• J Am Med Dir Assoc · Aug 2019

    Reducing Avoidable Facility Transfers (RAFT): Outcomes of a Team Model to Minimize Unwarranted Emergency Care at Skilled Nursing Facilities.

    • Daniel S Stadler, Brant J Oliver, Jennifer G Raymond, George F Routzhan, Ellen A Flaherty, James E Stahl, John A Batsis, and Stephen J Bartels.
    • General Internal Medicine, Dartmouth Hitchcock Medical Center One Medical Center Drive, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; The Collaboratory for Implementation Science at Dartmouth, Lebanon, NH; Dartmouth Centers for Health & Aging, Lebanon, NH. Electronic address: Daniel.S.Stadler@Hitchcock.org.
    • J Am Med Dir Assoc. 2019 Aug 1; 20 (8): 929-934.

    BackgroundAcute 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.ObjectiveAssess 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.DesignProspective cohort, pre/post study.SettingThree rural SNFs in collaboration with a geriatric practice in a tertiary academic medical center.ParticipantsPost-acute care (PAC) and long-term care (LTC) residents of 3 rural SNFs.InterventionRAFT 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.MeasuresED and hospital utilization.ResultsRAFT demonstrated a 35% reduction in monthly ED transfers and a 30.5% reduction in monthly hospitalizations. These reductions were greatest for LTC residents.Conclusions/ImplicationsThe 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.Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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