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Variations in hospitalization rates for nursing home residents may be due to facility and market characteristics

No benchmarks exist to determine which hospital transfer rates are acceptable for nursing home residents, which vary two- to five-fold across studies. These variations are not due solely to actual differences in resident case mix, but also to facility and market influences, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS07585).

Mary W. Carter, Ph.D., of West Virginia University, and Frank W. Porell, Ph.D., of the University of Massachusetts, analyzed State Medicaid case-mix reimbursement data from 1991 to 1994 from 527 Massachusetts nursing homes. They linked these data with Medicare claims and nursing facility data to produce 72,319 person-quarter observations. The researchers then controlled for individual resident characteristics to estimate the influence of facility-level and market-level factors on variations in hospitalization rates.

Individuals residing in nonprofit facilities, facilities with a patient case mix with heavier care demands, those classified as intermediate care facilities, and those with a greater proportion of resident days reimbursed by Medicare showed a 9 percent, 13 percent, 27 percent, and 11 percent, respectively, lower risk of hospital transfer in the next quarter than otherwise similar residents in other nursing facilities.

In contrast, residents residing in facilities operated by management chains instead of being independently managed, with a greater percentage of Medicaid reimbursed resident days, and that spent a greater proportion of total nursing expenses for licensed practical nurses, appeared to be at 7 percent, 10 percent, and 30 percent, respectively, greater risk of hospitalization in the next quarter than similar residents in other nursing homes. The 2.39-fold difference between counties with the lowest and highest probability of resident hospitalization, after controlling for resident and facility factors, suggests that the likelihood of a resident being hospitalized reflects at least in part, broader hospital bed and physician supply factors.

See "Variations in hospitalization rates among nursing home residents: The role of facility and market attributes," by Drs. Carter and Porell, in the Gerontologist 43(2), pp. 175-191, 2003.

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