Life In The Slower Lane

Here is the PICO analysis for the fourth uploaded article:

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✅ PICO Analysis

Full Article Title:

Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) Project

Type of Study:

Qualitative evaluation of a multicomponent intervention (implementation-focused formative evaluation)

Journal and Year:

The Gerontologist (2018); 58(6):1177–1187

DOI: 10.1093/geront/gnx155

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P – Population

• Setting: 19 long-term care facilities (nursing homes) in Indiana, USA
• Participants in evaluation:
  • 23 nursing home staff and leaders
  • 4 primary care providers
  • 10 family members of residents
  • 26 OPTIMISTIC clinical staff (19 RNs and 7 NPs)
• Resident Profile: Long-stay nursing home residents (predominantly older adults with complex health needs)

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I – Intervention

• Name: OPTIMISTIC Project
• Description:A multicomponent clinical demonstration model embedding project-employed Registered Nurses (RNs) and Nurse Practitioners (NPs) within nursing homes to:
  • Reduce avoidable hospitalisations
  • Improve symptom management
  • Conduct in-depth advance care planning (ACP)
  • Deliver staff education and clinical mentorship
  • Implement INTERACT tools (e.g. SBAR, Stop and Watch)
  • Perform polypharmacy reviews, transition visits, and quality improvement initiatives
  • Use ACP frameworks such as Respecting Choices® and complete POST forms

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C – Comparison

• No formal control group within this qualitative implementation evaluation.
• The broader OPTIMISTIC initiative was externally evaluated using matched controls to assess hospitalisation outcomes, but this paper focuses on stakeholder perceptions within the intervention sites.

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O – Outcomes

Primary Outcomes (as perceived by stakeholders):

1. Advance Care Planning (ACP) & POST Implementation
   • Identified as the most effective component
   • Improved clarity on residents’ care goals and reduced unwanted hospitalisations
   • Supported by dedicated RN time and trust with families
2. Symptom and Medication Management
   • Transition visits and polypharmacy reviews seen as effective in reducing readmissions
   • Nurses valued for timely assessments and proactive care
3. Staff Capacity-Building
   • In-service training, bedside mentoring, and role modelling by OPTIMISTIC RNs supported sustained improvements
   • SBAR and other INTERACT tools had mixed feedback—valuable when embedded into culture, but burdensome where poorly implemented
4. Barriers Identified
   • Miscommunication about roles of project staff
   • Staff turnover and inadequate baseline training
   • Resistance from existing leadership or primary care providers
   • Confusion between OPTIMISTIC and other managed care programs
5. Facilitators of Adoption
   • Clinical expertise and availability of RNs/NPs as “extra hands” with time
   • Trusted relationships built with staff and families
   • Flexibility and tailoring to each facility’s needs

Outcome Classification:

• Person-centred outcomes: Enhanced ACP and goal-concordant care
• Process outcomes: Reduced avoidable hospitalisations, improved staff confidence and practice
• Health system outcomes: Estimated Medicare savings of $236–$408 per resident per year; reduction in potentially avoidable hospitalisations by nearly 40% 

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