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Nursing home facility characteristics and quality-of-care factors may contribute to unnecessary hospitalization of residents

Several studies have used ambulatory-care-sensitive hospitalizations (ACSHs)—hospitalizations for medical conditions thought to be largely avoidable and/or manageable through timely access to appropriate primary care—to evaluate potential access-to-care problems.

This preliminary study is the first one to examine the impact of nursing home factors on ACSHs. It found that nursing home facility factors and quality-of-care indicators contribute significantly to the risk of ACSH among nursing home residents. This raises concerns that some nursing home residents may be hospitalized unnecessarily and/or may not be receiving health care services promptly enough to prevent worsening of problems leading to hospitalization, concludes Mary W. Carter, Ph.D., of West Virginia University School of Medicine's Center on Aging.

In her study, which was supported in part by the Agency for Healthcare Research and Quality (HS07585), Dr. Carter analyzed 3 years of quarterly Medicaid reimbursement data from more than 500 nursing homes. She linked these data to 4 years of Medicare Provider Analysis and Review hospital claims data, nursing facility attribute data, and Area Resource File data to investigate the relative contribution of patient-, facility-, and market-level risk factors to ACSH among nursing home residents.

ACSHs seemed particularly sensitive to those facility-level factors linked to quality-of-care practices in the nursing home. Residents of facilities that were operated by a management company, had a greater proportion of patient days reimbursed by Medicare, and spent a greater proportion of total nursing expenses for practical nurses and less on registered nurses had a greater risk of ACSH. For example, for every percentage point increase in the facility's percentage of total nursing expenses paid for RNs, the risk of ACSH decreased by 28 percent, holding other factors constant. These findings suggest a fairly strong relationship between facility staffing ratios, ambulatory care practices, and resident outcomes.

See "Factors associated with ambulatory care-sensitive hospitalizations among nursing home residents," by Dr. Carter, in the May 2003 Journal of Aging and Health 15(2), pp. 295-331.

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