OBJECTIVES From 2013 to 2016, the Centers for Medicare and Medicaid Services Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents ("the Initiative") tested a series of clinical interventions and care models, through organizations called Enhanced Care and Coordination Providers (ECCPs), with the goal of reducing avoidable inpatient hospital admissions among long-stay nursing home residents. We identify the effect of the Initiative on the probability and count of acute care transfers [capturing any transfer to the hospital, including hospitalizations (inpatient stays), emergency department visits, and observation stays]. DESIGN We evaluate the effect of the Initiative on the probability and count of all-cause acute care transfers and potentially avoidable acute care transfers and estimate the average effect of the Initiative per resident per year. SETTING AND PARTICIPANTS We use 2011-2016 data from the Centers for Medicare and Medicaid Services Minimum Data Set, version 3.0, nursing home resident assessments linked with Medicare eligibility and enrollment data and Medicare inpatient and outpatient hospital claims. Our sample is limited to Medicare fee-for-service beneficiaries in participating ECCP facilities and a comparison group of long-stay nursing facility residents. METHODS We evaluate the effect of the Initiative on both the probability and count of all-cause acute care transfers and potentially avoidable acute care transfers using difference-in-differences regression models controlling for both resident-level clinical and demographic characteristics as well as facility-level characteristics. RESULTS We found statistically significant evidence of a reduction in both the probability and count of all-cause and potentially avoidable acute care transfers among long-stay nursing facility residents who participated in the Initiative, relative to comparison group residents. CONCLUSIONS AND IMPLICATIONS The clinical interventions and care models implemented by the ECCPs show that by using staff education, facility leadership and physician engagement, and/or clinical assessment and treatment of residents who experienced a change in condition, it is possible to reduce acute care transfers of nursing facility residents. This could lead to better outcomes and reduced cost of care for this vulnerable patient population.

中文翻译：

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减少长期护理机构居民向急症护理机构的转移：2013-2016 年医疗保险和医疗补助服务中心计划的影响

目标 从 2013 年到 2016 年，医疗保险和医疗补助服务中心减少护理机构居民可避免住院的倡议（“倡议”）通过称为增强护理和协调提供者 (ECCP) 的组织测试了一系列临床干预和护理模式，目标是减少长期入住疗养院居民中可避免的住院人数。我们确定了该倡议对急诊转诊的概率和计数的影响 [捕获到医院的任何转诊，包括住院（住院）、急诊科就诊和观察住院]。设计 我们评估了该倡议对全因急症护理转移和可能可避免的急症护理转移的概率和数量的影响，并估计了该倡议对每位居民每年的平均影响。设置和参与者 我们使用来自医疗保险和医疗补助服务中心最低数据集 3.0 版的 2011-2016 年数据、与医疗保险资格和注册数据以及医疗保险住院和门诊医院索赔相关的疗养院居民评估。我们的样本仅限于参与 ECCP 设施的 Medicare 按服务收费受益人和长期护理设施居民的对照组。方法 我们使用控制居民级临床和人口统计学特征以及设施的差异回归模型来评估该倡议对全因急性护理转移和可能可避免的急性护理转移的概率和数量的影响。级特征。结果 我们发现，与对照组居民相比，参与该计划的长期护理机构居民中全因和可能可避免的急性护理转移的概率和数量均有所减少，具有统计学意义。结论和意义 ECCP 实施的临床干预和护理模式表明，通过使用员工教育、设施领导和医生参与，和/或对病情发生变化的居民进行临床评估和治疗，可以减少护理机构居民的紧急护理转移。这可能会为这个脆弱的患者群体带来更好的结果并降低护理成本。