The Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program: An Overview for Medical Directors and Primary Care Clinicians in Long Term-Care



Unnecessary or avoidable hospitalizations of vulnerable long-term care residents can lead to serious medical complications—even death in certain cases. Such “acute care transfers,” as they are known, also result in millions of dollars of excess health care expenses. With support from The Commonwealth Fund, researchers and experts developed Interventions to Reduce Acute Care Transfers (INTERACT), a publicly available quality improvement program that helps nurse aides and other direct-care staff at long-term care facilities identify, evaluate, and manage acute changes in residents’ medical conditions. The program’s goal is to safely manage clinical situations on site whenever possible, and thus avoid the substantial risks associated with hospital admission.

How Does INTERACT Work?

The INTERACT program has four primary components:

  • Quality improvement tools, including a tracking tool that helps facilities measure hospitalizations and readmissions against benchmark measures.
  • Communication tools, including “Stop and Watch,” which uses simple language to help direct-care staff identify common changes in condition.
  • Decision-support tools that help staff evaluate changes in residents and guide decisions about when to communicate with primary care physicians, when to consider a hospital transfer, and how to manage certain conditions in the facility.
  • Advance care planning tools that help residents and families decide whether a hospital transfer is appropriate and whether other interventions, such as a feeding tube, are called for.


Facilities that have successfully implemented INTERACT share three characteristics: support from executive leadership, a champion who engages direct-care staff, and a culture of quality improvement. More information on INTERACT is available at

Publication Details

Publication Date: July 28, 2014
Authors: Joseph G. Ouslander, Alice Bonner, Laurie Herndon, and Jill Shutes
Contact: Joseph G. Ouslander, Professor of Clinical Biomedical Science and Associate Dean for Geriatric Programs, Charles E. Schmidt College of Biomedical Science, Florida Atlantic University
Summary Writer: Deborah Lorber
J. G. Ouslander, A. Bonner, L. Herndon et al., “The Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program: An Overview for Medical Directors and Primary Care Clinicians in Long-Term Care,” Journal of the American Medical Directors Association, March 2014 15(3)162–70.
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Health Care Delivery

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