JMIR Publications

ABSTRACT

Background:

Reducing avoidable nursing home (NH)-to-hospital transfer of residents with Alzheimer’s Disease and related dementias (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare & Medicaid. NH residents with ADRD have increased risk for hospital transfer due to high incidence of comorbidities, polypharmacy, and progressive loss of language resulting in difficulty communicating. Improving communication among healthcare team members could have considerable impact on reducing avoidable NH-to-hospital transfers.

Objective:

Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using text messages (TMs) and how salient and timely communication can be used to avert poor outcomes of NH residents with ADRD, including hospitalization.

Methods:

This project is a retrospective analysis of data collected from a Centers for Medicare & Medicaid Services (CMS) funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: 1) TMs exchanged among the multidisciplinary team across the seven-year CMS study period (August 2013-September 2020) and 2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in text messages occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD.

Results:

After accounting for inclusion and exclusion criteria, we will analyze over 30,000 text messages pertaining to over 3,600 NH-to-hospital transfers. Development of the 4M ontology is in progress and the three-year project is expected to run until mid-2025.

Conclusions:

To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. Clinical Trial: N/A