PMID- 35832205
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221210
IS  - 2399-5300 (Electronic)
IS  - 2399-5300 (Linking)
VI  - 6
IP  - 4
DP  - 2022
TI  - The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable 
      Hospital Transfers of Nursing Home Residents.
PG  - igac031
LID - 10.1093/geroni/igac031 [doi]
LID - igac031
AB  - BACKGROUND AND OBJECTIVES: Prior approaches to identifying potentially avoidable 
      hospital transfers (PAHs) of nursing home residents have involved detailed root 
      cause analyses that are difficult to implement and sustain due to time and 
      resource constraints. They relied on the presence of certain conditions but did 
      not identify the specific issues that contributed to avoidability. We developed 
      and tested an instrument that can be implemented using review of the electronic 
      medical record. RESEARCH DESIGN AND METHODS: The OPTIMISTIC project was a Centers 
      for Medicare and Medicaid Services demonstration to reduce avoidable hospital 
      transfers of nursing home residents. The OPTIMISTIC team conducted a series of 
      root cause analyses of transfer events, leading to development of a 27-item 
      instrument to identify common characteristics of PAHs (Stage 1). To refine the 
      instrument, project nurses used the electronic medical record (EMR) to score the 
      avoidability of transfers to the hospital for 154 nursing home residents from 7 
      nursing homes from May 2019 through January 2020, including their overall 
      impression of whether the transfer was avoidable (Stage 2). Each transfer was 
      rated independently by 2 nurses and assessed for interrater reliability with a 
      kappa statistic. RESULTS: Kappa scores ranged from -0.045 to 0.556. After 
      removing items based on our criteria, 12 final items constituted the Avoidable 
      Transfer Scale. To assess validity, we compared the 12-item scale to nurses' 
      overall judgment of avoidability of the transfer. The 12-item scale scores were 
      significantly higher for submissions rated as avoidable than those rated 
      unavoidable by the nurses (mean 5.3 vs 2.6, p < .001). DISCUSSION AND 
      IMPLICATIONS: The 12-item Avoidable Transfer Scale provides an efficient approach 
      to identify and characterize PAHs using available data from the EMR. Increased 
      ability to quantitatively assess the avoidability of resident transfers can aid 
      nursing homes in quality improvement initiatives to treat more acute changes in a 
      resident's condition in place.
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of The 
      Gerontological Society of America.
FAU - Carnahan, Jennifer L
AU  - Carnahan JL
AUID- ORCID: 0000-0001-9964-4735
AD  - Department of Medicine, Division of General Internal Medicine and Geriatrics, 
      Indiana University School of Medicine, Indianapolis, Indiana, USA.
FAU - Unroe, Kathleen T
AU  - Unroe KT
AD  - Department of Medicine, Division of General Internal Medicine and Geriatrics, 
      Indiana University School of Medicine, Indianapolis, Indiana, USA.
FAU - Evans, Russell
AU  - Evans R
AD  - Probari Inc., Indianapolis, Indiana, USA.
FAU - Klepfer, Sarah
AU  - Klepfer S
AD  - Probari Inc., Indianapolis, Indiana, USA.
FAU - Stump, Timothy E
AU  - Stump TE
AD  - Department of Biostatistics, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Monahan, Patrick O
AU  - Monahan PO
AD  - Department of Biostatistics, Indiana University School of Medicine, Indianapolis, 
      Indiana, USA.
FAU - Torke, Alexia M
AU  - Torke AM
AD  - Department of Medicine, Division of General Internal Medicine and Geriatrics, 
      Indiana University School of Medicine, Indianapolis, Indiana, USA.
LA  - eng
GR  - K23 AG062797/AG/NIA NIH HHS/United States
PT  - Journal Article
DEP - 20220511
PL  - England
TA  - Innov Aging
JT  - Innovation in aging
JID - 101703706
PMC - PMC9273404
OTO - NOTNLM
OT  - Care transitions
OT  - Emergency Department
OT  - Geriatrics
OT  - Hospitalization
OT  - Older adults
EDAT- 2022/07/15 06:00
MHDA- 2022/07/15 06:01
PMCR- 2022/05/11
CRDT- 2022/07/14 02:16
PHST- 2021/09/28 00:00 [received]
PHST- 2022/07/14 02:16 [entrez]
PHST- 2022/07/15 06:00 [pubmed]
PHST- 2022/07/15 06:01 [medline]
PHST- 2022/05/11 00:00 [pmc-release]
AID - igac031 [pii]
AID - 10.1093/geroni/igac031 [doi]
PST - epublish
SO  - Innov Aging. 2022 May 11;6(4):igac031. doi: 10.1093/geroni/igac031. eCollection 
      2022.