Virtual care support programs can lower the number of nursing home residents who are unnecessarily hospitalized by 33% and can soothe staffing issues, according to a recent study.  Building trust among all staff is essential to make these programs work.

While an estimated 67% of hospitalizations among nursing home residents could have been avoided, interventions to prevent hospitalizations often require time and dedicated clinical staff—a challenge to nursing homes where staff are stretched thin.

OPTIMISTIC Reduces Hospitalizations

Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) was one of seven “enhanced care & coordination providers” demonstrations the Centers for Medicare & Medicaid Innovation (CMMI) chose as potential models to avoid unnecessary hospitalizations. The program ran from 2012 to 2020.

Initially, nurses gave in-person resident care and worked with nursing home staff to avoid hospitalizations. Nurses helped review medical records and care plans and educate staff on assessing patients and using evidence-based practices, said the study report.

In a virtual program developed in the spring of 2020 and based on OPTIMISTIC’s principles, virtual care nurses received remote access to residents’ electronic medical records and supported facility-based staff through email and Zoom.

OPTIMISTIC reduced potentially avoidable hospitalizations of nursing home residents by 33% and overall hospitalizations of nursing home residents by 20%, according to a news release from Regenstrief Institute, which piloted the follow-on virtual study.

Qualitative Study Offers Keys to Program Success

The nurses’ opinions informed the virtual study results and surfaced three needs for an effective program.

• Professional Interpersonal Relationships: Nurses giving virtual care support and nursing home leaders and clinical staff need to trust one another. To build trust, offer in-person onboarding for virtual program nurses, customize the program for each nursing home, and use a collaborative rather than authoritarian approach when working with nursing home staff.

• Interprofessional Communication: Direct communications between virtual program nurses and nursing home clinical staff about residents’ care needs is essential.

• Access to Medical Record Information: Virtual program nurses need consistent access to timely and complete resident medical records—including nursing home and hospital medical records—to make recommendations that serve residents’ current health status.

Implications for Value-Based Care

“Perceptions of Nurses Delivering Nursing Home Virtual Care Support: A Qualitative Pilot Study” was published in Gerontology and Geriatric Medicine. Results explore ways that telehealth can bridge health care workforce gaps in nursing homes.

The authors note that study results may be especially applicable to nursing homes that participate in accountable care organizations, which focus on patient care management.

McKnight’s Senior Living offers additional insight in “Study finds virtual care cuts avoidable rehospitalizations by 33 percent,” and Skilled Nursing News offers more in “Virtual Care Model Shown to Reduce Nursing Homes’ Avoidable Hospitalizations by 33%.”