Reducing Veterans Hospitalizations From Community Living Centers

Quality Improvement Clinical Trial

— INTERACT  

Official title:

Implementing and Evaluating INTERACT in VA CLCs

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04195880
• Other study ID #: CRE 12-025
• Secondary ID: CIRB 13-10
• Status: Completed
• Phase: N/A
• Start date: January 1, 2016
• Est. completion date: June 1, 2018

Study information

• Verified date: July 2023
• Source: VA Office of Research and Development
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of the project was to implement and evaluate the intervention, Interventions to Reduce Acute Care Transfers (INTERACT) in VHA CLCs, which is designed to improve the care of Veterans using CLCs who experience acute changes in their condition and at the same time reduce their rate of hospitalization.

Description:

The project was designed to show that engagement by frontline CLC staff, in using the INTERACT (VA version of INTERACT) program will identify Veterans' clinical problems earlier, help evaluate and safely initiate management of acute changes in conditions in the CLC, communicate more effectively with physicians about Veterans' conditions, thereby avoiding unnecessary hospitalizations, and provide more emergent hospitalizations when necessary. The project planned to implement the INTERACT quality improvement program as the intervention in up to 15 randomly selected, pair matched CLCs for a 6 month intensive training period and an additional 12-18 month ongoing follow-up monitoring period. Additionally, a quantitative and qualitative evaluation of the implementation of the INTERACT intervention was done to characterize the fidelity with which CLCs in the intervention pairs participated in training, engaged in regular conference calls, undertook root cause analyses identifying why hospitalizations occurred and used the tools in which they were trained. The program's effect is based on three core strategies: 1) enabling front-line NH staff to identify acute conditions early in their course, thereby helping to prevent them from becoming severe enough to require acute hospitalization; 2) providing communication and decision support tools that assist with the safe and effective management of certain conditions in the Community Living Center (CLC) without transfer to the acute hospital; and 3) educating CLC staff in advance care planning and discussions about end-of-life and comfort care plans, and thus increasing the use of advance directives, comfort care measures, and palliative and hospice care as an alternative to hospitalization when appropriate.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 6543
• Est. completion date: June 1, 2018
• Est. primary completion date: December 1, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Veterans in experimental and control CLCs during 18 months during which the INTERAC intervention was implemented.

Exclusion Criteria:

• Veterans not in participating CLCs

Related Conditions & MeSH terms

• Quality Improvement

Intervention

Other:
• Interventions to Reduce Acute Care Transfers
Experimental CLCs were trained in INTERACT QI Intervention, containing tools, strategies and educational resources designed to catch and manage acute changes in conditions early that a Veteran may be experiencing, leading to a potential reduction in preventable hospital transfers from CLCs.

Locations

Country	Name	City	State
United States	Providence VA Medical Center, Providence, RI	Providence	Rhode Island

Sponsors (2)

Lead Sponsor	Collaborator
VA Office of Research and Development	Providence VA Medical Center

Country where clinical trial is conducted

United States, 

References & Publications (2)

Mochel AL, Henry ND, Saliba D, Phibbs CS, Ouslander JG, Mor V. INTERACT in VA Community Living Centers (CLCs): Training and Implementation Strategies. Geriatr Nurs. 2018 Mar-Apr;39(2):212-218. doi: 10.1016/j.gerinurse.2017.09.002. Epub 2017 Oct 5. — View Citation

Mochel AL, Holle CL, Rudolph JL, Ouslander JG, Saliba D, Mor V, Mittman BS. Influencing Factors Associated with Implementation of INTERACT (Interventions to Reduce Acute Care Transfers) in VA Community Living Centers (CLCs) Using the Consolidated Framewor — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Hospital Admissions Per Person Year Alive Measured at the Facility Month Level	hospital admissions from nursing home per person year at risk of being hospitalized calculated for each of the 16 facilities per month of observation during the 18 months of the active study and 18 months preceding introduction of the intervention in the experimental facilities. This measure is constructed from EMR data and not from a scale.	36 months
Secondary	Potentially Avoidable Hospitalizations	Potentially avoidable hospitalization per person year alive aggregated to the facility level. These hospitalizations are a sub-set of all hospitalizations based upon an AHRQ algorithm frequently referenced in the literature.	18 months followup during observation period.

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