Session 1c Overview of the INTERACT Program This session is designed for: Certified Nursing...

Session 1cOverview of the INTERACT Program

This session is designed for:

• Certified Nursing Assistants (CNAs)• All non-nursing staff with direct resident contact

such as those working in activities, housekeeping, dietary, and laundry departments

The development and evaluation of the INTERACT quality improvement program have been supported by grants from The Commonwealth Fund

and the Retirement Research Foundation.

The INTERACT Interdisciplinary Team

Joseph Ouslander, MD Florida Atlantic UniversityRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversityJill Shutes, GNP Florida Atlantic UniversityNancy Henry, PhD, GNP Florida Atlantic UniversityMaria Rojido, MD Florida Atlantic UniversitySanya Diaz, MD Florida Atlantic UniversityLaurie Herndon, MSN, GNP-BC Mass Senior Care FoundationJo Taylor, RN, MPH The Carolinas Center for Medical ExcellenceGerri Lamb, PhD, RN, FAAN Arizona State UniversityAnnie Rahman, PhD, MSW USC Davis School of GerontologyDan Osterweil, MD California Association of Long Term Care MedicineMary Perloe, GNP Georgia Medical Care FoundationJohn Schnelle, PhD Vanderbilt UniversitySandra Simmons, PhD Vanderbilt UniversityAlice Bonner, PhD, GNP Center for Medicare and Medicaid Services

In collaboration with participating nursing homes

Overview of the INTERACT Program

What is INTERACT? Why does INTERACT matter to you? How does INTERACT work?

Questions Answered in This Module


“Interventions to Reduce Acute Care Transfers”

What is INTERACT?

A quality improvement program to improve the care of nursing home residents who have

acute changes in condition


The INTERACT Program includes: Tools and how to use them Educational resources

The basic program is located on the internet:

http://interact2.net


Acknowledgement

The INTERACT Program and Tools were initially developed by Joseph G. Ouslander, MD and Mary Perloe, MS, GNP at the Georgia Medical Care Foundation with the support of a contract from the Center for Medicare and Medicaid Services.

The current version of the INTERACT Program, including the INTERACT II Tools, educational materials, and implementation strategies were developed by Drs. Ouslander, Gerri Lamb, Alice Bonner, and Ruth Tappen, and Ms. Laurie Herndon with input from many direct care providers and national experts in a project based at Florida Atlantic University supported by The Commonwealth Fund. The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.

Some materials herein are © Florida Atlantic University 2011. Such materials and the trademark INTERACTTM may be used with the permission of Florida Atlantic University.


Hospital transfers are common,

often result in complications in older NH residents,

and are very expensive.

$$$

Why Does INTERACT Matter?


Hospital transfers Break in continuity of care

Changed routines

New caregivers

New environment





• 1 in 4 patients admitted to a skilled nursing facility are readmitted to the hospital within 30 days.

• Cost of 30 day rehospitalizations is $4.3 billion.

Mor et al. Health Affairs 29: 57-64, 2010


1.Distress and discomfort for resident and family2.Delirium 3.Polypharmacy4.Falls5.Incontinence and catheter use

Hospitalizations can cause many complications.

10 Common Complications of Hospitalization of Older Adults


6. Hospital acquired infections7. Weight loss and poor nutrition8. Immobility9. Loss of function 10. Pressure ulcers

Hospitalizations can cause many complications.

10 Common Complications of Hospitalization of Older Adults


Video Clip

Patient who suffers a complication during an unnecessary hospitalization


Why does this matter?A national perspective

• Some hospital transfers are preventable.

• Care can be improved with fewer complications and less cost.


Why does this matter?A national perspective

Regulations and payment for services provided in the nursing home

are changing.

The INTERACT Program:What is It and Why Does It Matter?Overview of the INTERACT Program

Affordable Care Act is focused on a “triple aim.”

1. Improving care2. Improving health3. Making care affordable

Berwick, DM, Nolan, TW, and Whittington, J. The Triple Aim: Care, Health, and Cost. Health Affairs 27:759-769, 2008.

This presents major opportunities to improve the care of older adults in the U.S.

Health Care Reform

The INTERACT Program:What is It and Why Does It Matter?Overview of the INTERACT Program

Why does this matter to you and your facility?

Improve quality of care for your residents.

Your facility may be able to get more money from Medicare by reducing hospitalizations.

Your facility can take advantage of the opportunities in health care reform


Opportunities for You and Your Facility

The Affordable Care Act requires each facility to have a Quality Assurance and Performance Improvement program (QAPI).

• Reducing hospitalizations safely is new goal for Advancing Excellence in America’s Nursing Homes campaign

(see http://www.nhqualitycampaign.org)


http://www.nhqualitycampaign.org/

What are your experiences?

What do you think are the major causes of unnecessary hospitalizations of residents from the facility or facilities that you work in?


Interventions to Reduce Acute Care Transfers

Is a quality improvement program to improve the care of nursing home residents

with acute changes in condition.


1. Prevents conditions from becoming severe enough for hospitalization through early identification and assessment of changes in resident condition.

2. Manages some conditions in the NH without transfer when this is practical and safe.

3. Improves advance care planning and the use of palliative care instead of hospitalization for some residents.

How does INTERACT Work?


1. Prevents conditions from becoming severe enough for hospitalization through early identification and assessment of changes in resident condition.

Step # 1 means: • Direct care staff identify and report early changes in resident

behavior, appearance, and condition using an Early Warning Tool called STOP and WATCH.

• Nurse completes an assessment and communicates with the physician using a special communication tool called SBAR.

How does INTERACT Work?


The goal of INTERACT is to improve care, not to prevent all hospital transfers.

In fact, INTERACT can help with more rapid transfer of residents who need hospital care.


Sadie Sara Sam

A Tale of Three Siblings


Hospitalized for urinary tract infection and dehydration

Discharged back to the NH after 4 days Re-hospitalized 7 days later for

dehydration and same infection

SadieA 96 year old long-stay NH resident

Avoidable?

INTERACT strategy: Prevent conditions from becoming severe enough to require

hospitalization through early detection and evaluation.


Hospitalized for a lower respiratory infection, but had normal vital signs

Developed delirium in the hospital, fell, fractured her pelvis, and developed a pressure ulcer

Sara (Sadie’s younger sister)A 92 year old long-stay NH resident

Avoidable?

INTERACT strategy: Manage some conditions in the NH without transfer.


Hospitalized for the 4th time in 2 months for aspiration pneumonia related to end-stage Alzheimer’s disease

Transferred to hospice on the day of admission

Sam (Sara and Sadie’s older brother)A 101 year old long-stay NH resident

Avoidable?

INTERACT strategy: Improve advance care planning and the use of palliative care

plans when appropriate instead of hospitalization.


Originally developed in a project supported by the Center for Medicare and Medicaid Services (CMS)

Revised based on input from staff from several nursing homes and national experts in projects supported by The Commonwealth Fund


Communication Tools

Decision Support Tools

Advance Care Planning Tools

Quality Improvement Tools


Use the INTERACT II tools

together in your daily work

http://interact2.net

On site training Facility INTERACT champion Phone calls with facility champions twice a

month Use of QI Review Tools

Commonwealth Fund INTERACT Project


Commonwealth Fund Project Results

FacilitiesReduction in

Hospitalizations

All INTERACT facilities (N = 25)

17%

Engaged facilities (N = 17)

24%

Comparison facilities(N = 11) 3%

Ouslander et al, J Am Geriatr Soc 59:745–753, 2011


Commonwealth Fund Project Results

For a 100-bed NH, this decrease would result in: 25 fewer hospitalizations per year $117,000 in savings

Medicare could share these savings to support NHs to further improve care.

Ouslander et al, J Am Geriatr Soc 59:745–753, 2011


Safe Reduction in Unnecessary Acute Care Transfers

Fewer Complications

Lower CostsHigher Quality


Medline University INTERACT modules The INTERACT website http://interact2.net Other


Educational Resources

http://interact2.net/

Please complete the Quiz and Evaluation If you do not complete them:

You will not receive continuing education credit If your facility is tracking who completes specific

modules, you will not be counted

Quiz and Evaluation



The development and evaluation of the INTERACT quality improvement program and curriculum have been supported by grants from The Commonwealth Fund and the Retirement Research Foundation.

In this module, we have:

Defined and discussed the goals of the INTERACT Program

Provided insights into why the program matters to you and your organization

Shared an overview of the INTERACT Program and tools

Session 1c Overview of the INTERACT Program This session is designed for: Certified Nursing...

Documents

Transcript of Session 1c Overview of the INTERACT Program This session is designed for: Certified Nursing...