Nursing facility patients tied to an initiative to reduce hospitalizations experienced fewer trips to the hospital in 2015, based on results of a study led by Kathleen Unroe, MD and Greg Sachs, MD, for the state of Indiana.

“Residents in OPTIMISTIC facilities experienced a 25% reduction in all-cause hospitalizations and a 40% reduction in potentially avoidable hospitalizations in 2015, compared to control group facilities” Unroe, Director of the Indiana OPTIMISTIC program, said.

The evaluation of the overall national demonstration project was published recently in Health Affairs.  This is the first journal publication from the evaluators of this demo – it shows overall results as well as results for all seven Phase 1 sites.

Indiana and Missouri stand out as the sites where the residents in facilities participating in the demo had consistent and significantly less all-cause hospitalizations, potentially avoidable hospitalizations, and Medicare savings.


Quality, and

Unroe, an assistant professor of medicine and Investigator at the IU Center for Aging Research and Regenstrief Institute, serves as the project director. Sachs, division chief for General Internal Medicine and professor of medicine, serves as a project director and investigator. In addition to Drs. Unroe and Sachs, OPTIMISTIC team leaders include Nicole Fowler, PhD, Susan Hickman , PhD, Dr. Jennifer Carnahan, MD, MPH, MA, Dr. Monica Tegeler, MD, Dr. Ellen Miller, PhD, Dr. Kathy Frank, RN, PhD.

Indiana University’s OPTIMISTIC project is an ongoing, $30.3 million, Centers for Medicare and Medicaid services (CMS) Center for Innovation demonstration project running from September 2012 to September 2020.

In the first phase of the project (2012-2016), RNs and NPs were embedded in 19 central Indiana nursing facilities to deliver a multicomponent program to reduce avoidable hospitalizations.

In phase 2 (2016-2020), an additional payment model is being tested in a cohort of new facilities as well as our current facilities.

To read or download the study or about the program, please follow these links: