Indiana University Center for Aging Research, Regenstrief Institute Incorporated, Indianapolis.
Department of Community and Health Systems, School of Nursing, Indiana University, Indianapolis.
Gerontologist. 2020 Nov 23;60(8):1566-1574. doi: 10.1093/geront/gnaa041.
To identify the implementation barriers, facilitators, and conditions associated with successful outcomes from a clinical demonstration project to reduce potentially avoidable hospitalizations of long-stay nursing facility residents in 19 Indiana nursing homes.
Optimizing Patient Transfers, Impacting Medical quality, Improving Symptoms-Transforming Institutional Care (OPTIMISTIC) is a multicomponent intervention that includes enhanced geriatric care, transition support, and palliative care. The configurational analysis was used to analyze descriptive and quantitative data collected during the project. The primary outcome was reductions in hospitalizations per 1,000 eligible resident days.
Analysis of barriers, facilitators, and conditions for success yielded a model with 2 solution pathways associated with a 10% reduction in potentially avoidable hospitalizations per 1,000 resident days: (a) lower baseline hospitalization rates and investment of senior management; or (b) turnover by the director of nursing during the observation period. Conditions for success were similar for a 20% reduction, with the addition of increased resident acuity.
Key conditions for successful implementation of the OPTIMISTIC intervention include strong investment by senior leadership and an environment in which baseline hospitalization rates leave ample room for improvement. Turnover in the position of director of nursing also linked to successful implementation; this switch in leadership may represent an opportunity for culture change by bringing in new perspectives and viewpoints. These findings help define the conditions for the successful implementation of the OPTIMISTIC model and have implications for the successful implementation of interventions in the nursing facility more generally.
确定在印第安纳州 19 家养老院中，通过一项临床示范项目减少长期护理机构居民潜在可避免住院的实施障碍、促进因素和成功结果相关条件。该项目旨在减少长期护理机构居民潜在可避免住院的次数。
优化患者转移，影响医疗质量，改善症状转化机构护理（OPTIMISTIC）是一个多组分干预措施，包括强化老年护理、过渡支持和姑息治疗。配置分析用于分析项目期间收集的描述性和定量数据。主要结果是每 1000 名符合条件的居民住院天数减少。
对成功的障碍、促进因素和条件的分析产生了一个模型，其中有 2 条解决方案途径与每 1000 名居民住院天数减少 10%相关：（a）较低的基线住院率和高级管理层的投资；或（b）在观察期间护理主任离职。成功的条件对于每 1000 名居民住院天数减少 20%是相似的，增加了居民的严重程度。
OPTIMISTIC 干预措施成功实施的关键条件包括高级领导层的大力投资和一个基线住院率有足够改善空间的环境。护理主任的职位更替也与成功实施相关；这种领导层的更替可能通过引入新的观点和视角为文化变革提供机会。这些发现有助于确定 OPTIMISTIC 模型成功实施的条件，并对更广泛地在护理机构实施干预措施具有意义。
