Diagnosis is not enough: Predicting avoidable transfers from nursing homes is complex

February 26, 2018, Regenstrief Institute
Kathleen Unroe, MD, MHA is a geriatrician specializing in long-stay nursing home care. She co-directed Phase I of OPTIMISTIC with Greg Sachs, MD and directs Phase II of the study. OPTIMISTIC is an acronym for Optimizing Patient Transfers, Impacting Medical quality and Improving Symptoms: Transforming Institutional Care. Credit: Regenstrief Institute

Treating acutely ill nursing home residents in place and avoiding hospitalizations when possible is better for their health and for the healthcare system. Common diagnoses, such as heart failure or urinary tract infection, are often used to classify whether a hospitalization of a nursing home resident was "potentially avoidable."

But predicting ahead of time which resident transfers will fall into these "potentially avoidable" categories is difficult, according to a new study from the Indiana University Center for Aging Research and the Regenstrief Institute which found that both symptoms and patient risk conditions were only weakly predictive of whether hospitalization would be considered potentially avoidable.

"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 Kathleen Unroe, MD, MHA of the IU Center for Aging Research and the Regenstrief Institute, who led the new study. "What was going on with the patient in the hours leading up to possible transfer? What is the association between current symptoms (fever or cough, for example) and the individual's risk conditions (such as Alzheimer's disease)?

"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," she said. "Multi-component, comprehensive quality improvement efforts like OPTIMISTIC, which embeds specially trained nurses in the facilities have been successful in reducing these transfers. But continued work is needed to understand and recognize true avoidability of these events."

The care of long-term nursing home residents can be fragmented by hospitalizations and re-hospitalizations which are especially burdensome for frail older adults. There is a significant likelihood of reduced functioning and overall negative impact on their health after discharge from the .

Keeping complex patients in the nursing facility is often the right choice according to Dr. Unroe who notes the nursing facility setting—a familiar place with staff and clinicians who know them—can provide a lot of care and may be the patient's best option in many circumstances.

Dr. Unroe, a geriatrician specializing in long-stay , co-directed Phase I of OPTIMISTIC with Greg Sachs, MD and directs Phase II of the study. OPTIMISTIC is an acronym for Optimizing Patient Transfers, Impacting Medical quality and Improving Symptoms: Transforming Institutional Care.

During the four-year initial phase of OPTIMISTIC, IU Center for Aging Research clinician-researchers and partners, including 19 nursing homes, reduced avoidable hospitalizations of long-stay nursing home residents a striking 33 percent, according to an independent evaluation prepared at the request of the Center for Medicare and Medicaid Innovation which funds the OPTIMISTIC study.

The evaluation also found that nearly one in five of all hospitalizations—both avoidable and unavoidable—was eliminated by OPTIMISTIC.

By lowering Medicare expenditures $1589 per nursing home resident per year, OPTIMISITC produced a total Medicare spending reduction of nearly $13.5 million and a net savings of over $3.4 million from 2014 to 2016.

Explore further: OPTIMISTIC lowers long-stay nursing home residents' avoidable hospitalizations by a third

Related Stories

OPTIMISTIC lowers long-stay nursing home residents' avoidable hospitalizations by a third

November 28, 2017
The initial phase of OPTIMISTIC, an innovative program developed and implemented by clinician-researchers from the Indiana University Center for Aging Research and partners to decrease avoidable hospitalizations of long-stay ...

Expanding throughout Indiana, OPTIMISTIC study tests new CMS payment model

January 26, 2017
Indiana University's OPTIMISTIC study has added an additional 25 facilities across Indiana as it expands its efforts to improve the health and health care of long-term nursing home residents.

OPTIMISTIC study: Advance care planning in nursing homes challenging but critical

November 1, 2016
The goal of advance care planning is to ensure that the health care an individual receives is consistent with his or her values and preferences. New research shows the critical need for advance care planning and highlights ...

OPTIMISTIC: New care model to prevent unnecessary hospitalizations of frail older adults

January 8, 2015
A new study from Indiana University and Regenstrief Institute researcher-clinicians reports on the first year of the implementation of OPTIMISTIC, an innovative program they developed and implemented to prevent unnecessary ...

How does it compare? Hospice care at home, at assisted living facility, at nursing home

February 15, 2018
Use of hospice has exploded over the past decades with approximately half of those who die while enrolled in Medicare receiving hospice care. A new study from the Indiana University Center for Aging Research and the Regenstrief ...

OPTIMISTIC study: Unique nurse practitioner role leads to safer care in nursing homes

October 24, 2016
Transfers of nursing home residents to and from the hospital frequently expose these frail, older adults to medication errors and poor follow-up care resulting in near or serious harm to one in four nationwide.

Recommended for you

Widespread declines in life expectancy across high income countries coincide with rising young adult, midlife mortality

August 15, 2018
The ongoing opioid epidemic in the United States is a key contributor to the most recent declines in life expectancy, suggests a study published by The BMJ today.

Diets high in vegetables and fish may lower risk of multiple sclerosis

August 15, 2018
People who consume a diet high in vegetables and fish may have a reduced risk of multiple sclerosis, new research led by Curtin University has found.

Can sleeping too much lead to an early death?

August 15, 2018
A recent study in the Journal of the American Heart Association has led to headlines that will make you rethink your Saturday morning sleep in.

Parental life span predicts daughters living to 90 without chronic disease or disability

August 15, 2018
Researchers at the University of California San Diego School of Medicine report that women whose mothers lived to at least age 90 were more likely to also live to 90, free of serious diseases and disabilities.

Mixing energy drinks with alcohol could enhance the negative effects of binge drinking

August 14, 2018
A key ingredient of energy drinks could be exacerbating some of the negative effects of binge drinking according to a new study.

New study finds fake, low-quality medicines prevalent in the developing world

August 10, 2018
A new study from the University of North Carolina at Chapel Hill found that substandard and falsified medicines, including medicines to treat malaria, are a serious problem in much of the world. In low- and middle-income ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.