failure, chronic obstructive pulmonary disease, skin infection, dehydration, urinary tract infection and pneumonia. Most on-site treatments were for pneumonia and UTI.

Lower admissions, mortality

Among the residents treated on-site, 14% were subsequently hospitalized and 8% died within 30 days. Residents treated in the hospital, meanwhile, were more likely to be admitted (26%) or to die (17%).

The study was not able to fully account for differences in unobserved illness severity between the two cohorts, but the results did not indicate any harm in on-site treatment. This finding held after controlling for observable differences in demographics, comorbidities, and cognitive and functional status, according to lead author Micah Segelman, PhD, of RTI International, Washington, DC, and colleagues.

The results also suggest the possible benefit of safe treatment, considering that residents treated on-site had lower admission rates and mortality, they added. 

Improved assessments, skills

There were other positive outcomes noted as well. Participating facilities improved the quality of their onsite assessments during the initiative treatment period, from 2012 to 2020, by implementing additional documentation and clinical pathway tools. This introduced more consistency to follow-up tests and treatments, the researchers noted. 

Nursing home staff also got a boost in skills practice, such as in administering intravenous antibiotics, which the researchers attributed to the special focus on the six medical conditions, and the added support and education provided during the initiative. There was also increased attention to advance directives and advance care planning, which in turn led to better alignment of clinical care with resident and family wishes, they reported.

Aside from those measured in the study, there are others benefits to treating residents on-site, Segelman and colleagues added. These include supporting continuity of care and the ability of residents to remain in a stable, familiar environment, they wrote.

‘Often a better choice’

Overall, the findings underscore the clinical value of early assessment and treatment on-site following changes in a resident’s health condition, the authors said.

“It is advisable that nursing facility medical directors consider our findings and be reassured that treatment within the facility is often the better choice for residents and their health outcomes,” they concluded.

Full findings were published in JAMDA.

Related articles:

Pandemic or not, readmissions still plague certain SNF patients

With little to show for past efforts, SNFs under the microscope again on readmissions (2022)

Observation status overuse undercuts hospital readmission progress (2022)