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Project OPTIMISTIC is improving outcomes for nursing facility residents

OPTIMISTIC about improved nursing home care

OPTIMISTIC, led by Dr. Kathleen Unroe and Dr. Greg Sachs of Indiana University, aims to improve nursing home care

OPTIMISTIC, led by Dr. Kathleen Unroe and Dr. Greg Sachs of Indiana University, is a Centers for Medicare & Medicaid Services (CMS) demonstration project that aims to improve nursing home care and create better outcomes for residents. Some of the work of OPTIMISTIC is focused on when and why nursing home residents are transferred to hospitals rather than remaining in place. Being transferred to a hospital is disruptive and expensive and, in many cases, is potentially avoidable.

OPTIMISTIC patient with nurse

Patient with OPTIMISTIC nurse

For Unroe and colleagues, it is important to better understand the “avoidable” transfers to improve nursing facility care. To this end, they conducted a study of hospital transfers in 19 nursing facilities in Indiana and presented the results at the 2017 annual meeting of the American Geriatrics Society. The aim of the study was to explore the relationship between symptoms and diagnoses of avoidable conditions and also to identify associations between patient risk factors and diagnoses. To do this work, the team used Indiana CTSI Research Electronic Data Capture (REDCap) service, administered by the Advanced Biomedical Information Technology Core (ABITC) in UITS Research Technologies at IU.

OPTIMISTIC facilities in Indiana

The OPTIMISTIC project has recently been expanded to include more than 40 facilities in Indiana.

The OPTIMISTIC team found that determining whether or not hospital transfers are avoidable is complex. Risk factors such as presence of chronic conditions, dementia, or recent hospital admissions were not predictive of whether a nursing facility resident would be transferred to a hospital. Moreover, having symptoms of illnesses in the nursing facility were only weakly predictive of the hospital diagnosis.