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| ID | Type | Description | Link |
|---|---|---|---|
| CIRB 13-10 | Other Identifier | Providence VA Medical Center |
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| Name | Class |
|---|---|
| Providence VA Medical Center | FED |
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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental VA Community Living Centers | Experimental | Eight VA CLCs selected to receive the INTERACT intervention |
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| Control VA Community Living Centers | No Intervention | 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 |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Interventions to Reduce Acute Care Transfers | Other | Experimental CLCs were trained in INTERACT QI Intervention, containing tools, strategies and educational resources designed to catch and manage acute changes in conditions early that a Veteran may be experiencing, leading to a potential reduction in preventable hospital transfers from CLCs. |
| Measure | Description | Time Frame |
|---|---|---|
| Hospital Admissions Per Person Year Alive Measured at the Facility Month Level | hospital admissions from nursing home per person year at risk of being hospitalized calculated for each of the 16 facilities per month of observation during the 18 months of the active study and 18 months preceding introduction of the intervention in the experimental facilities. This measure is constructed from EMR data and not from a scale. | 36 months |
| Measure | Description | Time Frame |
|---|---|---|
| Potentially Avoidable Hospitalizations | Potentially avoidable hospitalization per person year alive aggregated to the facility level. These hospitalizations are a sub-set of all hospitalizations based upon an AHRQ algorithm frequently referenced in the literature. | 18 months followup during observation period. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Vincent Mor, PhD | Providence VA Medical Center, Providence, RI | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Providence VA Medical Center, Providence, RI | Providence | Rhode Island | 02908-4734 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28988835 | Result | Mochel AL, Henry ND, Saliba D, Phibbs CS, Ouslander JG, Mor V. INTERACT in VA Community Living Centers (CLCs): Training and Implementation Strategies. Geriatr Nurs. 2018 Mar-Apr;39(2):212-218. doi: 10.1016/j.gerinurse.2017.09.002. Epub 2017 Oct 5. | |
| 34085597 | Result | Mochel AL, Holle CL, Rudolph JL, Ouslander JG, Saliba D, Mor V, Mittman BS. Influencing Factors Associated with Implementation of INTERACT (Interventions to Reduce Acute Care Transfers) in VA Community Living Centers (CLCs) Using the Consolidated Framework. J Aging Soc Policy. 2022 Sep 3;34(5):673-689. doi: 10.1080/08959420.2021.1926862. Epub 2021 Jun 4. |
| Label | URL |
|---|---|
| Related Info | View source |
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All Veterans admitted to any of the eight experimental and eight control facilities (VA Community Living Centers) during the study timeframe, January 2016 - December 2017.
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| ID | Title | Description |
|---|---|---|
| FG000 | Experimental VA Community Living Centers | Eight VA CLCs selected to receive the INTERACT intervention Interventions to Reduce Acute Care Transfers: Experimental CLCs were trained in INTERACT QI Intervention, containing tools, strategies and educational resources designed to catch and manage acute changes in conditions early that a Veteran may be experiencing, leading to a potential reduction in preventable hospital transfers from CLCs. |
| FG001 | Control VA Community Living Centers | 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 |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Experimental VA Community Living Centers | Eight VA CLCs selected to receive the INTERACT intervention Interventions to Reduce Acute Care Transfers: Experimental CLCs were trained in INTERACT QI Intervention, containing tools, strategies and educational resources designed to catch and manage acute changes in conditions early that a Veteran may be experiencing, leading to a potential reduction in preventable hospital transfers from CLCs. |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Hospital Admissions Per Person Year Alive Measured at the Facility Month Level | hospital admissions from nursing home per person year at risk of being hospitalized calculated for each of the 16 facilities per month of observation during the 18 months of the active study and 18 months preceding introduction of the intervention in the experimental facilities. This measure is constructed from EMR data and not from a scale. | Posted | Mean | Standard Error | hospitalizations per person year alive | 36 months |
|
Adverse event data were collected during the study timeframe (18 Months, introduction of intervention, implementation and monitoring) for the eight experimental CLC Veterans and eight controls
To ensure the safety of Veterans in the CLC and confirm the intervention is not reducing hospitalizations to the detriment of Veterans', we had a safety monitoring plan in place which was reviewed and signed off by the Data Safety Monitoring Board (DSMB) and we generated mortality data for all CLC residents in both INTERACT (experimental) and control facilities, charting changes in mortality rates relative to the historical and contemporary mortality rates of paired facilities.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Experimental VA Community Living Centers | Eight VA CLCs selected to receive the INTERACT intervention Interventions to Reduce Acute Care Transfers: Experimental CLCs were trained in INTERACT QI Intervention, containing tools, strategies and educational resources designed to catch and manage acute changes in conditions early that a Veteran may be experiencing, leading to a potential reduction in preventable hospital transfers from CLCs. |
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Our intervention and control CLCs were not perfectly matched. Due to incomplete implementation of INTERACT in all intervention sites, we acknowledge that this was an incomplete test of the efficacy of the program when properly implemented
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Vincent Mor, Principal Investigator | Providence VAMC | 4012737100 | 6259 | vincent_mor@brown.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 28, 2017 | Dec 23, 2019 | Prot_SAP_000.pdf |
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Pair matched cluster randomized trial; randomization at the provider level.
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Intervention implemented in providers assigned to experimental condition, so all knew they were in a study. Control facilities did not know there was a study underway.
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| BG001 | Control VA Community Living Centers | 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 |
| BG002 | Total | Total of all reporting groups |
| Participants |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race/Ethnicity, Customized | Count of Participants | Participants |
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| Region of Enrollment | Count of Participants | Participants |
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| OG001 | Control VA Community Living Centers | 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 |
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| Secondary | Potentially Avoidable Hospitalizations | Potentially avoidable hospitalization per person year alive aggregated to the facility level. These hospitalizations are a sub-set of all hospitalizations based upon an AHRQ algorithm frequently referenced in the literature. | Posted | Number | 95% Confidence Interval | hospitalizations per person year alive | 18 months followup during observation period. |
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| 0 |
| 3,205 |
| 0 |
| 3,205 |
| 0 |
| 3,205 |
| EG001 | Control VA Community Living Centers | 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 | 0 | 3,338 | 0 | 3,338 | 0 | 3,338 |
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