Evaluation of Nursing Facility Resident Safety During Implementation of the INTERACT Quality Improvement Program

Abstract

Background: Medicare incentivizes the reduction of hospitalizations of nursing facility (NF) residents. The effects of these incentives on resident safety have not been examined.

Objective: Examine safety indicators in NFs participating in a randomized, controlled trial of the INTERACT Quality Improvement Program.

Design: Secondary analysis of a randomized trial in which intervention NFs exhibited a statistically nonsignificant reduction in hospitalizations.

Setting: NFs with adequate on-site medical, radiography, laboratory, and pharmacy services, and capability for online training and data input were eligible.

Participants: 264 NFs randomized into intervention and comparison groups stratified by previous INTERACT use and self-reported hospital readmission rates.

Intervention: NFs randomized to the intervention group received INTERACT materials, access to online training and a series of training webinars, feedback on hospitalization rates and root-cause analysis data, and monthly telephonic support.

Measures: Minimum data set (MDS) data for unintentional weight loss, malnutrition, hip fracture, pneumonia, wound infection, septicemia, urinary tract infection, and falls with injury for the intervention year and the year prior; unintentional weight loss, dehydration, changes in rates of falls, pressure ulcers, severe pain, and unexpected deaths obtained from the NFs participating in the intervention through monthly telephone calls.

Results: No adverse effects on resident safety, and no significant differences in safety indicators between intervention and comparison group NFs were identified, with 1 exception. Intervention NFs with high levels of INTERACT tool use reported significantly lower rates of severe pain.

Conclusions/implications: Resident safety was not compromised during implementation of a quality improvement program designed to reduce unnecessary hospitalization of NF residents.

Trial registration: ClinicalTrials.gov NCT02177058.

Keywords: INTERACT; Nursing facilities; nursing facility residents; quality improvement; safety.