Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations

Peter Huckfeldt, Robert L Kane, Zhiyou Yang, Gabriella Engstrom, Ruth Tappen, Carolina Rojido, David Newman, Bernardo Reyes, Joseph G. Ouslander

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objectives: To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents. Design: Secondary analysis from a randomized controlled trial. Setting: SNFs from across the United States (N=264). Participants: Two hundred of the SNFs from the randomized trial that provided baseline and intervention data on INTERACT use. Interventions: During a 12-month period, intervention SNFs received remote training and support for INTERACT implementation; control SNFs did not, although most control facilities were using various components of the INTERACT program before and during the trial on their own. Measurements: INTERACT use data were based on monthly self-reports for SNFs randomized to the intervention group and pre- and postintervention surveys for control SNFs. Primary outcomes were rates of all-cause hospitalizations, potentially avoidable hospitalizations (PAHs), ED visits without admission, and 30-day hospital readmissions. Results: The 65 SNFs (32 intervention, 33 control) that reported increases in INTERACT use had reductions in all-cause hospitalizations (0.427 per 1,000 resident-days; 11.2% relative reduction from baseline, p<.001) and PAHs (0.221 per 1,000 resident-days; 18.9% relative reduction, p<.001). The 34 SNFs (12 intervention, 22 control) that reported consistently low or moderate INTERACT use had statistically insignificant changes in hospitalizations and ED visit rates. Conclusion: Increased reported use of core INTERACT tools was associated with significantly greater reductions in all-cause hospitalizations and PAHs in both intervention and control SNFs, suggesting that motivation and incentives to reduce hospitalizations were more important than the training and support provided in the trial in improving outcomes. Further research is needed to better understand the most effective strategies to motivate SNFs to implement and sustain quality improvement programs such as INTERACT.

Original languageEnglish (US)
Pages (from-to)1830-1837
Number of pages8
JournalJournal of the American Geriatrics Society
Issue number9
StatePublished - Sep 2018

Bibliographical note

Funding Information:
Conflict of Interest: Dr. Ouslander is a full-time employee of Florida Atlantic University (FAU) and has received support through FAU for research on INTERACT from the National Institutes of Health, the Centers for Medicare and Medicaid Services, the Commonwealth Fund, the Retirement Research Foundation, the Florida Medical Malpractice Joint Underwriting Association, PointClickCare, Medline Industries, and Think Research. Dr. Ouslander and his wife had ownership interest in INTERACT Training, Education, and Management (“I TEAM”) Strategies, LLC, which had a license agreement with FAU for use of INTERACT materials and trademark for training during the time of the study, and now receive royalties from Pathway Health, which currently holds the license. Dr. Ouslander serves as a paid advisor to Pathway Health, Think Research, and Curavi. Work on funded INTERACT research is subject to the terms of Conflict of Interest Management plans developed and approved by the FAU Financial Conflict of Interest Committee. None of the other authors have any conflicts of interests.

Funding Information:
Sponsor’s Role: This study was supported by Grant 1R01NR012936 from the National Institute for Nursing Research and is registered at (Identifier: NCT02177058). Medline Industries provided support for components of an online training program used during the study.


  • potentially avoidable hospitalizations
  • skilled nursing facilities

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