session 1c overview of the interact program this session is designed for: certified nursing...
TRANSCRIPT
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
Overview of the INTERACT Program
“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
Overview of the INTERACT Program
The INTERACT Program includes: Tools and how to use them Educational resources
The basic program is located on the internet:
http://interact2.net
Overview of the INTERACT Program
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.
Overview of the INTERACT Program
Hospital transfers are common,
often result in complications in older NH residents,
and are very expensive.
$$$
Why Does INTERACT Matter?
Overview of the INTERACT Program
Hospital transfers Break in continuity of care
Changed routines
New caregivers
New environment
Why Does INTERACT Matter?
Overview of the INTERACT Program
Overview of the INTERACT Program
Why Does INTERACT Matter?
• 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
Overview of the INTERACT Program
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
Overview of the INTERACT Program
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
Overview of the INTERACT Program
Video Clip
Patient who suffers a complication during an unnecessary hospitalization
Overview of the INTERACT Program
Why does this matter?A national perspective
• Some hospital transfers are preventable.
• Care can be improved with fewer complications and less cost.
Overview of the INTERACT Program
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
Overview of the INTERACT Program
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)
Overview of the INTERACT Program
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?
Overview of the INTERACT Program
Interventions to Reduce Acute Care Transfers
Is a quality improvement program to improve the care of nursing home residents
with acute changes in condition.
Overview of the INTERACT Program
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?
Overview of the INTERACT Program
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?
Overview of the INTERACT Program
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.
Overview of the INTERACT Program
Sadie Sara Sam
A Tale of Three Siblings
Overview of the INTERACT Program
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.
Overview of the INTERACT Program
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.
Overview of the INTERACT Program
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.
Overview of the INTERACT Program
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
Overview of the INTERACT Program
Communication Tools
Decision Support Tools
Advance Care Planning Tools
Quality Improvement Tools
Overview of the INTERACT Program
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
Overview of the INTERACT Program
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
Overview of the INTERACT Program
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
Overview of the INTERACT Program
Safe Reduction in Unnecessary Acute Care Transfers
Fewer Complications
Lower CostsHigher Quality
Overview of the INTERACT Program
Medline University INTERACT modules The INTERACT website http://interact2.net Other
Overview of the INTERACT Program
Educational Resources
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
Overview of the INTERACT Program
Overview of the INTERACT Program
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