Citation
Stadler, Daniel S.; Oliver, Brant J.; Raymond, Jennifer G.; Routzhan, George F.; Flaherty, Ellen A.; Stahl, James E.; Batsis, John A.; & Bartels, Stephen J. (2019). Reducing Avoidable Facility Transfers (RAFT): Outcomes of a Team Model to Minimize Unwarranted Emergency Care at Skilled Nursing Facilities. Journal of the American Medical Directors Association, 20(8), 929-934. PMCID: PMC7008009Abstract
BACKGROUND: Acute health care interventions for residents of skilled nursing facilities (SNFs) are often unwarranted, unwanted, and/or harmful. We describe a provider-focused care model to reduce unwarranted or unwanted acute health care utilization.OBJECTIVE: Assess the capability of the Reducing Avoidable Facility Transfers (RAFT) model to reduce unwanted and unwarranted acute health care utilization among residents in 3 rural SNFs between January 1, 2016 and June 30, 2017.
DESIGN: Prospective cohort, pre/post study.
SETTING: Three rural SNFs in collaboration with a geriatric practice in a tertiary academic medical center.
PARTICIPANTS: Post-acute care (PAC) and long-term care (LTC) residents of 3 rural SNFs.
INTERVENTION: RAFT includes the following components: (1) a small team of providers who manage longitudinal care and after hours call; (2) elicitation of advance care plans and preferences regarding acute care; (3) standardized communication process engaging the provider at the identification of an acute care event; (4) a biweekly case review of all emergency department (ED) transfers.
MEASURES: ED and hospital utilization.
RESULTS: RAFT demonstrated a 35% reduction in monthly ED transfers and a 30.5% reduction in monthly hospitalizations. These reductions were greatest for LTC residents.
CONCLUSIONS/IMPLICATIONS: The RAFT approach substantially reduced unwarranted ED and hospital utilization in this study. Results support replication and evaluation in a larger, more diverse setting and population.
URL
https://doi.org/10.1016/j.jamda.2019.03.010Reference Type
Journal ArticleYear Published
2019Journal Title
Journal of the American Medical Directors AssociationAuthor(s)
Stadler, Daniel S.Oliver, Brant J.
Raymond, Jennifer G.
Routzhan, George F.
Flaherty, Ellen A.
Stahl, James E.
Batsis, John A.
Bartels, Stephen J.