INTERACT quality improvement initiative did not reduce acute care transfers from nursing homes

1. Implementation training and support for the Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement initiative, which offered education and decision support tools to nursing home staff in an attempt to reduce hospital transfers, did not statistically reduce hospitalization rates or emergency department (ED) visits compared to the control group.

2. There was no difference in hospitalization or ED visit rates even when analyzed within the first 30 days after nursing home admission, considered higher-risk days.

Evidence Rating Level: 2 (Good)

Study Rundown: Reducing unnecessary hospital admission and emergency department visits from nursing homes (NH) may help reduce the overall cost to the healthcare system. This study provided nursing homes with training and support to implement the Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement initiative and determined if there was a subsequent reduction in hospital admissions or emergency department (ED) visits.

This randomized implementation project showed that there were non-significant reductions in hospitalization and emergency department visits as compared to control nursing homes. All-cause hospitalizations did not change significantly even when analyzed by high-risk days (0-30 days after NH admission) or lower-risk days (≥ 31 days after NH admission). Strengths of this study included randomized, controlled design of the study, however many of patients from the original cohort had to be excluded because of prior exposure to INTERACT, which may limit the validity of the results.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: The INTERACT Quality Improvement Program: An Overview for Medical Directors and Primary Care Clinicians in Long-Term Care

In-Depth [randomized study]: This large, randomized implementation project was conducted from January 2012 to February 2014 in community nursing homes across the US who had no prior experience with INTERACT. The intervention of interest was INTERACT training and implementation support. Nursing homes were randomized to either receive the implementation training or to receive no information about INTERACT. The outcome of interest was changes in hospitalization and ED visit rates between the pre-intervention (January 2012 to February 2013) and post-intervention (March 2013 to February 2014) periods. Statistical analysis included regression analysis of the pre- and post-intervention periods.

A total of 85 randomly selected nursing homes with no previous INTERACT experience, received the INTERACT training and implementation support and 176 nursing homes were in the control group. In the intervention group, there was a non-significant reduction in hospitalization rates (net difference -0.13 per 1000 resident days; p = 0.25), hospitalizations during the first 30 days after NH admission (net difference -0.37 per 1000 resident days; p = 0.48), hospitalizations during periods ≥31 days after NH admission (net difference, -0.09 per 1000 resident days; p = 0.39), 30-day readmission rates (net change in rate among hospital discharge, -0.01; p = 0.36) and ED visits without admission (net difference, 0.02 per 1000 resident-days; p = 0.83).

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