Overview of the INTERACT Program and Curriculum - Collaborative ...

Overview of the INTERACTProgram and CurriculumINTERACT – definition and goals• INTERACT stands for “Interventions to ReduceAcute Care Transfers”• It is a quality improvement program designed toimprove the care of nursing home residents by:• Identifying situations that commonly result in transfersto the hospital – and working together to manage themeffectively and safely in the nursing home withouttransfer whenever possibleOverview of the INTERACTProgram and CurriculumINTERACT – definition and goals• INTERACT can result in reduced hospital transfersby helping you to:1. Prevent conditions from becoming severe enough torequire hospitalization through early identification andassessment of changes in resident condition2. Manage some conditions in the NH without transfer whenthis is feasible and safe3. Improve advance care planning and the use of palliativecare plans when appropriate as an alternative tohospitalization for some residents2

Overview of the INTERACTProgram and CurriculumINTERACT – definition and goals• The goal of INTERACT is to improve carequality, not to prevent all hospitaltransfers• In fact, INTERACT can result in morerapid transfer of residents who needhospital careOverview of the INTERACTProgram and Curriculum• The INTERACT program was:• Originally developed in a projectsupported by the Center for Medicareand Medicaid Services (CMS)• Revised based on input from staff fromseveral nursing homes and nationalexperts in a project supported by TheCommonwealth Fund3

Overview of the INTERACTProgram and CurriculumINTERACT – definition and goals• The INTERACT program includes clinicaltools, strategies to implement them, andrelated educational resources• The INTERACT program is located on theinternet at:http://interact2.netOverview of the INTERACTProgram and CurriculumINTERACT – definition and goals• INTERACT includes 3 types of tools for you to use in yourdaily work in the nursing home:Communication ToolsCare PathsAdvance Care Planning Tools4

Overview of the INTERACTProgram and CurriculumObjectives of the Tools• Improve management of acutechanges in clinical status:• Identification• Assessment• Treatment in the facility• Documentation• Communication• Internal• With hospitalsCriteria for Tools• Evidence-based• Simple• Feasible and efficient to use• Acceptable to staff• Consistent with federalregulations and guidance forsurveyors• Incorporated into HITapplicationsOverview of the INTERACTProgram and CurriculumINTERACT – definition and goals• The INTERACT tools are designed to help you:1. Identify changes in residents condition2. Evaluate these changes3. Manage some conditions in the nursing home4. Document the changes and how they wereassessed and managed5. Communicate effectively:a. With staff in your nursing homeb. With staff at your local hospitals5

The differentINTERACT toolsare meant to beused together inyour daily work inthe nursing homeOverview of the INTERACTProgram and CurriculumEarly Warning Tool“Stop and Watch”SBAR Communication(Nurse to Physician and/or ER)Acute Change in ConditionGuidance for CommunicationResident Transfer FormNursing Home CapabilitiesINTERACT II ToolsAcute Care Transfer DocumentsCommunication ToolsPocket Cards and Report FormsForm and Progress NoteFile CardsForm completed on transferPre- populated ChecklistEnvelope with Checklisthttp://interact2.net6

Overview of the INTERACTProgram and CurriculumINTERACT II ToolsCare PathsFeverAcute mental status changeSymptoms of LowerRespiratory IllnessSymptoms of CHFSymptoms of UTIDehydrationPostershttp://interact2.netOverview of the INTERACTProgram and CurriculumAdvance Care Planning ToolsIdentifying Residents to Consider forPalliative Care and HospiceAdvance Care Planning CommunicationGuideComfort Care Order SetINTERACT II ToolsPocket CardFile CardsFile CardsAdvance Care Planning TrackingEducational Information for FamiliesFormReprints, Websiteshttp://interact2.net7

Overview of the INTERACTProgram and CurriculumINTERACT II ToolsQuality ImprovementAcute Care Transfer LogForm for tracking hospitaltransfersAcute Care Transfer Review Standard form completedafter transferhttp://interact2.netOverview of the INTERACTProgram and CurriculumImplementation Model in theCommonwealth Fund Grant Collaborative• On site training (part of one day)• Facility-based champion• Collaborative phone calls with up to 10facility champions twice monthly facilitatedby an experienced nurse practitioner• Availability for telephone and email consults• Completion and faxing of QI Review Tools8

Overview of the INTERACTProgram and CurriculumCommonwealth Fund Project ResultsFacilitiesMean Hospitalization Rateper 1000 resident days (SD)PreinterventionDuringInterventionMeanChange (SD)95%ConfidenceIntervalpvalueRelativeReductionAll INTERACTfacilities (N = 25) 3.99 (2.30) 3.32 (2.04) - 0.69 (1.47) -0.08 to -1.30 0.0217%Engaged facilities(N = 17) 4.01 (2.56) 3.13 (2.27) - 0.90 (1.28) -0.23 to -1.56Not engaged facilities(N = 8) 3.96 (1.79) 3.71 (1.53) - 0.26 (1.83) -1.79 to 1.27Comparison facilities(N = 11) 2.69 (2.23) 2.61 (1.82) - 0.08 (0.74) - 0.41 to 0.580.010.690.7224%6%3%Ouslander et al, J Am Geriatr Soc 59:745–753, 2011Overview of the INTERACTProgram and CurriculumCommonwealth Fund Project Results• For a 100-bed NH, the average reduction of 0.69hospitalizations/1000 resident days would result in:• 25 fewer hospitalizations in a year• $125,000 in savings to Medicare Part A (using avery conservative DRG payment of $5,000)• The intervention as implemented in this project cost~ $7,700 per facility• The savings could help support NH infrastructure toimprove care and further reduce avoidable transfers9

Overview of the INTERACTProgram and CurriculumINTERACT Curriculum• 12 sessions• Available online withteleconference support• Power Point presentations withaudio and text• Brief video clips illustratingkey points• Implementation assignments• Reports on training completion• CE’s available for nursesThe development and evaluation of the INTERACT Curriculum has beensupported by a grant from the Retirement Research FoundationOverview of the INTERACTProgram and CurriculumWhy it matters – to you and your facility (1)• INTERACT will help you and facility:• Improve quality of care for your residents• Benefit from tools to help your team worktogether more effectively• Take advantage of everyone’s contributions toresident care10