Expanding the Nurses Improving Care for Health System Elders (NICHE) Program to Rural New York State Hospitals
Special Projects Fund
April 1, 2010
New York State has the third largest population of older adults in the U.S. Older patients account for 38% of all US hospital admissions; this is even higher in rural areas.
Older patients experience more complications during hospitalization compared to any other age group, which results in a lower survival rate, loss of independence, hospital readmissions, increased usage of rehabilitation services, and new placements in nursing homes.
As of October 2008, hospitals no longer receive payment from Medicare for eight complications, three of which—falls/fall injuries, pressure ulcers, and urinary tract infections—are known to occur more frequently in older patients and are found to be reduced when geriatric care models are used. Thus, avoidance of the costs for these complications is a priority for hospitals.
The NICHE program has emerged as a national leader in improving geriatric care. It has been adopted by nearly 300 hospitals nationally, including 18 in New York State. It provides evidence-based clinical protocols and operational tools that they have developed to improve elder care. It builds geriatric staff knowledge and competence within participating hospitals. With this grant, NICHE developed and adapted its approach for rural hospitals. It facilitated an online rural hospital learning community and a rural-urban collaborative via Web-based and other long-distance communication strategies. It recruited and implemented the program in 20 small, rural hospitals.