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

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.