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Nursing Home Characteristics and Potentially Preventable Hospitalizations of Long‐Stay Residents

Objectives: To examine the association between having a nurse practitioner/physician assistant (NP/PA) on staff, other nursing home (NH) characteristics, and the rate of potentially preventable/avoidable hospitalizations of long‐stay residents, as defined using a list of ambulatory care–sensitive (ACS) diagnoses.

Facility characteristics associated with hospitalization of nursing home residents: results of a national study.

OBJECTIVES To test the effect of facility characteristics on the probability of hospitalization of nursing home residents, controlling for resident characteristics and the competing risk of death. RESEARCH DESIGN Study data were derived from the evaluation of the implementation of the Resident Assessment Instrument, the Minimum Data Set (MDS) in 1993. The data consisted of 2080 residents in 253 NHs as well as the annual On-Line Survey Certification of Automated Records (OSCAR). MEASURES Multinomial logistic regression was used to determine the effects of selected resident and facility characteristics on hospitalization or death within 6 months of baseline, adjusting for the complex sampling design (using SUDAAN). RESULTS By controlling for resident demographics, advance directives, diagnoses, selected clinical signs, and type of payer, we found that homes with special care units, more physicians (above the median 0.08 FTE physicians on staff or contract), and any physician extenders (nurse practitioners or physician assistants) were less likely to hospitalize their residents. Homes in which over 3.6% of the residents received respiratory treatment were more likely to hospitalize their residents. CONCLUSIONS Findings suggest that Medicare HMOs should consider the capacity of nursing facilities, especially in terms of medical care capacity and clinical resources, to limit hospital admissions.

Changes in Hospitalization Associated with Introducing the Resident Assessment Instrument

OBJECTIVE: To compare the rates of hospitalization among cohorts of nursing home residents assembled before and after the implementation of the federally mandated Resident Assessment Instrument (RAI).

Hospital Characteristics Associated With Feeding Tube Placement in Nursing Home Residents With Advanced Cognitive Impairment

CONTEXT Tube-feeding is of questionable benefit for nursing home residents with advanced dementia. Approximately two-thirds of US nursing home residents who are tube fed had their feeding tube inserted during an acute care hospitalization. OBJECTIVE To identify US hospital characteristics associated with higher rates of feeding tube insertion in nursing home residents with advanced cognitive impairment. DESIGN, SETTING, AND PATIENTS The sample included nursing home residents aged 66 years or older with advanced cognitive impairment admitted to acute care hospitals between 2000 and 2007. Rate of feeding tube placement was based on a 20% sample of all Medicare Claims files and was assessed in hospitals with at least 30 such admissions during the 8-year period. A multivariable model with the unit of the analysis being the hospital admission identified hospital-level factors independently associated with feeding tube insertion rates, including bed size, ownership, urban location, and medical school affiliation. Measures of each hospitals care practices for all patients with serious chronic illnesses were evaluated, including intensive care unit (ICU) use in the last 6 months of life, the use of hospice services, and the ratio of specialist to primary care physicians. Patient-level characteristics were also considered. MAIN OUTCOME MEASURE Endoscopic or surgical insertion of a gastrostomy tube during a hospitalization. RESULTS In 2797 acute care hospitals with 280,869 admissions among 163,022 nursing home residents with advanced cognitive impairment, the rate of feeding tube insertion varied from 0 to 38.9 per 100 hospitalizations (mean [SD], 6.5 [5.3]; median [interquartile range], 5.3 [2.6-9.3]). The mean rate of feeding tube insertions per 100 admissions was 7.9 in 2000, decreasing to 6.2 in 2007. Higher insertion rates were associated with the following hospital features: for-profit ownership vs government owned (8.5 vs 5.5 insertions per 100 hospitalizations; adjusted odds ratio [AOR], 1.33; 95% confidence interval [CI], 1.21-1.46), larger size (>310 beds vs <101 beds: 8.0 vs 4.3 insertions per 100 hospitalizations; AOR, 1.48; 95% CI, 1.35-1.63), and greater ICU use in the last 6 months of life (highest vs lowest decile: 10.1 vs 2.9 insertions per 100 hospitalizations; AOR, 2.60; 95% CI, 2.20-3.06). These differences persisted after controlling for patient characteristics. Specialist to primary care ratio and hospice use were weakly or not associated with feeding tube placement. CONCLUSION Among nursing home residents with advanced cognitive impairment admitted to acute care hospitals, for-profit ownership, larger hospital size, and greater ICU use was associated with increased rates of feeding tube insertion, even after adjusting for patient-level characteristics.

The Residential History File: Studying Nursing Home Residents' Long-Term Care Histories

OBJECTIVE To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations, including non-Medicare-paid NH stays. DATA SOURCES Online Survey of Certification and Reporting (OSCAR) data for 202 free-standing NHs, Medicare Denominator, claims (parts A and B), and MDS assessments for 60,984 people who were present in one of these NHs in 2006. METHODS The algorithm creating the RHF is outlined and the RHF for the study data are used to describe place of death. The identification of residents in NHs is compared with the reports in OSCAR and part B claims. PRINCIPAL FINDINGS The RHF correctly identified 84.8 percent of part B claims with place-of-service in NH, and it identified 18.3 less residents on average than reported in the OSCAR on the day of the survey. The RHF indicated that 17.5 percent non-Medicare NH decedents were transferred to the hospital to die versus 45.6 percent skilled nursing facility decedents. CONCLUSIONS The population-based design of the RHF makes it possible to conduct policy-relevant research to examine the variation in the rate and type of health care transitions across the United States.

Government Expenditures at the End of Life for Short- and Long-Stay Nursing Home Residents: Differences by Hospice Enrollment Status

Objectives: To examine end‐of‐life government expenditures for short‐ and long‐stay Medicare‐ and Medicaid‐eligible (dual‐eligible) nursing home (NH) hospice and nonhospice residents.

Decisions to forgo hospitalization in advanced dementia: a nationwide study.

OBJECTIVES: To examine the prevalence and factors associated with decisions to forgo hospitalization in nursing home (NH) residents with advanced dementia.

Effect of State Medicaid Reimbursement Rates on Hospitalizations from Nursing Homes

Objectives: To estimate the effect of state Medicaid nursing home reimbursement rates on hospitalizations of nursing home residents.

Preliminary Derivation of a Nursing Home Confusion Assessment Method Based on Data from the Minimum Data Set

OBJECTIVES: To develop a Nursing Home Confusion Assessment Method (NH‐CAM) for diagnosing delirium using items found on the Minimum Data Set (MDS) and to compare its performance with that of the delirium Resident Assessment Protocol (RAP) trigger and to an additive score of six of the RAP items.

Panel Data with Survival: Hospitalization of HIV-Positive Patients

Abstract This article provides an analysis of the hospitalization experience of a panel of HIV-positive patients. It is part of a program of work designed to study the medical expenditures of such patients and their variation both between people and over time. We model the joint distribution of the inpatient episodes and the survival times of a panel of patients over 15 months. The model induces correlation between hospitalization and death via an unmeasured, person-specific, frailty term, and it allows rates of hospitalization and of death each to be affected by time-invariant and time-varying covariates. We subject the model to a variety of predictive tests and show that it is generally consistent with the data. We study and present estimates of the time variation in the rate of hospitalization. We also report the effects of a large number of covariates on rates of hospitalization and mortality. The model generalizes fairly easily in a number of ways, one of which is to handle vector-valued measures of ...