Reducing Transfers among Long-Stay Nursing Facility Residents to Acute Care Settings: Effect of the 2013-2016 Centers for Medicare and Medicaid Services Initiative

被引:11
作者
Vadnais, Alison J. [1 ]
Vreeland, Emily [1 ]
Coomer, Nicole M. [1 ]
Feng, Zhanlian [1 ]
Ingber, Melvin J. [1 ]
机构
[1] RTI Int, 307 Waverley Oaks Rd,Suite 101, Waltham, MA 02451 USA
关键词
Medicare; nursing home; avoidable hospital transfer; avoidable hospitalization; POTENTIALLY AVOIDABLE HOSPITALIZATIONS; HOME RESIDENTS;
D O I
10.1016/j.jamda.2020.01.002
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objectives: From 2013 to 2016, the Centers for Medicare and Medicaid Services Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents ("the Initiative") tested a series of clinical interventions and care models, through organizations called Enhanced Care and Coordination Providers (ECCPs), with the goal of reducing avoidable inpatient hospital admissions among long-stay nursing home residents. We identify the effect of the Initiative on the probability and count of acute care transfers [capturing any transfer to the hospital, including hospitalizations (inpatient stays), emergency department visits, and observation stays]. Design: We evaluate the effect of the Initiative on the probability and count of all-cause acute care transfers and potentially avoidable acute care transfers and estimate the average effect of the Initiative per resident per year. Setting and Participants: We use 2011-2016 data from the Centers for Medicare and Medicaid Services Minimum Data Set, version 3.0, nursing home resident assessments linked with Medicare eligibility and enrollment data and Medicare inpatient and outpatient hospital claims. Our sample is limited to Medicare fee-for-service beneficiaries in participating ECCP facilities and a comparison group of long-stay nursing facility residents. Methods: We evaluate the effect of the Initiative on both the probability and count of all-cause acute care transfers and potentially avoidable acute care transfers using difference-in-differences regression models controlling for both resident-level clinical and demographic characteristics as well as facility-level characteristics. Results: We found statistically significant evidence of a reduction in both the probability and count of all-cause and potentially avoidable acute care transfers among long-stay nursing facility residents who participated in the Initiative, relative to comparison group residents. Conclusions and Implications: The clinical interventions and care models implemented by the ECCPs show that by using staff education, facility leadership and physician engagement, and/or clinical assessment and treatment of residents who experienced a change in condition, it is possible to reduce acute care transfers of nursing facility residents. This could lead to better outcomes and reduced cost of care for this vulnerable patient population. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
引用
收藏
页码:1341 / 1345
页数:5
相关论文
共 19 条
[1]   Nursing Home Resident Symptomatology Triggering Transfer: Avoiding Unnecessary Hospitalizations [J].
Ashcraft, Alyce S. ;
Champion, Jane Dimmitt .
NURSING RESEARCH AND PRACTICE, 2012, 2012
[2]   Trends in Emergency Department Visits for Ambulatory Care Sensitive Conditions by Elderly Nursing Home Residents, 2001 to 2010 [J].
Brownell, Julia ;
Wang, Joseph ;
Smith, Alexander ;
Stephens, Caroline ;
Hsia, Renee Y. .
JAMA INTERNAL MEDICINE, 2014, 174 (01) :156-158
[3]   HAZARDS OF HOSPITALIZATION OF THE ELDERLY [J].
CREDITOR, MC .
ANNALS OF INTERNAL MEDICINE, 1993, 118 (03) :219-223
[4]   Nursing Facilities Can Reduce Avoidable Hospitalizations Without Increasing Mortality Risk For Residents [J].
Feng, Zhanlian ;
Ingber, Melvin J. ;
Segelman, Micah ;
Zheng, Nan Tracy ;
Wang, Joyce M. ;
Vadnais, Alison ;
Coomer, Nicole M. ;
Khatutsky, Galina .
HEALTH AFFAIRS, 2018, 37 (10) :1640-1646
[5]   The costs and potential savings associated with nursing home hospitalizations [J].
Grabowski, David C. ;
O'Malley, A. James ;
Barhydt, Nancy R. .
HEALTH AFFAIRS, 2007, 26 (06) :1753-1761
[6]   Initiative To Reduce Avoidable Hospitalizations Among Nursing Facility Residents Shows Promising Results [J].
Ingber, Melvin J. ;
Feng, Zhanlian ;
Khatutsky, Galina ;
Wang, Joyce M. ;
Bercaw, Lawren E. ;
Zheng, Nan Tracy ;
Vadnais, Alison ;
Coomer, Nicole M. ;
Segelman, Micah .
HEALTH AFFAIRS, 2017, 36 (03) :441-450
[7]  
Ingber Melvin J., 2016, Evaluation of the Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents: Final Annual Report Project Year 3
[8]   Validity of the nursing diagnosis of relocation stress syndrome [J].
Mallick, MJ ;
Whipple, TW .
NURSING RESEARCH, 2000, 49 (02) :97-100
[9]  
Medicare Payment Advisory Commission (MedPAC), 2018, REP C MED PAYM POL C
[10]  
Office of Inspector General (OIG), 2013, MEDICARE NURSING HOM