PMID- 34030672
OWN - NLM
STAT- MEDLINE
DCOM- 20210527
LR  - 20210528
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 21
IP  - 1
DP  - 2021 May 24
TI  - Facility and resident characteristics associated with variation in nursing home 
      transfers: evidence from the OPTIMISTIC demonstration project.
PG  - 492
LID - 10.1186/s12913-021-06419-y [doi]
LID - 492
AB  - BACKGROUND: Centers for Medicare and Medicaid Services (CMS) funded demonstration 
      project to evaluate financial incentives for nursing facilities providing care 
      for 6 clinical conditions to reduce potentially avoidable hospitalizations 
      (PAHs). The Optimizing Patient Transfers, Impacting Medical Quality, and 
      Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) site tested 
      payment incentives alone and in combination with the successful nurse-led 
      OPTIMISTIC clinical model. Our objective was to identify facility and resident 
      characteristics associated with transfers, including financial incentives with or 
      without the clinical model. METHODS: This was a longitudinal analysis from April 
      2017 to June 2018 of transfers among nursing home residents in 40 nursing 
      facilities, 17 had the full clinical + payment model (1726 residents) and 23 had 
      payment only model (2142 residents). Using CMS claims data, the Minimum Data Set, 
      and Nursing Home Compare, multilevel logit models estimated the likelihood of 
      all-cause transfers and PAHs (based on CMS claims data and ICD-codes) associated 
      with facility and resident characteristics. RESULTS: The clinical + payment model 
      was associated with 4.1 percentage points (pps) lower risk of all-cause transfers 
      (95% confidence interval [CI] - 6.2 to - 2.1). Characteristics associated with 
      lower PAH risk included residents aged 95+ years (- 2.4 pps; 95% CI - 3.8 to 
      - 1.1), Medicare-Medicaid dual-eligibility (- 2.5 pps; 95% CI - 3.3 to - 1.7), 
      advanced and moderate cognitive impairment (- 3.3 pps; 95% CI - 4.4 to - 2.1; 
      - 1.2 pps; 95% CI - 2.2 to - 0.2). Changes in Health, End-stage disease and 
      Symptoms and Signs (CHESS) score above most stable (CHESS score 4) increased the 
      risk of PAH by 7.3 pps (95% CI 1.5 to 13.1). CONCLUSIONS: Multiple resident and 
      facility characteristics are associated with transfers. Facilities with the 
      clinical + payment model demonstrated lower risk of all-cause transfers compared 
      to those with payment only, but not for PAHs.
FAU - Blackburn, Justin
AU  - Blackburn J
AD  - Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard 
      Blvd, RG 5194, Indianapolis, IN, USA. jblackb@iu.edu.
FAU - Balio, Casey P
AU  - Balio CP
AD  - Cecil G. Sheps Center for Health Services Research, University of North Carolina, 
      Chapel Hill, NC, USA.
FAU - Carnahan, Jennifer L
AU  - Carnahan JL
AD  - Indiana University School of Medicine, Indianapolis, IN, USA.
AD  - Regenstrief Institute, Inc, Indianapolis, IN, USA.
FAU - Fowler, Nicole R
AU  - Fowler NR
AD  - Indiana University School of Medicine, Indianapolis, IN, USA.
AD  - Regenstrief Institute, Inc, Indianapolis, IN, USA.
FAU - Hickman, Susan E
AU  - Hickman SE
AD  - Indiana University School of Medicine, Indianapolis, IN, USA.
AD  - Regenstrief Institute, Inc, Indianapolis, IN, USA.
AD  - Indiana University School of Nursing, Indianapolis, IN, USA.
FAU - Sachs, Greg A
AU  - Sachs GA
AD  - Indiana University School of Medicine, Indianapolis, IN, USA.
AD  - Regenstrief Institute, Inc, Indianapolis, IN, USA.
FAU - Tu, Wanzhu
AU  - Tu W
AD  - Department of Biostatistics, Indiana University School of Medicine, Indianapolis, 
      IN, USA.
FAU - Unroe, Kathleen T
AU  - Unroe KT
AD  - Indiana University School of Medicine, Indianapolis, IN, USA.
AD  - Regenstrief Institute, Inc, Indianapolis, IN, USA.
LA  - eng
PT  - Journal Article
DEP - 20210524
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Hospitalization
MH  - Humans
MH  - *Medicare
MH  - *Nursing Homes
MH  - Patient Transfer
MH  - Skilled Nursing Facilities
MH  - United States
PMC - PMC8142645
OTO - NOTNLM
OT  - Avoidable hospitalizations
OT  - Long-term care
OT  - Medicare
OT  - Nursing facility
OT  - Resident characteristics
COIS- Kathleen Unroe is CEO and Founder of Probari, Inc., a program to train nurses to 
      reduce nursing home hospital transfers. All other authors have no conflicts of 
      interest to disclose.
EDAT- 2021/05/26 06:00
MHDA- 2021/05/28 06:00
PMCR- 2021/05/24
CRDT- 2021/05/25 05:49
PHST- 2021/01/26 00:00 [received]
PHST- 2021/04/19 00:00 [accepted]
PHST- 2021/05/25 05:49 [entrez]
PHST- 2021/05/26 06:00 [pubmed]
PHST- 2021/05/28 06:00 [medline]
PHST- 2021/05/24 00:00 [pmc-release]
AID - 10.1186/s12913-021-06419-y [pii]
AID - 6419 [pii]
AID - 10.1186/s12913-021-06419-y [doi]
PST - epublish
SO  - BMC Health Serv Res. 2021 May 24;21(1):492. doi: 10.1186/s12913-021-06419-y.