The goal of OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care) is to avoid unnecessary hospitalizations of patients in long-term care (LTC) facilities and make the necessary transitions to and from hospitals as effective as possible. This is done by improving medical care, enhancing transitional care, and supporting palliative care.
The OPTIMISTIC model is meant to improve care standards in LTC facilities. Supported by project geriatricians and nurse practitioners (NPs), registered nurses (RNs) are placed full-time in a nursing home to extend clinical resources by mentoring nursing staff, implementing evidence-based tools to improve care and communication, and leading efforts in advance care planning. NPs address gaps in clinical coverage through urgent visits, transition of care visits, and in-depth Collaborative Care Reviews. Using a train-the-trainer model, the OPTIMISTIC clinical staff receive extensive training in geriatrics, palliative care and quality improvement.
OPTIMISTIC uses to two fundamental systems in its design. One is a data tracking system that provides collection and management support of patient records. These files are readily accessible and consulted when deciding on courses of action in the future. The second system is an education plan that is comprised of the standards by which clinical staff are trained by the RNs and NPs in each facility. Together, the data and education systems serve as a guide for each OPTIMISTIC facility to follow.
LTC facilities using the OPTIMISTIC model also utilize a new payment model that will reduce overall health care spending for patients without restricting access to care or choice of providers. This new plan provides more Medicare Part B coverage for certain qualifying conditions. Although OPTIMISTIC practitioners are concerned about the whole health of their patients, they focus care on seven key conditions—pneumonia, urinary tract infections (UTI), congestive heart failure (CHF), dehydration, skin ulcers (cellulitis), chronic obstructive pulmonary disease (COPD) and asthma. These conditions receive favorable reimbursement from Medicare, which makes OPTIMISTIC financially feasible for more patients and nursing homes. Overall, the objective is to reduce out-of-pocket spending for patients and package care in a way that allows for more insurance coverage