Hospitalization reduction is aim of nursing home resident study

Improving healthcare, reducing avoidable hospitalizations and increasing access to palliative care are the goals of a nursing home initiative supported by a $13.4 million award from the Centers for Medicare & Medicaid Services (CMS). The OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care) study involves 19 nursing facilities in Central Indiana and was developed by research-clinicians from Indiana University (IU) and the Regenstrief Institute.

"We chose the acronym OPTIMISTIC to set a tone for how we feel about the potential to improve care for this vulnerable population," said the project’s co-director, Kathleen T. Unroe, MD, MHA, in a press release. "Working with the IU School of Nursing and the University of Indianapolis and community partners including nursing homes, we are providing education and training in real-world environments to develop a new model of care, putting increased resources into nursing homes, which we hope will result in system change in Indiana and across the nation."

The study’s underlying goal is to improve care and communication within nursing facilities and between nursing homes and acute care institutions so issues can be caught and managed before it becomes necessary to transport residents to the hospital. Nursing aides working in the 19 nursing homes are trained to recognize warning signs to identify a change in a resident early—for example, that a resident's swollen feet may indicate heart failure. They and the nursing staff also are educated to communicate quickly with the resident's medical team so that appropriate treatment can begin before an issue escalates to a level requiring hospitalization.

"Long-stay nursing facility residents are high-need and high-risk individuals who have gotten little attention in the research arena and have been neglected previously to a great extent by healthcare reform," said Greg A. Sachs, MD, the project’s director. "With OPTIMISTIC, we are working with the residents where they live to improve many aspects of their lives, including chronic disease management—especially for dementia, which affects more than half of long-stay residents—as well as improve the care they receive during the transition process to and from a hospital, when that transfer is necessary."

The study is supported by a project team of IU and Regenstrief geriatrics and palliative care experts along with their nursing facility partners. Specially trained nurses are stationed on site at the 19 nursing facilities to provide direct support to long-stay residents as well as education and training to the staff. Study nurses also lead care management reviews of long-stay patients to optimize chronic disease management, reduce unnecessary medications and clarify care goals. Nurse practitioners cover "pods" of geographically related facilities, providing additional resources and expertise to the onsite nurses.

The study is supported by one of seven cooperative agreement awards nationwide to implement CMS' Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. Other programs are under way in Alabama, Missouri, Nebraska, New York, Nevada and Pennsylvania.

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Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.