Reducing Veterans Hospitalizations From Community Living Centers

Not Applicable

Completed

Conditions: Quality Improvement

Interventions: Other: Interventions to Reduce Acute Care Transfers

Registration Number: NCT04195880

Lead Sponsor: VA Office of Research and Development

Brief Summary: The goal of the project was to implement and evaluate the intervention, Interventions to Reduce Acute Care Transfers (INTERACT) in VHA CLCs, which is designed to improve the care of Veterans using CLCs who experience acute changes in their condition and at the same time reduce their rate of hospitalization.

Detailed Description: The project was designed to show that engagement by frontline CLC staff, in using the INTERACT (VA version of INTERACT) program will identify Veterans' clinical problems earlier, help evaluate and safely initiate management of acute changes in conditions in the CLC, communicate more effectively with physicians about Veterans' conditions, thereby avoiding unnecessary hospitalizations, and provide more emergent hospitalizations when necessary.

The project planned to implement the INTERACT quality improvement program as the intervention in up to 15 randomly selected, pair matched CLCs for a 6 month intensive training period and an additional 12-18 month ongoing follow-up monitoring period.

Additionally, a quantitative and qualitative evaluation of the implementation of the INTERACT intervention was done to characterize the fidelity with which CLCs in the intervention pairs participated in training, engaged in regular conference calls, undertook root cause analyses identifying why hospitalizations occurred and used the tools in which they were trained.

The program's effect is based on three core strategies: 1) enabling front-line NH staff to identify acute conditions early in their course, thereby helping to prevent them from becoming severe enough to require acute hospitalization; 2) providing communication and decision support tools that assist with the safe and effective management of certain conditions in the Community Living Center (CLC) without transfer to the acute hospital; and 3) educating CLC staff in advance care planning and discussions about end-of-life and comfort care plans, and thus increasing the use of advance directives, comfort care measures, and palliative and hospice care as an alternative to hospitalization when appropriate.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 6543

Inclusion Criteria

Veterans in experimental and control CLCs during 18 months during which the INTERAC intervention was implemented.

Exclusion Criteria

Veterans not in participating CLCs

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Experimental VA Community Living Centers	Interventions to Reduce Acute Care Transfers	Eight VA CLCs selected to receive the INTERACT intervention

Primary Outcome Measures

Name	Time	Method
Hospital Admissions Per Person Year Alive Measured at the Facility Month Level	36 months	hospital admissions from nursing home per person year at risk of being hospitalized calculated for each of the 16 facilities per month of observation during the 18 months of the active study and 18 months preceding introduction of the intervention in the experimental facilities. This measure is constructed from EMR data and not from a scale.

Secondary Outcome Measures

Name	Time	Method
Potentially Avoidable Hospitalizations	18 months followup during observation period.	Potentially avoidable hospitalization per person year alive aggregated to the facility level. These hospitalizations are a sub-set of all hospitalizations based upon an AHRQ algorithm frequently referenced in the literature.