Improved Preventive Care in Nursing Homes Could Potentially Reduce Hospitalizations by 60 Percent, AHRQ Study Finds

A new AHRQ-funded study found that 60 percent of hospitalizations of long-stay nursing home residents could potentially have been avoided with appropriate preventive care. The study applied a nursing home–specific measure that doubled the estimate of potentially avoidable hospitalizations based on Ambulatory Case Sensitive Conditions data. The study’s broader measure includes conditions that could have been avoided with appropriate preventive care, such as injuries, dehydration, and urinary tract, blood, respiratory, and gastrointestinal infections. The nursing home-–specific measure also identified additional nursing home patients at high risk, including those with renal disease or pressure ulcers or who received catheter or ostomy care. The study showed that nursing homes with fewer quality deficiencies and in states with higher Medicaid reimbursement had fewer avoidable hospitalizations. The study, “Potentially Avoidable Hospitalizations for Elderly Long-stay Residents in Nursing Homes,” was published in the August issue of Medical Care. Select to access the PubMed® abstract.

2013 Aug;51(8):673-81. doi: 10.1097/MLR.0b013e3182984bff.

Potentially Avoidable Hospitalizations for Elderly Long-stay Residents in Nursing Homes.

Spector WD, Limcangco R, Williams C, Rhodes W, Hurd D.

Source

*Agency for Healthcare Research & Quality, Rockville †Social & Scientific Systems Inc., Silver Spring, MD ‡Abt Associates, Durham, NC §Abt Associates, Cambridge, MA.

Abstract

BACKGROUND:

Hospitalizations of long-stay nursing home (NH) residents are common. The high estimates of potentially avoidable hospitalizations in NHs suggest that efforts to reduce avoidable hospitalizations may be effective in lowering health care expenditures as well as improving the quality of care for NH residents.

OBJECTIVE:

To determine the relationship between clinical risk factors, facility characteristics and State policy variables, and both avoidable and unavoidable hospitalizations.

METHOD:

Hospitalization risk is estimated using competing risks proportional hazards regressions. Three hospitalization measures were constructed: (1) ambulatory care-sensitive conditions (ACSCs); (2) additional NH-sensitive avoidable conditions (ANHACs); and (3) nursing home "unavoidable" conditions (NHUCs). In all models, we include clinical risk factors, facility characteristics, and State policy variables that may influence the decision to hospitalize.

SUBJECTS:

The population of interest is a cohort of long-stay NH residents. Data are from the Nursing Home Stay file, a sample of residents in 10% of certified NHs in the United States (2006-2008).

RESULTS:

Three fifths of hospitalizations were potentially avoidable and the majority was for infections, injuries, and congestive heart failure. Clinical risk factors include renal disease, diabetes, and a high number of medications among others. Staffing, quality, and reimbursement affect avoidable, but not unavoidable hospitalizations.

CONCLUSIONS:

A NH-sensitive measure of avoidable hospitalizations identifies both clinical facility and policy risk factors, emphasizing the potential for both reimbursement and clinical strategies to reduce hospitalizations from NHs.