by Dan Osterweil, MD, FACP, CMD

I am very happy to report that the word is spreading through our State... INTERACT works!

More adopters have ventured to incorporate elements of the quality improvement system. In a recent survey of a convenient sample of 12 Nursing facilities in Northern California, we learned that 5 have fully have adopted INTERACT,  4 partially and the rest were trying to learn more about it. These adopters seem to come from chains and had a vested interest in improving performance due to market forces as well as a conviction that quality is good for business.

CALTCM has further expanded its role in training more facilities and pushing the envelope beyond nursing homes (NH).  CALTCM has partnered with SCAN Health Plan to create collaboratives consisting of clusters of NHs and hospitals to not only fully implement the program but also create cross continuum committees, composed of NH and hospital representatives to sustain the process over time, and to gauge its impact on the quality of care transitions between NHs and hospitals and vice versa. The most salient metrics arehospital admission rates.

In August, we conducted a training day co-sponsored by CALTCM, SCAN Health Plan and John Muir Health System to a cluster of NH teams. The fact that many of the participants had a prior notion of what the system consists of allowed us to focus on the new elements in INTERACT III and on implementation strategies.  Each facility came to the workshop with 2 completed unplanned readmission assessed using the INTERACT Investigative Tool. This enriched the exercise on root cause analysis and revealed possible quality improvement opportunities.

The group spent quality time in small working groups, problem-solving and capped off the day with detailed action planning, spelling out their specific objectives with timelines.

Participants committed to participate in bi-weekly coaching sessions over the next 3 months followed by monthly telephonic coaching sessions. The goals of these sessions is to keep the implementation on track, help with problem solving and ensure that implementation momentum is kept .The Health System and the Health Plan committed coaching resources to provide feedback and support the collaborative.

In my mind, this model, previously tested by CALTCM under a grant from CHCF, has promise. We have learned that coaching is critical, as is having more than one Champion per facility. We have also learned that it is critical to keep a timeline of about 6 months to fully implement the program. Each NH has set goals to reduce hospitalizations by about 20% which translates to about 2 readmissions less per month for most participating buildings. We all realize that this may be a high aspiring goal, but as an old Chinese sage once said:  The race for quality has no finish line!

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