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Incorporating INTERACT II Clinical Decision Support Tools into Nursing Home Health Information Technology

The Issue

Interventions to Reduce Acute Care Transfers (INTERACT) is a quality improvement project designed to help reduce rates of unnecessary hospitalizations among nursing home residents. It uses tools to help nursing home staff identify changes in resident's health for six common conditions that cause hospitalizations: dehydration, fever, mental status changes, congestive heart failure, lower respiratory infections, and urinary tract infections. INTERACT's paper-based tools have proven useful in trials, but the program may have greater potential impact electronically. This Commonwealth Fund–supported study examined some of the steps necessary to incorporate the paper-based tools into health information technology (HIT).

What the Study Found

Several INTERACT tools should be integrated into nursing homes' HIT systems, the authors say. These include, among others: Stop and Watch, which can be used by certified nurse assistants to note acute changes in resident conditions; Care Paths, to help nursing staff assess a resident's condition and notify the appropriate primary care provider; and the Resident Transfer Form, which ensures that important information about a resident who requires hospitalization is sent to the emergency department.

For INTERACT to be incorporated successfully into nursing homes' HIT systems, developers will need software requirements, and an integrated team comprising frontline staff, software developers, and facilitators will need to be assembled. The electronic versions must then be integrated into the daily workflow before pilot-testing in nursing homes can begin. 


The INTERACT quality improvement intervention has shown that it can help detect, manage, and communicate changes in the condition of nursing home residents. With its integration into HIT systems, the tools could help providers further reduce avoidable hospital admissions. 

Publication Details



S. M. Handler, S. S. Sharkey, S. Hudak et al., "Incorporating INTERACT II Clinical Decision Support Tools into Nursing Home Health Information Technology," Annals of Long-Term Care, Nov. 2011 19(11):23–26.