Please select the eligibility criteria that correspond to the clinical trial below.
Title: Implementing Interventions to Reduce Hospitalizations of Nursing Home Residents
Brief Summary: This project directly addresses the national imperative for innovative strategies to improve care for Medicare beneficiaries and reduce health care costs. The overall objective of the proposed project is to improve the care of older individuals who reside in nursing homes (NHs), and at the same time reduce unnecessary Medicare expenditures. This goal will be accomplished by testing a quality improvement program designed to reduce the number of avoidable hospitalizations of NH residents in a randomized controlled trial.

The primary hypotheses to be tested are:

Hypothesis1: Interventions to Reduce Acute Care Transfers (INTERACT) implementation NHs will have a greater reduction in hospitalization rate than the control and monitoring only NHs during the 12-month implementation compared to a 12-month baseline period.

Hypothesis 2: Reductions in Medicare expenditures for hospitalizations in the INTERACT implementation NHs will be greater than the estimated costs of implementing the intervention.

Hypothesis 3: The effects of INTERACT on hospitalization rates will be greater among patients on the Medicare skilled benefit for post-acute care, than for long-stay patients.

Hypothesis 4: The effects of INTERACT on hospitalization rates will be greatest among those NHs with higher vs. lower intensity (fidelity) of implementing the program.

Hypothesis 5: There will be a greater reduction in measures of hospitalizations for conditions defined as "potentially preventable" than for other transfers and hospitalizations.

Hypothesis 6: Implementation of INTERACT will not be associated with worsening of relevant quality measures in the participating NHs.


Options:
A: Inclusion Criteria:

* Resident of one of the participating nursing homes
* At least 18 years old
* Written informed consent
* Consent of the guardian for residents who are not legally able to give consent

Exclusion Criteria:

* Persons placed in an institution by order of an authority or court
* Persons who are in a dependent or employment relationship with the investigator
B: Inclusion Criteria:

* \> 40 Beds
* MD, NP or PA available on-site at least 1/week
* Capable of Starting intravenous fluids
* Capable of Providing respiratory treatments
* Capable of Assessing oxygenation status by pulse oximetry
* \< 4 hrs turnaround time for STAT medications ("stat" is an abbreviation of the Latin word statim, meaning "immediately, without delay")
* \< 8 hrs. turnaround time for STAT laboratory tests
* \< 8 hrs. turnaround time for STAT X-rays
* Computers available for online staff training
* Strong support for participation from the facility administrator, director of nursing, and medical director, as well as corporate leadership (for NHs that are part of a corporate chain), as evidenced by a signed agreement before enrollment
* \> 10% 30-day readmission rates

Exclusion Criteria:

* Hospital based
* Having only private pay residents (no Medicare/Medicaid, no Medicare provider number).
* Participation in a project designed specifically to reduce acute care transfers or hospitalization rates (including federal demonstrations)
* Conducting more than one other major quality improvement or research project during the project period which would threaten their ability to fully participate in the trial.
* Specialize in Pediatrics (\> 30 % of patients in NHs are pediatric)
* Specialize in HIV (\> 30 % of patients in NHs are HIV)
* Specialize in Respiratory care with ventilator care (\>30% of patients in NH are in this category)
* Robust INTERACT implementation and/or very low hospitalization rate
* Located in a country outside USA
C: Inclusion Criteria Residents:

* at least one GP visit in recent three months or
* two GP visits in recent 6 months or
* admission to the nursing home during the precedent 6 months independently of documented GP contacts
* at least 18 years of age
* written informed consent by the resident or her/his legal guardian

Inclusion Criteria Nursing Homes:

* minimum size of 40 residents
* written consent provided by the nursing home Manager Prior to randomisation

Exclusion Criteria Residents:

- admission for short term care only

Exclusion Criteria Nursing Homes:

- participation in other projects on interprofessional collaboration.
D: Inclusion Criteria:

* ≥72 years old
* Either have a diagnosis of dementia or have a severe cognitive impairment as judged by the GP
* Are permanently living at the nursing home
* Are prescribed at least one antidepressant with the following ATC-codes

  * Selective serotonin reuptake inhibitors (SSRIs): N06AB10 (Escitalopram); N06AB04 (Citalopram); N06AB08 (Fluvoxamin); N06AB03 (Fluoxetin); N06AB05 (Paroxetin); N06AB06 (Sertralin);
  * Serotonin-Norepinephrine Reuptake inhibitors (SNRIs): N06AX21 (Duloxetin); N06AX16 (Venlafaxin);
  * Tricyclic antidepressants (TCAs): N06AA09 (Amitriptylin); N06AA04 (Clomipramin); N06AA02 (Imipramin); N06AA10 (Nortriptylin); (Dosulepin); N06AA17
  * Noradrenergic and specific serotonergic antidepressants (NaSSAs) / Atypical antidepressants N06AX03 (Mianserin); N06AX11 (Mirtazapin);
  * Monoamine oxidase inhibitors (MAOIs):N06AF01 (Isocarboxazid);
  * Noradrenaline reuptake inhibitor (NARI): N06AX18 (Reboxetin);
  * Other antidepressant with effect on the serotonin-system: N06AX26 (Vortioxetin);
  * Melatonin agonists: N06AX22 (Agomelatin);

Exclusion Criteria:

* They are under treatment of a psychiatrist.
* They are enrolled in another psychopharmacological trial
* There is a suspicion of a current clinical, major depression or suicidal behavior and intentions.
* Receiving end-of-life care

Answer: B