While major reforms of the Affordable Care Act, such as those proposed by the Trump administration and Republican leaders in Congress are sure to have an impact on the post-acute and long-term care industry--if passed--by dedicating all our attention to the big "what ifs", we may be ignoring the trees for the forest.
This commentary offers a few examples of successful healthcare delivery pilot studies designed to lower cost and improve outcomes for seniors. Regardless of what happens to federal healthcare reform, they have demonstrated evidence of success and offer best practices that operators can incorporate today without needing a grant from the Centers for Medicare & Medicaid Services (CMS) or a research institution.
Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents
Study: Program evaluation of a CMS pilot study
Publication Source: Health Affairs
Program Design: Seven Enhanced Care and Coordination Provider (ECCP) models in seven states partnered with 143 nursing homes to develop and implement strategies to lower hospitalizations among long-stay residents. The ECCP models were required to hire on-site staff focused on care coordination and communication. The seven ECCP models also hired nursing staff that either provided direct services or training at participating facilities, and employed some elements of the Interventions to Reduce Acute Care Transfers (IMPACT) system. All programs included an emphasis on end-of-life. Facilities did not receive incentive payments based on participation or outcomes.
Best Practices:
Quality Improvement Interventions Designed to Prevent Hospital Readmission
Study: Original investigation of several pilot studies
Publication Source: Journal of the American Medical Association
Study Design: Researchers examined 50 unique pilots aimed at reducing hospital readmissions. Half of the studies considered heart failure patients, while most of the other studies included general populations. The investigation aimed to determine if interventions that target hospital readmissions save health systems money.
Best Practices:
Aerobic Exercise and Dementia
Study: Independent study
Publication Source: British Journal of Sports Medicine
Program Design: Older adults diagnosed with vascular cognitive impairment participated in aerobic exercise three times per week for six months. Study participants completed a functional MRI (fMRI) at the beginning and end of the trial to determine if the addition of exercise resulted in improvements. Patients in the test group were compared to a control group based on their performance on a cognitive test at baseline and at the end of the trial period. Vascular cognitive impairment is the second-most common form of cognitive dysfunction.
Best Practices:
Comprehensive Unit-based Safety Program
Study: Program evaluation of Agency for Healthcare Research and Quality (AHQR) Safety Program for Long-Term Care pilot
Publication Source: AHRQ.gov
Program Design: The Health Research & Education Trust, a research arm of the American Hospital Association, designed an evidence-based process for nursing home staff to follow for residents with catheters. The process was designed to reduce catheter-related infections and other acquired infections. Over 400 nursing homes participated in the pilot study, which included training on the CAUTI Intervention process. Staff were instructed to reduce catheter use, increase hand-washing, use catheters properly, and employ behavioral interventions to improve incontinence care. Participating nursing homes had access to webinars, regular coaching calls, and training sessions.
Best Practices:
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