Life In The Slower Lane

Here is the PICO analysis for the thirty-second uploaded article:

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✅ PICO Analysis

Full Article Title:

Reducing Potentially Preventable Hospital Transfers: Results from a Thirty Nursing Home Collaborative

Type of Study:

Pre–post intervention study (without control group)

Journal and Year:

Journal of the American Medical Directors Association (JAMDA), 2012; 13(6):651–656

DOI: 10.1016/j.jamda.2012.06.011

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P – Population

• Setting:
  • 30 non-profit or public nursing homes in the New York City area
• Participants:
  • Nursing home leadership, clinical staff, certified nursing assistants, physicians, case managers, and social workers
• Resident Demographics:
  • Predominantly Medicaid-funded residents; facilities were larger than national average (mean 377 beds)

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I – Intervention

• Program:
  • INTERACT NY (Interventions to Reduce Acute Care Transfers – New York Collaborative)
  • Implemented as a collaborative quality improvement initiative, involving:
    • Staff education (13 structured sessions across 1 year)
    • INTERACT tools: Early Warning Tool (Stop and Watch), SBAR communication, care paths, transfer documentation, hospital transfer review tools, advance care planning guides
    • Local in-facility implementation with administrative support, quality review, and goal setting
  • Facilities were encouraged to pilot implementation on one post-acute and one long-term care unit

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C – Comparison

• Design:
  • Pre-intervention period: July 2009 – June 2010
  • Post-intervention period: April – September 2011
  • No formal control group
  • Comparisons were made within facilities that reported full pre–post data (n = 18 of 30 facilities)

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O – Outcomes

Primary Outcome:

• Hospital Transfer Rate per 1000 Resident-Days
  • Overall reduction: 10.6% (from 4.07 to 3.64; P = .332) – not statistically significant
  • High-engagement facilities: 14.3% reduction (from 4.19 to 3.59; P = .213)
  • Facilities with high baseline transfer rates: 27.2% reduction (from 7.32 to 5.33; P = .102) 

Secondary Outcomes:

• Tool Uptake:
  • Most implemented: Early Warning Tool (13 homes), SBAR (12), hospital transfer review (9)
  • Facilities implemented on average 5.8 tools (among high-engagement homes)
• Staff Participation:
  • 333 attendees total across 13 training sessions
  • 2000 staff trained locally at participating facilities

Implementation Feedback:

• Effective strategies included:
  • Executive leadership buy-in
  • Clear implementation plans
  • Integration with existing QI processes
  • Interactive training (e.g., simulation, role-play)
• Barriers included:
  • Staff turnover
  • Competing priorities (e.g., regulatory changes)
  • Partial implementation (e.g., on limited units only) 

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Outcome Classification

• Person-centred outcomes:
  • Indirect; goal was to prevent disruptive and unnecessary hospitalisation, maintaining care continuity
• Process outcomes:
  • Tool uptake, interdisciplinary training, improved documentation, and communication processes
• Health system outcomes:
  • Modest (non-significant) reductions in avoidable hospital transfers; greater benefit in high-transfer rate facilities

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Summary Conclusion

This study demonstrated that INTERACT NY—a collaborative, multi-facility quality improvement program—was associated with modest, though statistically non-significant, reductions in hospital transfers from nursing homes. Facilities with higher baseline hospitalisation rates saw the largest improvements (27.2% reduction). The program achieved broad engagement, with widespread staff training and tool adoption, suggesting feasibility and scalability. Key facilitators included executive support, clinical leadership, and integration with QI systems. However, the lack of a control group, incomplete evaluation data, and variable implementation across sites limit the strength of causal inferences. INTERACT appears most effective when implemented comprehensively, especially in high-utilisation settings .

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