Study: Resident symptoms, risk factors aren't enough to predict hospitalization
A lengthy trial designed to optimize transfers from nursing homes reduced avoidable hospitalizations by 33%, researchers report.
The initial phase of OPTIMISTIC, short for Optimizing Patient Transfers, Impacting Medical quality and Improving Symptoms: Transforming Institutional Care, ran for four years at 19 nursing homes.
An independent evaluation found that nearly one in five of all hospitalizations — both avoidable and unavoidable -— was eliminated during the intervention period, saving more than $3.4 million between 2014 and 2016.
The study was funded by the Center for Medicare and Medicaid Innovation and designed to improve of understanding of why long-term care residents are rehospitalized.
Common diagnoses, such as heart failure or urinary tract infection, are often used to determine if a resident's hospital admission was potentially avoidable, but this study found symptoms and risk factors were only “weakly predictive” of avoidable hospitalization.
"We need to be asking and answering a lot of questions in order to determine if a nursing home resident should have been transported to the hospital," said lead author Kathleen Unroe, M.D., of Indiana University Center for Aging Research and the Regenstrief Institute.
"Our findings of the difficulty of predicting the avoidability of hospital transfers with information available at the time of transfer highlights the challenge of designing targeted strategies to reduce potentially avoidable transfers from the nursing home to the hospital.”
OPTIMISTIC embedded specially trained nurses in participating facilities with a planned target of keeping complex patients in the nursing facility whenever possible. The researchers noted a familiar place with staff and clinicians who know the resident may be his or her best treatment option.