Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms

Transforming Institutional Care (OPTIMISTIC) Project

Mary Ersek, Susan Hickman, Anne C. Thomas, Brittany Bernard, Kathleen Unroe

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Objectives: The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption. Research Design and Methods: Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data. Results: We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities. Discussion and Implications: These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes.

Original languageEnglish (US)
Pages (from-to)1177-1187
Number of pages11
JournalThe Gerontologist
Volume58
Issue number6
DOIs
StatePublished - Nov 3 2018

Fingerprint

Patient Transfer
Nursing Homes
Advance Care Planning
Hospitalization
Patient Care Planning
Nurse Practitioners
Nursing Staff
Primary Health Care
Research Design
Nurses
Interviews
Education

ASJC Scopus subject areas

  • Gerontology
  • Geriatrics and Gerontology

Cite this

Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms : Transforming Institutional Care (OPTIMISTIC) Project. / Ersek, Mary; Hickman, Susan; Thomas, Anne C.; Bernard, Brittany; Unroe, Kathleen.

In: The Gerontologist, Vol. 58, No. 6, 03.11.2018, p. 1177-1187.

Research output: Contribution to journalArticle

@article{552d8beb7ed24ed4a43727bee7657a1e,
title = "Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) Project",
abstract = "Background and Objectives: The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption. Research Design and Methods: Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data. Results: We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities. Discussion and Implications: These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes.",
author = "Mary Ersek and Susan Hickman and Thomas, {Anne C.} and Brittany Bernard and Kathleen Unroe",
year = "2018",
month = "11",
day = "3",
doi = "10.1093/geront/gnx155",
language = "English (US)",
volume = "58",
pages = "1177--1187",
journal = "The Gerontologist",
issn = "0016-9013",
publisher = "Oxford University Press",
number = "6",

}

TY - JOUR

T1 - Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms

T2 - Transforming Institutional Care (OPTIMISTIC) Project

AU - Ersek, Mary

AU - Hickman, Susan

AU - Thomas, Anne C.

AU - Bernard, Brittany

AU - Unroe, Kathleen

PY - 2018/11/3

Y1 - 2018/11/3

N2 - Background and Objectives: The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption. Research Design and Methods: Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data. Results: We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities. Discussion and Implications: These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes.

AB - Background and Objectives: The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption. Research Design and Methods: Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data. Results: We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities. Discussion and Implications: These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes.

UR - http://www.scopus.com/inward/record.url?scp=85056288553&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056288553&partnerID=8YFLogxK

U2 - 10.1093/geront/gnx155

DO - 10.1093/geront/gnx155

M3 - Article

VL - 58

SP - 1177

EP - 1187

JO - The Gerontologist

JF - The Gerontologist

SN - 0016-9013

IS - 6

ER -