Question or




Research Design (include tools) and Sample Size

Key Findings

Recommendations and Implications

Rantz, Flesner, Franklin, Galambos, Pudlowski, Pritchett, Alexander, &Lueckenotte, 2015

This study explores staff perceptions in a nursing home that successfully achieved 4 key project goals of Missouri Quality Initiative intervention (MOQI).

Not indicated

Single facility case study using quantitative and qualitative measures

The facility meets MOQI goals. The facility has decreased use of antipsychotic medications. Education was identified as a theme in reducing hospital transfers. INTERACT assessment tools are important parts of MOQI. Clinical skills of nursing staff improved.

Key implementation findings can help guide others as they find ways to accomplish goals. Reducing unnecessary hospitalizations of nursing home residents can be achieved.

Abrahamson, Mueller, Davila, &Arling, 2014

What are the experiences of licensed nursing staff when organizational efforts are made to reduce hospital transfers? How does the role of the nurse as boundary-spanner within an open organizational system influence the nursing staff experience?

Open System model of organizational structure

Semi-structured qualitative interviews; PIPP evaluation; sample size 76 RNs and LPNs within 38 of the 46 nursing home participating in a QI effort. IRB approval obtained prior to initiation of data collection. Data was analyzed and coded using a thematic analysis and inductive category development approach.

Five themes emerged from the data: 1) negotiating the hospitalization decision, 2) increased nurse confidence, 3) working inside the boundary, and 4) working within a system. Findings are consistent with the idea that licensed nursing staff are in an organizational role that requires them to negotiate the boundary between multiple internal and external stakeholders to influence the hospitalization decision.

Further hospitalization reduction efforts would benefit from interventions that seek to reduce the barriers that emerge when nurses are in the position to span the boundary between the nursing home and outside stakeholders.

The Center for Health Workforce Studies, 2014

The study was conducted to better understand the roles and functions of the health workforce responsible for managing patient transitions to and from hospitals and nursing homes.

Not indicated

Qualitative research using case study methodology; convenience sampling; semi-structured interviews. Sample size was 30 telephone and face-to-face interviews from five hospitals and six nursing homes.

Interview participants said the more the healthcare workforces know about the transition process goals, the more they can do to effect positive outcomes. Training “from the bottom up and from the top down” was emphasized.

Staff education is fundamental in efforts to reduce rates of avoidable hospitalizations.

The INTERACT QI program encourages training of staff.

Lamb, Tappen, Diaz, Herndon & Ouslander, 2011

To describe nursing staff perceptions of avoidability of hospital transfers of nursing home clients

Not indicated

Mixed methods qualitative and quantitative analysis of 1347 QI review tools completed by staff at 26 nursing home and transcripts of conference calls; an interprofessional team coded and quantified reasons for hospital transfer on 1347 QI review tools; participants were site coordinators and staff

Nursing home staff rated fewer hospital transfers as avoidable then published estimates. Nursing homes that were more engaged in INTERACT submitted the majority of QI review tools. The percentage of transfers rated avoidable and possibly avoidable was significant at the 0.05 level.

Findings related to the level of engagement of the nursing home with INTERACT may provide useful insights into the process associated with changing perspectives about avoidability in nursing home staff. Future QI initiatives to reduce potentially avoidable acute care transfers from nursing homes will need to be conducted to be effective.

Ouslander, Lamb, Tappen, Herndon, Diaz, Roos, Grabowski, & Bonner, 2011

Does the use of INTERACT II collaborative project reduce hospitalizations from nursing homes?

Not indicated

The INTERACT intervention was conducted as a quality improvement project. Descriptive data were collected on participating nursing homes at project initiation and completion using the Online Survey and Certification and Reporting (OSCAR) file and Nursing Home Compare; 25 nursing homes in 3 states

17% reduction in self-reported hospital admissions from the same 6-month period the year before; a group of 17 of those nursing homes had a 24% reduction, compared with 6% in the group who was not as engaged.

INTERACT should be further evaluated in RCTs to determine its effect on avoidable hospitalizations and their related morbidity and cost. Results are encouraging.