The IU and Regenstrief clinician-researchers have created “OPTIMISTIC” — “Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care” — a comprehensive four-year initiative that will be targeted to 100-day or longer-stay nursing facilities four counties: 14 facilities in Marion, two each in Hamilton and Johnson and one in Hendricks. The diverse facilities, both for-profit and not-for-profit, are located in a variety of settings, from urban to suburban to near rural.
“Long-stay nursing facility residents are high-need and high-risk individuals who have gotten little attention in the research arena and have been neglected to a great extent by health care reform,” said Greg A. Sachs, M.D., OPTIMISTIC project director and director of the IU School of Medicine’s Division of General Internal Medicine and Geriatrics. Dr. Sachs is also a professor of medicine, an IU Center for Aging Research center scientist and a Regenstrief Institute investigator. “With OPTIMISTIC, we are going to work with the residents where they live to improve many aspects of their lives including chronic disease management — especially for dementia, which affects about half of long-stay residents — as well as improve the care they receive during the transition process to and from a hospital.”
OPTIMISTIC is supported by a project team of IU and Regenstrief geriatrics and palliative care experts along with their nursing facility partners. Specially trained nurses will be stationed on site at the 19 central Indiana nursing facilities to provide direct support to long-stay residents as well as education and training to the staff. OPTIMISTIC nurses also will lead care management reviews of long-stay patients to optimize chronic disease management, reduce unnecessary medications and clarify care goals.
“OPTIMISTIC will be focused on long-term-care goals as well as acute changes in condition. We will be involving the resident, his or her family as well as the health care team in advance-care planning and palliative care — keeping the long-stay resident comfortable through pain management and other symptom relief,” said Project Co-director Kathleen T. Unroe, M.D., MHA, assistant professor of medicine at the IU School of Medicine, IU Center for Aging Research center scientist and Regenstrief Institute investigator.
According to CMS, “nearly two-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled in Medicare. These Medicare-Medicaid enrollees are among the most fragile and chronically ill individuals served by the programs. Research found that approximately 45 percent of hospitalizations among Medicare-Medicaid enrollees receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided. Total costs for these potentially avoidable hospitalizations for Medicare-Medicaid enrollees for 2011 were estimated to be between $7 and 8 billion.”
The interdisciplinary project team includes Arif Nazir, M.D., IU School of Medicine (medical director); Susan E. Hickman, Ph.D., IU School of Nursing (leader of the palliative care component); Ellen Miller, PT, PhD, Center for Aging and Community, University of Indianapolis (leader of the education/training component) and Michael La Mantia, M.D., IU School of Medicine and Regenstrief Institute (leader of the transitions of care component). Laura Holtz of the IU Center for Aging Research and the Regenstrief Institute is project coordinator.
The CMS funding will create 26.5 new jobs in Central Indiana — 18 for registered nurses, six for advance practice nurses and 2.5 for project support personnel.
The award is one of only seven cooperative agreement awards nationwide to implement CMS’ Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents. The initiative is run collaboratively by the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, both created by the Affordable Care Act to improve health care quality and reduce costs in the Medicare and Medicaid programs.
In addition to the award to IU, the six other organizations funded are: