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Elderly/Long-Term Care

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Certain interventions have the potential to reduce costly and risky hospitalizations of the frail elderly

More than one-fourth of long-stay nursing home residents are hospitalized in any given 6-month period. These costly hospitalizations can lead to hospital-acquired infections and other risks to frail nursing home residents, and many are avoidable. For example, while hospitalization is necessary for conditions such as hip fracture and a second stroke, transfer to a hospital is often discretionary for conditions such as pneumonia and influenza.

William Spector, Ph.D., of the Agency for Healthcare Research and Quality, and colleagues conducted a review of 55 articles that identified strategies with the most potential to reduce hospitalizations among elderly long-term care recipients across settings ranging from nursing homes and assisted living facilities to adult day care centers and home health care.

Promising interventions included more skilled staffing in nursing homes, especially physician assistants and nurse practitioners; improved care management at transitions from hospital to home or from hospital to skilled nursing facility; substitution of home health care for selected hospital admissions and instead of longer hospital stays; and alignment of reimbursement policies, so that providers do not have a financial incentives to hospitalize elderly persons receiving long-term care.

Two other approaches also have potential to reduce hospitalization of this group. They are prevention of high-risk clinical problems that lead to hospitalization via use of medication, equipment, and clinical care processes, and improving system quality of care, for example, with better patient assessment and end-of-life care. Nevertheless, the study authors note that much of the evidence is weak and could benefit from improved research design and methodology.

More details are in "Reducing hospitalizations from long-term care settings," by Tamara Konetzka, Ph.D., Dr. Spector, and M. Rhona Limcangco, Ph.D., in the September 25, 2007 Medical Care Research and Review.

Reprints are available from the Agency for Healthcare Research and Quality (Publication No. 08-R020), AHRQ Publications Clearinghouse.

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