Adapting Project RED to Skilled Nursing Facilities

Abstract

This article describes our recommendation for adapting hospital-based RED (Reengineered Discharge) processes to skilled nursing facilities (SNFs). Using focus groups, the SNFs’ discharge processes were assessed twice additionally, research staff then recorded field notes documenting discussions about facility discharge processes as they related to RED processes. Data were systematically analyzed using thematic analysis to identify recommendations for adapting RED to the SNF setting including (a) rapidly identifying, involving, and preparing family/caregivers to implement a patient focused SNF discharge plan; (b) reconnecting patients quickly to primary care providers; and (c) educating patients at discharge about their target health condition, medications, and impact of changes on other chronic health needs. Limited SNF staff capacity and corporate-level policies limited adoption of some key RED components. Transitional care processes such as RED, developed to avoid discharge problems, can be adapted for SNFs to improve their discharges.

Utilizing the care coordination Atlas as a framework: An integrative review of transitional care models

“…This integrative review explored the relationships between the RED and BOOST model components, related them to the CC Atlas activity domains, and identified facilitators and barriers to implementation and associated outcomes across studies in 50 hospitals and 18 skilled nursing facilities. 24–36,43 Similar to other studies in the outpatient setting 18,19 this review reports the utility of the CC Atlas as a framework for analysis of acute hospital and skilled nursing facility CC activities. This review added to what we understand about how the transitional models’ components relate to each other, compare to each other, and mapped to the corresponding CC Atlas activity domain.…”

“…22,23 Yet even leaders who bought into implementation sometimes lacked understanding of the models’ complexity leading to problems, specifically that it took more effort and manpower than expected. 27,30,35,43 Facilities lacking knowledge of their current hospital discharge process experienced more difficulty with implementation. 25,27,34,35,43 The current culture was found to be both a barrier or a facilitator depending on the level of staff buy-in and communication proficiency in their discharge planning workflow across disciplines and departments.…”

“…21 Two widely implemented and tested transitional care models chosen for this review are the RED 15 (See Table 3) and BOOST 23 (Table 4) which were both designed primarily to reduce hospital readmissions, emergency department visits, and adverse outcomes 14,22,23 and have substantial evidence that they reduce 30-day all-cause hospital readmission rates. 16,[24][25][26][27][28][29][30][31][32][33][34][35][36] Although the CC Atlas was used successfully in studies on CC measurement, 18,19 no information is known about how the CC Atlas could be used to explore the components of transitional care models such as the RED and BOOST models. This paper reports the results of an integrative review conducted to better understand how individual components of RED and BOOST might relate to each other within the CC Atlas domains, similarities and differences in component implementation effects, and the models' effects on outcomes.…”

“…The other was excluded because the preprint had already been included in the review. 30 A total of 14 articles were included in this review.…”

Testing Re-Engineered Discharge Program Implementation Strategies in SNFs

“…In multimethod research it is important to report in an integrated way both the qualitative and quantitative strands of studies (Stange et al, 2006). The qualitative strand, reported elsewhere (Popejoy et al, 2020a(Popejoy et al, , 2020b, will be briefly reviewed below to add needed context to the quantitative analysis of utilization outcomes reported in this paper.…”