Project aims to improve nursing home care

(Time Online) Robert Morris University and several area health-care organizations will start work soon on a federally-funded initiative to improve care and reduce avoidable hospital admissions of nursing home residents.

The initiative in western Pennsylvania is being led by UPMC Community Provider Services, which last week was one of seven organizations nationwide to receive a $19 million grant from the Centers for Medicare and Medicaid Services (CMS) to test various models for improving care.

The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, or RAVEN, is aimed at improving care of nursing home residents and reducing costs in the Medicare and Medicaid programs — all goals of the federal Affordable Care Act.

According to CMS estimates, about 45 percent of hospitalizations among Medicaid and Medicare nursing home residents are avoidable and last year cost the nation between $7 billion and $8 billion.

Over the next four years, UPMC, along with Robert Morris, Irwin-based Excela Health, Heritage Valley Health System and the Jewish Healthcare Foundation in downtown Pittsburgh, will implement the project at 16 participating nursing homes in the region, including Beaver County-owned Friendship Ridge in Brighton Township.

RMU professor Joe Angelelli said the project is designed to improve medical assessment by providing on-site nurse practitioners and such technology as telemedicine carts for one-on-one video conferences between physicians and residents.

Angelelli said the process starts with training direct-care workers to identify changes in residents, including such issues as dehydration, infection and heart failure. The concerns can then be communicated to nurses and clinical staff to develop a care plan.

The role being taken by Moon Township-based Robert Morris will be to develop and deliver the additional training directly to nurse practitioners, direct-care staff and others working in the nursing homes.

“This is going to have a bigger effect than just those 16 nursing facilities, because we’re going to be delivering this training that’s going to spread,” said Angelelli, who serves as director of RMU’s Health Services Administration program.

Charles Rhoads, administrator at Friendship Ridge, which represents about 20 percent of the total resident census involved in the western Pennsylvania project, said the facility welcomes the opportunity. He noted positive outcomes from similar interventions and training efforts in the recent past.

“We will have additional clinical expertise available to us, and available to patients, and available to the physicians to assess the patient and make the optimal medical assessment, which is whether to send the patient to the hospital or not, especially on off hours,” Rhoads said.

Angelelli said the project participants will work closely not only with the nursing homes, but also with the health-care providers and hospitals that serve them — including Heritage Valley Beaver — in order to improve communication across the spectrum on such issues as medication management.

Another large piece of the project will include providing end-of-life discussions and planning and support for patients choosing palliative care, Angelelli said.

“Staff may have some discussions around end-of-life when people come into nursing homes, but by a year later, their needs may have changed,” Angelelli said. “A big role of the nurse practitioners is going to be participating in these regular care plan meetings and revisiting the end-of-life plan meetings.”

Besides UPMC, other recipients of RAVEN awards include the Alabama Quality Assurance Foundation, Alegent Health of Nebraska, the Curators of the University of Missouri, Greater New York Hospital Foundation, HealthInsight of Nevada and Indiana University.