OBJECTIVES The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project led to significant decreases in potentially avoidable hospitalizations of long-stay nursing facility residents in external evaluation. The purpose of this study was to quantify hospitalization risk from the start of the project and describe the heterogeneity of the enrolled facilities in order to better understand the context for successful implementation. DESIGN Pre-post analysis design of a prospective intervention within a single group. SETTING AND PARTICIPANTS A total of 4320 residents in the 19 facilities were included from admission until time to the first hospitalization. MEASURES Data were extracted from Minimum Data Set assessments and linked with facility-level covariates from the LTCFocus.org data set. Kaplan-Meier and Cox proportional hazards regression were used to assess risk of hospitalization during the preintervention period (2011-2012), a "ramp-up" period (2013-2014), and an intervention period (2015-2016). RESULTS The cohort consisted of 4230 long-stay nursing facility residents. Compared with the preintervention period, residents during the intervention period had an increased probability of having no hospitalizations within 1 year, increasing from 0.51 to 0.57, which was statistically significant (P < .001). In adjusted Cox models, the risk of hospitalization was lower in the ramp-up period compared to the pre-period [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.75-0.95] and decreased further during the intervention period (HR 0.74, 95% CI 0.65-0.84). CONCLUSIONS AND IMPLICATIONS As part of a large multisite demonstration project, OPTIMISTIC has successfully reduced hospitalizations. However, this study highlights the magnitude and extent to which results differ across facilities. Implementing the OPTIMISTIC program was associated with a 16% risk reduction after the first 18 months and continued to a final risk reduction of 26% after 5½ years. Although this model of care reduces hospitalizations overall, facility variation should be expected.

中文翻译：

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降低疗养院居民的住院风险：OPTIMISTIC 的效果和设施变化

目标 优化患者转移、影响医疗质量和改善症状：改造机构护理 (OPTIMISTIC) 项目导致在外部评估中长期护理机构居民可能避免的住院治疗显着减少。本研究的目的是从项目开始就量化住院风险，并描述登记设施的异质性，以便更好地了解成功实施的背景。设计 单组内前瞻性干预的事前分析设计。设置和参与者 从入院到首次住院，共有 19 个机构的 4320 名居民被纳入研究。测量数据从最小数据集评估中提取，并与来自 LTCFocus 的设施级协变量相关联。组织数据集。Kaplan-Meier 和 Cox 比例风险回归用于评估干预前（2011-2012）、“加速”期（2013-2014）和干预期（2015-2016）的住院风险。结果 该队列由 4230 名长期入住护理机构的居民组成。与干预前相比，干预期间居民1年内无住院的概率增加，从0.51增加到0.57，具有统计学意义（P < .001）。在调整后的 Cox 模型中，与前期相比，上升期的住院风险较低 [风险比 (HR) 0.85，95% 置信区间 (CI) 0.75-0.95]，并在干预期间进一步降低（ HR 0.74，95% CI 0.65-0.84)。结论和影响 作为大型多站点示范项目的一部分，OPTIMISTIC 已成功减少住院人数。然而，这项研究强调了不同设施结果差异的幅度和程度。实施 OPTIMISTIC 计划与前 18 个月后风险降低 16% 相关，并在 5.5 年后继续降低最终风险 26%。虽然这种护理模式总体上减少了住院治疗，但应该预料到设施的变化。