Good morning, ProviderNation. INTERACT, the quality improvement program used to help skilled nursing centers cut down on unnecessary hospitalizations, has shown promise for assisted living, too, a new study finds.
With a grant from the fine folks at CMS, researchers with Brookdale Senior Living, the University of North Texas Health Science Center, Florida Atlantic and the University of South Florida found that drilling a slightly modified INTERACT curriculum into staff at assisted living centers reduced the mean number of hospitalizations, 30-day readmissions, emergency room trips, and observation stays. They also slashed the average total cost for every resident’s by nearly $30 per day while the INTERACT experiment was being run, lead researcher and North Texas professor Thomas J. Fairchild tells me.
Fairchild presented his findings last week at the Gerontological Society of America meeting in Orlando, Fla.
“This is the first time, really, that this had been done in assisted living,” Fairchild says. “The challenge of trying to make this idea work is you are really changing the habits of people. And getting them to do that on a consistent basis and trying to get them to appreciate the value of doing it, even there, it was clearly challenging.”
His findings come at a critical time for the profession, Brookdale Chief Medical Officer Kevin O’Neil, MD, says. Acuity is intensifying in assisted living centers, and—especially for large places like Brookdale—the “social model” that gave birth to assisted living is evolving into a more integrated model where providers will have to look out for the social and physical needs of their residents. O’Neil likens INTERACT to a kind of preflight checklist.
“I’m really delighted to see that pilot, who’s probably been doing this for years, remembers everything, still going through the discipline checklist,” he says. “For a vulnerable population like this, it’s really important that we employ safeguards.”
O’Neil co-directed the CMS grant and helped lead the research.
Fairchild says the results show genuine promise that the program is scalable, but he’s still “not naïve” about the challenges providers face in assisted living—especially on a scale such as Brookdale’s. “I think the magnitude of it wasn’t fully appreciated. I mean, you’re trying do this at the same time that the environment you’re in is constantly evolving.”
The key to INTERACT, or any quality improvement program, is communication, O’Neil says.
Getting The Message Across (And Through)
“The system has become pretty fragmented. We don’t have…primary care docs going to the hospitals. We have hospitalists. When it comes to skilled nursing, we actually have a specialty emergency called SNFists, and now there’s a number of physicians where they just go to assisted living and home care settings,” he says. “INTERACT is really a comprehensive program that helps keep information from falling through the cracks.”
The difference between INTERACT and airlines, though, is that everyone in an assisted living center—from part-time cafeteria workers to top executives—is trained to run through their INTERACT checklists, O’Neil says.
“We’re not asking them to diagnose,” he says. “But we need their observations.”
‘Saved That Person’s Life’
Just recently, a housekeeper in the Cleveland area noticed that one of her residents seemed “a little off,” O’Neil recalls. The change wasn’t dramatic, but the housekeeper noticed it. It turned out, the resident had a nasty infection, and if things had gone unchecked for just a couple of hours longer, she might have gone into septic shock, O’Neil says.
“It really saved that person’s life,” he says. “What we’ve found is, the more we train our staff to recognize things early and get the appropriate clinical support…we notice a marked diminution of people having to be sent off to the hospital.”
Turnover remains an obstacle, O’Neil says. It’s hard to keep having to train and retrain.
But, whatever quality program providers adopt, Brookdale has learned a lot from Fairchild’s study, O’Neil says.
“I think the reality is, we’ve got to collect this data,” he says. “This is a vulnerable population and I think the reason we got the grant is because CMS recognized that, even if the assisted living population isn’t an at-risk population for hospitalization, it’s a rising risk population. As these systems start looking at geriatric population health management, assisted living is going to be the next big frontier.
“I think we have an opportunity to really make a difference,” he says.