Reducing Veterans Hospitalizations From Community Living Centers (INTERACT)

VA Office of Research and Development

Status: Completed

Conditions: Quality Improvement

Treatments: Other: Interventions to Reduce Acute Care Transfers

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT04195880

CRE 12-025

CIRB 13-10 (Other Identifier)

Details and patient eligibility

About

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.

Full 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.

Enrollment: 6,543 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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6,543 participants in 2 patient groups

Experimental VA Community Living Centers

Experimental group

Description:

Eight VA CLCs selected to receive the INTERACT intervention

Treatment:

Other: Interventions to Reduce Acute Care Transfers

Control VA Community Living Centers

No Intervention group

Description:

Eight CLCs, matched to experiment CLCs, based on size, location to VAMC, and hospitalization rates, did not receive the intervention and continued care as usual