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Nursing homes vary widely in their hospitalization of residents, particularly those with Alzheimer's disease

Nursing homes vary more in their nonpsychiatric discretionary hospital admission rates for Alzheimer's disease (AD) than non-AD residents, according to a recent study supported by the Agency for Healthcare Research and Quality (HS07585). Nursing home factors clearly influence decisions to hospitalize nursing home residents in general. However, this is particularly true for more vulnerable AD residents, such as those with behavioral problems, in the poorest health, and with the greatest daily nursing care needs, note Frank W. Porell, Ph.D., of the University of Massachusetts, and Mary Carter, Ph.D., of West Virginia University.

For example, Drs. Porell and Carter found no evidence that discretionary hospitalization rates of Medicaid residents without AD varied with the proprietary status of a nursing home. Yet, AD residents with behavioral problems in for-profit nursing homes were more likely to be admitted to the hospital than those in non-profit homes. Furthermore, the expected discretionary hospital admission rates of the sickest, high-cost AD residents were much lower in nursing homes with more registered nurses (RNs), while no such relationship was found for similar residents without AD. Hospital transfer rates were also lower for AD patients in nursing homes using nurse practitioners.

Future research should focus on subpopulations of residents, like those with AD, where there is a greater likelihood that hospital admissions can be prevented through good nursing home practices, suggest the researchers. Their findings are based on an analysis of hospital transfers among 19,217 and 18,399 Medicaid residents with and without AD, respectively, from 546 nursing homes in Massachusetts between 1991 and 1993.

For more details, see "Discretionary hospitalization of nursing home residents with and without Alzheimer's disease: A multilevel analysis," by Drs. Porell and Carter, in the April 2005 Journal of Aging and Health 17(2), pp. 207-238.

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