Alliant Quality, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA.
Alliant Quality, Atlanta, GA.
J Am Med Dir Assoc. 2017 Nov 1;18(11):991.e11-991.e15. doi: 10.1016/j.jamda.2017.08.002. Epub 2017 Sep 28.
Identify contextual and implementation factors impacting the effectiveness of an organizational-level intervention to reduce preventable hospital readmissions from affiliated skilled nursing facilities (SNFs).
Observational study of the implementation of Interventions to Reduce Acute Care Transfers tools in 3 different cohorts.
SNFs.
SNFs belonging to 1 of 2 corporate entities and a group of independent SNFs that volunteered to participate in a Quality Improvement Organization (QIO) training program.
Two groups of SNFs received INTERACT II training and technical assistance from corporate staff, and 1 group of SNFs received training from QIO staff.
Thirty-day acute care hospital readmissions from Medicare fee-for-service claims, contextual factors using the Model for Understanding Success in Quality framework.
All 3 cohorts were able to deliver the INTERACT training program to their constituent facilities through regional events as well as onsite technical assistance, but the impact on readmission rates varied. Facilities supported by the QIO and corporation A were able to achieve statistically significant reductions in 30-day readmission rates. A review of contextual factors found that although all cohorts were challenged by staff turnover and workload, corporation B facilities struggled with a less mature quality improvement (QI) culture and infrastructure.
Both corporations demonstrated a strong corporate commitment to implementing INTERACT II, but differences in training strategies, QI culture, capacity, and competing pressures may have impacted the effectiveness of the training. Proactively addressing these factors may help long-term care organizations interested in reducing acute care readmission rates increase the likelihood of QI success.
确定影响降低附属熟练护理机构（SNF）可预防医院再入院的组织层面干预措施效果的背景和实施因素。
在 3 个不同队列中观察性研究干预措施实施情况，以减少急性医疗转院。
SNF。
隶属于 2 家公司实体之一的 SNF 以及自愿参加质量改进组织（QIO）培训计划的一组独立 SNF。
两组 SNF 接受了 INTERACT II 培训和公司员工的技术援助，一组 SNF 接受了 QIO 员工的培训。
来自 Medicare 按服务收费索赔的 30 天急性护理医院再入院率，使用理解质量成功模型的背景因素。
所有 3 个队列都能够通过区域活动以及现场技术援助向其组成设施提供 INTERACT 培训计划，但再入院率的影响不同。由 QIO 和公司 A 支持的设施能够实现 30 天再入院率的统计学显著降低。对背景因素的审查发现，尽管所有队列都面临员工流动和工作量的挑战，但公司 B 的设施在质量改进（QI）文化和基础设施方面存在不成熟的问题。
两家公司都表现出对实施 INTERACT II 的强烈企业承诺，但培训策略、QI 文化、能力和竞争压力方面的差异可能会影响培训的效果。积极解决这些因素可能有助于有兴趣降低急性护理再入院率的长期护理组织提高 QI 成功的可能性。
