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The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable Hospital Transfers of Nursing Home Residents
BACKGROUND AND OBJECTIVES: Prior approaches to identifying potentially avoidable hospital transfers (PAHs) of nursing home residents have involved detailed root cause analyses that are difficult to implement and sustain due to time and resource constraints. They relied on the presence of certain con...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9273404/ https://www.ncbi.nlm.nih.gov/pubmed/35832205 http://dx.doi.org/10.1093/geroni/igac031 |
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author | Carnahan, Jennifer L Unroe, Kathleen T Evans, Russell Klepfer, Sarah Stump, Timothy E Monahan, Patrick O Torke, Alexia M |
author_facet | Carnahan, Jennifer L Unroe, Kathleen T Evans, Russell Klepfer, Sarah Stump, Timothy E Monahan, Patrick O Torke, Alexia M |
author_sort | Carnahan, Jennifer L |
collection | PubMed |
description | BACKGROUND AND OBJECTIVES: Prior approaches to identifying potentially avoidable hospital transfers (PAHs) of nursing home residents have involved detailed root cause analyses that are difficult to implement and sustain due to time and resource constraints. They relied on the presence of certain conditions but did not identify the specific issues that contributed to avoidability. We developed and tested an instrument that can be implemented using review of the electronic medical record. RESEARCH DESIGN AND METHODS: The OPTIMISTIC project was a Centers for Medicare and Medicaid Services demonstration to reduce avoidable hospital transfers of nursing home residents. The OPTIMISTIC team conducted a series of root cause analyses of transfer events, leading to development of a 27-item instrument to identify common characteristics of PAHs (Stage 1). To refine the instrument, project nurses used the electronic medical record (EMR) to score the avoidability of transfers to the hospital for 154 nursing home residents from 7 nursing homes from May 2019 through January 2020, including their overall impression of whether the transfer was avoidable (Stage 2). Each transfer was rated independently by 2 nurses and assessed for interrater reliability with a kappa statistic. RESULTS: Kappa scores ranged from −0.045 to 0.556. After removing items based on our criteria, 12 final items constituted the Avoidable Transfer Scale. To assess validity, we compared the 12-item scale to nurses’ overall judgment of avoidability of the transfer. The 12-item scale scores were significantly higher for submissions rated as avoidable than those rated unavoidable by the nurses (mean 5.3 vs 2.6, p < .001). DISCUSSION AND IMPLICATIONS: The 12-item Avoidable Transfer Scale provides an efficient approach to identify and characterize PAHs using available data from the EMR. Increased ability to quantitatively assess the avoidability of resident transfers can aid nursing homes in quality improvement initiatives to treat more acute changes in a resident’s condition in place. |
format | Online Article Text |
id | pubmed-9273404 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-92734042022-07-12 The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable Hospital Transfers of Nursing Home Residents Carnahan, Jennifer L Unroe, Kathleen T Evans, Russell Klepfer, Sarah Stump, Timothy E Monahan, Patrick O Torke, Alexia M Innov Aging Special Issue: Translational Research on the Future of U.S. Nursing Home Care BACKGROUND AND OBJECTIVES: Prior approaches to identifying potentially avoidable hospital transfers (PAHs) of nursing home residents have involved detailed root cause analyses that are difficult to implement and sustain due to time and resource constraints. They relied on the presence of certain conditions but did not identify the specific issues that contributed to avoidability. We developed and tested an instrument that can be implemented using review of the electronic medical record. RESEARCH DESIGN AND METHODS: The OPTIMISTIC project was a Centers for Medicare and Medicaid Services demonstration to reduce avoidable hospital transfers of nursing home residents. The OPTIMISTIC team conducted a series of root cause analyses of transfer events, leading to development of a 27-item instrument to identify common characteristics of PAHs (Stage 1). To refine the instrument, project nurses used the electronic medical record (EMR) to score the avoidability of transfers to the hospital for 154 nursing home residents from 7 nursing homes from May 2019 through January 2020, including their overall impression of whether the transfer was avoidable (Stage 2). Each transfer was rated independently by 2 nurses and assessed for interrater reliability with a kappa statistic. RESULTS: Kappa scores ranged from −0.045 to 0.556. After removing items based on our criteria, 12 final items constituted the Avoidable Transfer Scale. To assess validity, we compared the 12-item scale to nurses’ overall judgment of avoidability of the transfer. The 12-item scale scores were significantly higher for submissions rated as avoidable than those rated unavoidable by the nurses (mean 5.3 vs 2.6, p < .001). DISCUSSION AND IMPLICATIONS: The 12-item Avoidable Transfer Scale provides an efficient approach to identify and characterize PAHs using available data from the EMR. Increased ability to quantitatively assess the avoidability of resident transfers can aid nursing homes in quality improvement initiatives to treat more acute changes in a resident’s condition in place. Oxford University Press 2022-05-11 /pmc/articles/PMC9273404/ /pubmed/35832205 http://dx.doi.org/10.1093/geroni/igac031 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Special Issue: Translational Research on the Future of U.S. Nursing Home Care Carnahan, Jennifer L Unroe, Kathleen T Evans, Russell Klepfer, Sarah Stump, Timothy E Monahan, Patrick O Torke, Alexia M The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable Hospital Transfers of Nursing Home Residents |
title | The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable Hospital Transfers of Nursing Home Residents |
title_full | The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable Hospital Transfers of Nursing Home Residents |
title_fullStr | The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable Hospital Transfers of Nursing Home Residents |
title_full_unstemmed | The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable Hospital Transfers of Nursing Home Residents |
title_short | The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable Hospital Transfers of Nursing Home Residents |
title_sort | avoidable transfer scale: a new tool for identifying potentially avoidable hospital transfers of nursing home residents |
topic | Special Issue: Translational Research on the Future of U.S. Nursing Home Care |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9273404/ https://www.ncbi.nlm.nih.gov/pubmed/35832205 http://dx.doi.org/10.1093/geroni/igac031 |
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