Daniel S Stadler1, Brant J Oliver2, Jennifer G Raymond3, George F Routzhan4, Ellen A Flaherty5, James E Stahl6, John A Batsis7, Stephen J Bartels8. 1. General Internal Medicine, Dartmouth Hitchcock Medical Center One Medical Center Drive, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; The Collaboratory for Implementation Science at Dartmouth, Lebanon, NH; Dartmouth Centers for Health & Aging, Lebanon, NH. Electronic address: Daniel.S.Stadler@Hitchcock.org. 2. Geisel School of Medicine at Dartmouth, Hanover, NH; The Collaboratory for Implementation Science at Dartmouth, Lebanon, NH; Dartmouth Centers for Health & Aging, Lebanon, NH; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH. 3. Population Health for D-H Health, Lebanon, NH. 4. General Internal Medicine, Dartmouth Hitchcock Medical Center One Medical Center Drive, Lebanon, NH. 5. General Internal Medicine, Dartmouth Hitchcock Medical Center One Medical Center Drive, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Centers for Health & Aging, Lebanon, NH; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH. 6. General Internal Medicine, Dartmouth Hitchcock Medical Center One Medical Center Drive, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; The Collaboratory for Implementation Science at Dartmouth, Lebanon, NH. 7. General Internal Medicine, Dartmouth Hitchcock Medical Center One Medical Center Drive, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; The Collaboratory for Implementation Science at Dartmouth, Lebanon, NH; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH. 8. The Mongan Institute, Massachusetts General Hospital, Boston, MA.
Abstract
BACKGROUND: Acute health care interventions for residents of skilled nursing facilities (SNFs) are often unwarranted, unwanted, and/or harmful. We describe a provider-focused care model to reduce unwarranted or unwanted acute health care utilization. OBJECTIVE: Assess the capability of the Reducing Avoidable Facility Transfers (RAFT) model to reduce unwanted and unwarranted acute health care utilization among residents in 3 rural SNFs between January 1, 2016 and June 30, 2017. DESIGN: Prospective cohort, pre/post study. SETTING: Three rural SNFs in collaboration with a geriatric practice in a tertiary academic medical center. PARTICIPANTS: Post-acute care (PAC) and long-term care (LTC) residents of 3 rural SNFs. INTERVENTION: RAFT includes the following components: (1) a small team of providers who manage longitudinal care and after hours call; (2) elicitation of advance care plans and preferences regarding acute care; (3) standardized communication process engaging the provider at the identification of an acute care event; (4) a biweekly case review of all emergency department (ED) transfers. MEASURES: ED and hospital utilization. RESULTS: RAFT demonstrated a 35% reduction in monthly ED transfers and a 30.5% reduction in monthly hospitalizations. These reductions were greatest for LTC residents. CONCLUSIONS/IMPLICATIONS: The RAFT approach substantially reduced unwarranted ED and hospital utilization in this study. Results support replication and evaluation in a larger, more diverse setting and population.
BACKGROUND: Acute health care interventions for residents of skilled nursing facilities (SNFs) are often unwarranted, unwanted, and/or harmful. We describe a provider-focused care model to reduce unwarranted or unwanted acute health care utilization. OBJECTIVE: Assess the capability of the Reducing Avoidable Facility Transfers (RAFT) model to reduce unwanted and unwarranted acute health care utilization among residents in 3 rural SNFs between January 1, 2016 and June 30, 2017. DESIGN: Prospective cohort, pre/post study. SETTING: Three rural SNFs in collaboration with a geriatric practice in a tertiary academic medical center. PARTICIPANTS: Post-acute care (PAC) and long-term care (LTC) residents of 3 rural SNFs. INTERVENTION: RAFT includes the following components: (1) a small team of providers who manage longitudinal care and after hours call; (2) elicitation of advance care plans and preferences regarding acute care; (3) standardized communication process engaging the provider at the identification of an acute care event; (4) a biweekly case review of all emergency department (ED) transfers. MEASURES: ED and hospital utilization. RESULTS: RAFT demonstrated a 35% reduction in monthly ED transfers and a 30.5% reduction in monthly hospitalizations. These reductions were greatest for LTC residents. CONCLUSIONS/IMPLICATIONS: The RAFT approach substantially reduced unwarranted ED and hospital utilization in this study. Results support replication and evaluation in a larger, more diverse setting and population.
Authors: Linda P Fried; Luigi Ferrucci; Jonathan Darer; Jeff D Williamson; Gerard Anderson Journal: J Gerontol A Biol Sci Med Sci Date: 2004-03 Impact factor: 6.053
Authors: D W Molloy; G H Guyatt; R Russo; R Goeree; B J O'Brien; M Bédard; A Willan; J Watson; C Patterson; C Harrison; T Standish; D Strang; P J Darzins; S Smith; S Dubois Journal: JAMA Date: 2000-03-15 Impact factor: 56.272