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Long-term Care

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Residents of nursing homes with special care units and more physicians are less likely to be hospitalized

From 13 percent to 63 percent of nursing home residents are hospitalized every year. These hospitalizations cause relocation stress as well as the risk of hospital-induced infections. Individuals who reside in nursing homes with special care units, more physicians, and physician extenders (nurse practitioners or physician assistants) are less apt to be hospitalized than residents at other homes, according to a recent study. Medicare managed care plans should consider the medical care capacity and clinical resources of nursing facilities if they want to limit costly hospital admissions, recommends Vincent Mor, Ph.D., of Brown University.

In a study supported in part by the Agency for Health Care Policy and Research (National Research Service Award T32 HS00011), the researchers analyzed 1993 data from 10 States on 2,080 residents in 253 nursing homes. They examined the effect of facility characteristics on the rate of hospitalization of nursing home residents while controlling for resident characteristics that are known to affect the decision to hospitalize.

Analysis showed that residents in facilities with special care units were 30 percent less likely to be hospitalized. There was no association between nursing staff levels and hospitalization, but residents of facilities with greater than the median full-time equivalent (FTE) physicians per 100 beds were 21 percent less likely to be hospitalized. Also, the presence of physician extenders in the nursing home reduced the risk of hospitalization by 41 percent. These findings suggest that increased physician involvement in nursing homes may improve quality of care. The availability of diagnostic resources, such as x-ray equipment and a laboratory on site, also might facilitate the decision to keep the patient in the home when a doctor is available.

See "Facility characteristics associated with hospitalization of nursing home residents," by Orna Intrator, Ph.D., Nicholas G. Castle, Ph.D., and Dr. Mor, in Medical Care 37(3), pp. 228-237, 1999.

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