Variations in Hospitalization Rates Among Nursing Home Residents: The Role of Facility and Market Attributes
Division of Health Sevices Research and Policy, School of Public Health University of Minnesota, Minneapolis, USA. The Gerontologist
(Impact Factor: 3.21).
05/2003; 43(2):175-91. DOI: 10.1093/geront/43.2.175
This study examined the contribution of facility-level and area market-level attributes to variations in hospitalization rates among nursing home residents.
Three years (1991-1994) of state quarterly Medicaid case-mix reimbursement data from 527 nursing homes (NH) in Massachusetts were linked with Medicare Provider Analysis and Review hospital claims and nursing facility attribute data to produce a longitudinal, analytical file containing 72,319 person-quarter observations. Logistic regression models were used to estimate the influence of facility-level and market-level factors on hospital use, after controlling for individual-level resident attributes, including: NH diagnoses, resident-level quality of care indicators, and diagnostic cost grouping classification from previous hospital stays.
Multivariate findings suggest that resident heterogeneity alone does not account for the wide variations in hospitalization rates across nursing homes. Instead, facility characteristics such as profit status, nurse staffing patterns, NH size, chain affiliation, and percentage of Medicaid and Medicare reimbursed days significantly influence NH residents' risk of hospitalization. Broader area market factors also appear to contribute to variations in hospitalization rates.
Variations in hospitalization rates may reflect underutilization, as well as overutilization. Continued efforts toward identifying medically necessary hospitalizations are needed.
Available from: Charlene Harrington
- "Several studies conclude that chain affiliated nursing homes have a higher rate of hospitalization than non-chain affiliated nursing homes (Carter and Porell 2003; Zimmerman et al. 2002). Similarly, for-profit nursing homes have been found to hospitalize its patients more often than non-profit nursing homes (Anderson et al. 1998; Carter 2003a; Carter and Porell 2003; Konetzka et al. 2004; Zimmerman et al. 2002; McGregor et al. 2014). "
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ABSTRACT: In this paper we seek to summarize research literature on hospitalization from nursing homes, to identify shared themes, findings and approaches, and to analyze strengths and weaknesses of the literature. The main aim of the article is to critically review current research on the topic of hospitalization from nursing homes, based on a variety of original research articles and literature overviews. First, we examine why studies of hospitalization from nursing homes are considered to be important in the literature, focusing on what is described as large variation in rates of hospitalization between institutions and geographical areas as well as the occurrence of unwanted and avoidable hospitalizations. Second, we present studies on reasons for rates of hospitalizations of nursing home patients based on patient characteristics. Third, we present studies that have focused on institutional characteristics that may explain rates of hospitalizations. Fourth, we examine factors and conditions highlighted in parts of the literature on hospitalization, more closely than others connected to practice and decision making. Finally, we discuss some of the weaknesses of these hospitalization studies and suggest areas for future research studies.
Available from: Darren Liu
- "In addition, we examined two market characteristics. Market characteristics may also be associated with facility operations and quality of nursing home care (Carter & Porell, 2003; Harrington, 2005). We examined two characteristics. "
Available from: Lisbeth Uhrenfeldt
- "Differences in acute care destinations and nursing home populations included in the studies may also affect the rates of inappropriate admissions. Several studies suggest that facility characteristics may be as important as residents’ clinical characteristics
[11,12]. In addition, regional differences in terms of financial incentives may also have an influence
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Residents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.
Systematic review of the literature of two databases (PubMed and CINAHL®). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.
Twenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents’ characteristics prior to admission (n = 6), residents’ or families’ wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.
Most assessment tools are not comprehensive and do not take into account residents’ individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.
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