Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL.
Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL.
J Am Med Dir Assoc. 2018 Oct;19(10):907-913.e1. doi: 10.1016/j.jamda.2018.06.017. Epub 2018 Aug 11.
Medicare incentivizes the reduction of hospitalizations of nursing facility (NF) residents. The effects of these incentives on resident safety have not been examined.
Examine safety indicators in NFs participating in a randomized, controlled trial of the INTERACT Quality Improvement Program.
Secondary analysis of a randomized trial in which intervention NFs exhibited a statistically nonsignificant reduction in hospitalizations.
NFs with adequate on-site medical, radiography, laboratory, and pharmacy services, and capability for online training and data input were eligible.
264 NFs randomized into intervention and comparison groups stratified by previous INTERACT use and self-reported hospital readmission rates.
NFs randomized to the intervention group received INTERACT materials, access to online training and a series of training webinars, feedback on hospitalization rates and root-cause analysis data, and monthly telephonic support.
Minimum data set (MDS) data for unintentional weight loss, malnutrition, hip fracture, pneumonia, wound infection, septicemia, urinary tract infection, and falls with injury for the intervention year and the year prior; unintentional weight loss, dehydration, changes in rates of falls, pressure ulcers, severe pain, and unexpected deaths obtained from the NFs participating in the intervention through monthly telephone calls.
No adverse effects on resident safety, and no significant differences in safety indicators between intervention and comparison group NFs were identified, with 1 exception. Intervention NFs with high levels of INTERACT tool use reported significantly lower rates of severe pain.
CONCLUSIONS/IMPLICATIONS: Resident safety was not compromised during implementation of a quality improvement program designed to reduce unnecessary hospitalization of NF residents.
医疗保险鼓励减少疗养院（NF）居民的住院率。这些激励措施对居民安全的影响尚未得到检验。
检查参与 INTERACT 质量改进计划的随机对照试验中 NF 的安全指标。
对一项随机试验的二次分析，其中干预性 NF 的住院率呈统计学上无显著降低。
有足够的现场医疗、放射、实验室和药房服务，以及在线培训和数据输入能力的 NF 符合条件。
264 名 NF 被随机分为干预组和对照组，按之前的 INTERACT 使用情况和自我报告的再入院率分层。
随机分配到干预组的 NF 收到了 INTERACT 材料、在线培训和一系列培训网络研讨会的访问权限、关于住院率和根本原因分析数据的反馈以及每月的电话支持。
干预年度和前一年的意外体重减轻、营养不良、髋部骨折、肺炎、伤口感染、败血症、尿路感染和受伤跌倒的最低数据集（MDS）数据；通过每月电话从参与干预的 NF 获得意外体重减轻、脱水、跌倒率变化、压疮、严重疼痛和意外死亡的情况。
没有对居民安全产生不利影响，也没有发现干预组和对照组 NF 之间的安全指标有显著差异，只有一个例外。高 INTERACT 工具使用率的干预性 NF 报告严重疼痛的发生率显著降低。
结论/意义：在实施旨在减少 NF 居民不必要住院的质量改进计划期间，居民安全未受到损害。
