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Implementing INTERACT in Veterans Health Administration Community Living Centers: A pragmatic randomized trial.

Vincent Mor^1,2, Debra Saliba^3,4, Orna Intrator^5,6

¹Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA.

Journal of the American Geriatrics Society

|December 4, 2024

Summary

Introducing the Intervention to Reduce Acute Care Transfers (INTERACT) program into VA Community Living Centers (CLCs) did not significantly lower hospitalization rates. Lower inappropriate transfers and higher staffing in CLCs may explain the lack of impact.

Keywords:

INTERACT VA Community Living Centers all‐cause hospitalizations

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Area of Science:

Gerontology
Healthcare Management
Clinical Quality Improvement

Background:

Hospital transfers from VA Community Living Centers (CLCs) are frequent.
The study evaluated the impact of the Intervention to Reduce Acute Care Transfers (INTERACT) program on these transfers.

Purpose of the Study:

To assess the effectiveness of the INTERACT program in reducing hospitalizations from VA CLCs.
To analyze changes in potentially inappropriate and preventable transfer decisions.

Main Methods:

A cluster randomized trial was conducted across 16 pair-matched VA CLCs.
Intervention CLC staff received training on INTERACT tools, with one tool integrated into the VA Electronic Medical Record.
Bi-weekly support calls were provided to intervention staff over 18 months.

Main Results:

Only five of eight intervention CLCs showed substantial engagement with the INTERACT program.
No statistically significant difference in all-cause hospitalization rates was observed between intervention and control CLCs.
Structured record reviews indicated low rates of inappropriate transfer decisions in intervention CLCs both before and after the intervention.

Conclusions:

The INTERACT program did not reduce all-cause hospitalizations in VA CLCs.
VA CLCs exhibited higher hospitalization rates but lower inappropriate transfers compared to community nursing homes.
Factors such as low inappropriate transfer rates and high staffing levels in CLCs may have limited INTERACT's implementation and impact.