The current study examined the policy and market context existing in the seven states where the Centers for Medicare & Medicaid Services (CMS) Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents took place. Stakeholder organizations with knowledge of the skilled nursing facility environment but who were not directly involved with the CMS Initiative were interviewed to assess the impact of policies and programs affecting transfers to the hospital from long-term care facilities. Focused interviews were used to identify areas of quality improvement as well as market forces that contributed to hospitalization rates. Interviews were qualitatively coded and emerging patterns and themes were identified. Market pressures were similar across states. Few policies were found that may have affected the Initiative, but most states had regional coalitions focused on improving some aspect of care. When asked what else could be done to reduce hospitalizations among nursing facility residents, participants across the stakeholder organizations suggested greater presence of physicians and nurse practitioners in nursing facilities, better training around behavioral health issues for frontline staff, and more advance care planning and education for families regarding end of life. [Journal of Gerontological Nursing, 48(8), 10–16.]

目前的研究检查了医疗保险和医疗补助服务中心 (CMS) 倡议减少护理机构居民可避免住院的七个州的政策和市场环境。采访了了解专业护理机构环境但未直接参与 CMS 倡议的利益相关者组织，以评估影响从长期护理机构转移到医院的政策和计划的影响。重点访谈被用来确定质量改进的领域以及有助于住院率的市场力量。对访谈进行了定性编码，并确定了新出现的模式和主题。各州的市场压力相似。几乎没有发现可能影响该倡议的政策，但大多数州都有区域联盟，专注于改善某些方面的护理。当被问及还可以采取哪些措施来减少护理机构居民的住院治疗时，利益相关组织的参与者建议在护理机构中增加医生和执业护士的存在，针对一线员工的行为健康问题进行更好的培训，并为护理人员提供更先进的护理计划和教育。关于生命终结的家庭。[ 为家庭提供更多关于临终关怀的预先护理计划和教育。[ 为家庭提供更多关于临终关怀的预先护理计划和教育。[老年护理杂志，48（8），10-16。]