Within the framework of a broader e-health strategy launched a decade ago, in 2015 Switzerland passed a new federal law on patients' electronic health records (EHR). The reform requires hospitals to adopt interoperable EHRs to facilitate data sharing and cooperation among healthcare providers, ultimately contributing to improvements in quality of care and efficiency in the health system. Adoption is voluntary for ambulatories and private practices, that may however be pushed towards EHRs by patients. The latter have complete discretion in the choice of the health information to share. Moreover, careful attention is given to data security issues. Despite good intentions, the high institutional and organisational fragmentation of the Swiss healthcare system, as well as the lack of full agreement with stakeholders on some critical points of the reform, slowed the process of adoption of the law. In particular, pilot projects made clear that the participation of ambulatories is doomed to be low unless appropriate incentives are put in place. Moreover, most stakeholders point at the strategy proposed to finance technical implementation and management of EHRs as a major drawback. After two years of intense preparatory work, the law entered into force in April 2017.

OBJECTIVES Nursing home (NH) residents with complex care needs ask for attentive monitoring of changes and appropriate in‐house decision making. However, access to geriatric expertise is often limited with a lack of geriatricians, general practitioners, and/or nurses with advanced clinical skills, leading to potentially avoidable hospitalizations. This situation calls for the development, implementation, and evaluation of innovative, contextually adapted nurse‐led care models that support NHs in improving their quality of care and reducing hospitalizations by investing in effective clinical leadership, geriatric expertise, and care coordination. DESIGN An effectiveness‐implementation hybrid type 2 design to assess clinical outcomes of a nurse‐led care model and a mixed‐method approach to evaluate implementation outcomes will be applied. The model development, tailoring, and implementation are based on the Consolidated Framework for Implementation Research (CFIR). SETTING NHs in the German‐speaking region of Switzerland. PARTICIPANTS Eleven NHs were recruited. The sample size was estimated assuming an average of .8 unplanned hospitalizations/1000 resident days and a reduction of 25% in NHs with the nurse‐led care model. INTERVENTION The multilevel complex context‐adapted intervention consists of six core elements (eg, specifically trained INTERCARE nurses or evidence‐based tools like Identify, Situation, Background, Assessment and Recommendation [ISBAR]). Multilevel implementation strategies include leadership and INTERCARE nurse training and support. MEASUREMENTS The primary outcomes are unplanned hospitalizations/1000 care days. Secondary outcomes include unplanned emergency department visits, quality indicators (eg, physical restraint use), and costs. Implementation outcomes included, for example, fidelity to the model's core elements. CONCLUSION The INTERCARE study will provide evidence about the effectiveness of a nurse‐led care model in the real‐world setting and accompanying implementation strategies. J Am Geriatr Soc 67:2145–2150, 2019

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ObjectivesReducing nursing home hospitalizations for ambulatory care sensitive conditions (ACSC) has been identified as an opportunity to improve patient well-being and reduce costs. The aim of this study was to identify number of hospitalizations for ACSCs for nursing home residents in a Swiss national sample, examine demographic characteristics of nursing home hospitalizations due to ACSCs, and calculate hospital expenses from these hospitalizations.MethodsUsing merged hospital administrative data with payment data based on diagnosis-related groups (DRGs) for the year 2013, we descriptively examined nursing home residents who were 65 years of age or older and were admitted to an acute care hospital.ResultsApproximately 42% of all nursing home admissions were due to ACSCs. Payments to Swiss hospitals for ACSCs can be estimated at between 89 and 105 million Swiss francs in 2013.ConclusionsA sizable share of hospitalizations for nursing home residents is for ACSCs, and the associated costs are substantial. Programs and policies designed to reduce these potentially avoidable hospitalizations from the nursing home setting could lead to an increased patient well-being and lower costs.Electronic supplementary materialThe online version of this article (10.1007/s00038-019-01294-1) contains supplementary material, which is available to authorized users.

Background: Unplanned nursing home (NH) transfers are burdensome for residents and costly for health systems. Innovative nurse-led models of care focusing on improving in-house geriatric expertise are needed to decrease unplanned transfers. The aim was to test the clinical effectiveness of a comprehensive, contextually adapted geriatric nurse-led model of care (INTERCARE) in reducing unplanned transfers from NHs to hospitals.Franziska Zúñiga and Raphaëlle-Ashley Guerbaai shared first authorship.

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Opening the public health facilities to a privileged private access to all hospital physicians based on patient's ability to pay, as Italy does, could be a source of social inequality in access to care and could probably represent a major obstacle to decreasing waiting times for patients in the standard formal 'free of charge' way of access.