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Elderly/Long-term Care

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Hospitalization rates vary for nursing home residents with suspected pneumonia

Many nursing home residents are hospitalized for pneumonia each year. This is mostly due to the inability of nursing homes to assess and monitor acutely ill residents and administer intravenous (IV) therapy. To prevent hospitalizations, EverCare Medicare Advantage plans employ nurse practitioners to work with network physicians, nursing home staff, and family members to augment care in nursing homes. They also provide nursing homes an additional per diem reimbursement when a resident is admitted to intensive service days (ISDs) that include more extensive monitoring and IV therapy in the nursing home.

Although EverCare's approach to managing care of nursing home residents has been shown to reduce hospitalizations, a study supported by the Agency for Healthcare Research and Quality (contract 290-00-0012) shows that the rate of hospitalization for residents with suspected pneumonia varies greatly by the geographical location of participating facilities. Residents in facilities with fewer RN staff per resident or whose pneumonia was detected on the weekends were more likely to be treated in the hospital. Nurse practitioners are not generally scheduled for weekend shifts. Extending nurse practitioner services to include weekends may further reduce hospital use, suggests William D. Spector, Ph.D., of the Agency for Healthcare Research and Quality, an author on the paper.

The researchers studied characteristics of the enrollee, nurse practitioner, physician, or nursing home to determine which factors affected whether an Evercare enrollee with suspected pneumonia received ISD or hospitalization. Study data were from 2002 for five metropolitan areas using Evercare administrative records.

More details are in "Pneumonia in nursing home residents: Factors associated with in-home care of EverCare enrollees," by Thomas S. Rector, Ph.D., Dr. Spector, Thomas J. Shaffer, M.H.S., and Michael D. Finch, Ph.D., in the March 2005 Journal of the American Geriatrics Society 53(3), pp. 472-477. Reprints (AHRQ Publication No. 05-R055) are available from the AHRQ Publications Clearinghouse.

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