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Analyzing Hospital Transfers Using INTERACT Acute Care Transfer Tools: Lessons from MOQI.

Lori L Popejoy1, Amy A Vogelsmeier1, Greg L Alexander1

  • 1Sinclair School of Nursing, University of Missouri, Columbia, Missouri.

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Over half of nursing home hospital transfers were avoidable. Improving early detection, communication, and resident preferences can reduce unnecessary transfers, enhancing care quality.

Keywords:
INTERACTavoidable transfersnursing homes

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Area of Science:

  • Gerontology
  • Health Services Research
  • Nursing Home Quality Improvement

Background:

  • Hospital transfers from nursing homes (NHs) are common, but the proportion that is potentially avoidable is not well-characterized.
  • The Missouri Quality Improvement (QI) Initiative (MOQI) utilized the Interventions to Reduce Acute Care Transfers (INTERACT) Acute Transfer Tools (ACTs) to analyze transfer reasons.

Purpose of the Study:

  • To identify factors contributing to potentially avoidable versus unavoidable hospital transfers from NHs.
  • To inform quality improvement (QI) efforts aimed at reducing unnecessary hospitalizations.

Main Methods:

  • Retrospective analysis of 3996 INTERACT ACTs completed by advanced practice registered nurses (APRNs) in 16 Missouri NHs between 2014 and 2016.
  • Descriptive statistics and multivariate logistic regression were used to examine differences and identify predictors of avoidable transfers.

Main Results:

  • 54% of hospital transfers were deemed avoidable.
  • Factors associated with avoidable transfers included delayed detection of symptoms, inadequate discussion of resident/family preferences, and lack of advance care planning.
  • Conditions manageable within the NH were a significant driver of avoidable transfers (OR = 16.63).
  • Unavoidable transfers were associated with bleeding, nausea/vomiting, and explicit resident/family preference for hospitalization.

Conclusions:

  • Reducing avoidable hospital transfers requires enhancing NH capacity to manage acute conditions and improving staff training on early detection and communication.
  • Policy changes supporting the presence and role of APRNs in NHs are crucial for improving resident outcomes and reducing unnecessary transfers.