The impact of nurses' confidence in the GRACE CARE model on improving 30-day readmission rates for geriatric patients

[Audio] The impact of nurses' confidence in the GRACE CARE model on improving 30-day readmission rates for geriatric patients Lori Simsek EBP.

[Audio] Clinical Question & Purpose Why is the 30-day readmission rate on a 20-bed geriatric care unit greater than 45%? Does a specific Nursing Care Model impact the readmission rate? This presentation explores the impact of the GRACE care model on geriatric patient outcomes when nurses are confident in its use. I conducted a study to determine whether a particular model could enhance the confidence of nurses and decrease the rate of readmissions within 30 days..

[Audio] The GRACE Care Model: Purpose As a BC—geriatric RN, I have worked in various medical settings, including large teaching hospitals, community healthcare, corrections, and mental health. Care models cannot be one-size-fits-all in gerontology. This proposal aims to customize a care model to meet the specific needs of geriatric patients. After carefully evaluating different care models, the GRACE care model was implemented in the Acute Care for the Elderly (ACE) 20-bed unit for 30 days with a daily census at 95% to 100% capacity. My lunch and learn sessions provided nursing education on the GRACE care model. All full-time and part-time RNs participated in the demographic and satisfaction surveys, results review, and GRACE education sessions..

[Audio] GRACE Care Model Literature Review The GRACE Care Model consists of a multidisciplinary team that includes experts in nursing, medical, allied health, and social work to promote a collaborative and people-centered approach to patient care for older adults (Counsell et al., 2006). GRACE highlights areas where nurses can gain confidence through education. According to Schubert et al.'s RCT study (2022), proper discharge planning, patient education, a multidisciplinary approach, and home services can reduce readmissions within 30 days..

[Audio] The case manager and unit manager provided statistical data from the EHR for the evidence-based practice (EBP). The Chief Nursing Officer and Quality Improvement approved the study. Fifty patients between the ages of 65 and 80 who used GRACE and Fifty patients who did not use GRACE were evaluated through data analysis and readmission. In total, the data of 100 geriatric patients were analyzed. As an employee of a different unit, I adhere to HIPPA policy. Full-time and part-time RNs participated. Nursing managers and assistants were excluded to gain a consistent bedside perspective. Unit case managers provided data and insight. My lunch and learn sessions provided nursing education on the GRACE care model. All full-time and part-time RNs participated in the demographic and satisfaction surveys, results review, and GRACE education sessions. Purposed Interventions.

[Audio] Project methodology The potentially preventable readmission (PPR) method uses administrative data to identify hospital readmissions that may indicate poor quality of care. The PPR logic determines whether the reason for readmission is clinically related to a prior admission and, therefore, potentially preventable (Brach & Borsky 2020). In the context of assessing readmissions in healthcare, both causality and preventability are evaluated through data. The 30-day readmission rate in a geriatric unit in the EBP hospital was less than 15% using the GRACE care model. The PPR method provides insights into readmission patterns, which can vary based on factors such as severity of illness, age, and mental health diagnoses, and the reliability and validity of this method is established. Quantitative tools and strategies commonly used to address this challenge include patient education and engagement (Polit & Beck, 2022). The case manager and unit manager provided statistical data from the EHR for the evidence-based practice (EBP). Evaluation of the GRACE care model was achieved through Systematic Reviews, Meta-analysis, and a Comparison study of Schubert et al initial RCT in 2016 and their Observational cohort study in 2022. The demographic survey administered to both part-time and full-time nursing staff revealed that 95% of them were unaware of any care model specifically focused on geriatric care, regardless of their cultural background, age, or experience..

[Audio] Dissemination of Plan and Rationale The assessment plan employs qualitative and quantitative approaches to evaluate the effectiveness of the project in the clinician's practice. Quantitative measures will involve the statistical analysis of the primary and secondary outcomes, including the hospital staff satisfaction scores, readmission rates, and patient-reported outcomes. Qualitative methods, such as focus groups or interviews with nurses, healthcare workers, patients, and caregivers, will be used to seek the hindrances, facilitators, and ultimate experiences with the implementation process of the GRACE Care Model..

[Audio] EVIDENCE EVALUATION The case managers on the unit indicated that they believed discharge education and the need for patient services had been addressed during the hospitalization and at daily team meetings. The nursing staff assumed that the case managers were handling these responsibilities. The GRACE care model ensures medication management during hospitalization and with home services to aid in proper administration and avoid polypharmacy among seniors. A significant factor in 30-day readmission rates (Flaherty et al., 2022). The lack of communication between the two groups significantly contributed to high readmission rates. This resulted in the nursing staff's lack of knowledge and poor care coordination between nursing and case management for discharge services. GRACE focuses on a multidisciplinary approach. According to Bandura's self-efficacy theory, nurses' confidence in implementing EBP strategies and care models supports evidence integration into practice, thereby improving healthcare quality (Tucker et al., 2021)..

[Audio] Evaluation Plan The nursing manager, case managers, and the nursing education department have agreed to continue the program for 30 days to see if the readmission rates continue to decrease. A 5-question questionnaire was administered to the nurses on the unit 30 days after the GRACE care model implementation. 100% agreed that they felt more confident speaking to their geriatric patients about discharge planning and coordinating care with a multidisciplinary team..

[Audio] Significance to the field of nursing Because of the improved confidence, interdisciplinary communication, and decrease in 30-day readmission rates, the manager spoke to the nursing clinical educator of the unit to implement the GRACE care model into the orientation process for the unit The QAPI and QI manager attended the results review “Lunch and learn session and were impressed with the information. They will address the implementation of GRACE at the the next administration meeting. Within 30 days, patients who were involved with the GRACE care model showed a decrease in 30-day readmission rates to 28%, while the patients not involved with GRACE maintained the previous statistic at 45 %. I was asked to teach new graduate nurses during there residency to share knowledge and encourage new graduates to continue EBP strategies.

[Audio] INNOVATION The GRACE model is an innovative approach that improves primary care for older patients with complex needs. The GRACE model has been proven in controlled trials and applied in various settings, including home-based primary care. Aims to overcome the limitations of delivering outpatient care to older patients. The innovative approaches are reducing hospital readmissions, improving patient safety, satisfaction, and engagement, and contributing to other positive outcomes (CMS.gov) Improved Quality of Life: GRACE patients reported higher quality of life compared to the control group..

[Audio] references Brach, C., & Borsky, A. (2020). How the U.S. Agency for Healthcare Research and Quality promotes health literate health care. Studies in Health Technology and Informatics, 269, 313–323. https://doi.org/10.3233/SHTI200046. Counsell, S. R., Callahan, C. M., Buttar, A. B., Clark, D. O., & Frank, K. I. (2006). Geriatric resources for assessment and care of elders (GRACE): A new primary care model for low‐income seniors. Journal of the American Geriatrics Society, 54(7), 1136–1141. https://doi.org/10.1111/j.1532-5415.2006.00791.x Tucker, A., Feiring, E., & Kjelsines, A. A. (2021). Geriatric care management for low-income seniors. JAMA Network | Home of JAMA and the Specialty Journals of the American Medical Association. Retrieved March 1, 2024, from https://jamanetwork.com/journals/jama/fullarticle/209717 Polit, D., & Beck, C. (2022). Essentials of nursing research: Appraising evidence for nursing practice (10th ed.). Wolters Kluwer. Schubert, C. C., Myers, L. J., Allen, K., & Counsell, S. R. (2016). Implementing Geriatric Resources for Assessment and Care of Elders (GRACE) Team Care in a Veterans Affairs Medical Center: Lessons learned and effects observed. Journal of the American Geriatrics Society, 64(7), 1503–1509. https://doi.org/10.1111/jgs.14179.