Objective To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations including non-Medicare paid Nursing Home (NH) stays. Data Sources Online Survey Certification and Reporting (OSCAR) data for 202 free-standing NHs, Medicare Denominator, claims (Parts A and B) and MDS assessments for 60,984 people who were present in one of these NHs in 2006. Methods The algorithm creating the RHF is outlined and the RHF for the study data is used to describe place of death. The identification of residents in nursing homes is compared to the reports in OSCAR and part B claims. Principal Findings The RHF correctly identified 84.8% of part B claims with place-of-service in NH, and identified 18.3 less residents on average than reported in the OSCAR on the day of the survey. The RHF indicated that 17.5% non-Medicare NH decedents were transferred to the hospital to die versus 45.6% SNF decedents. Conclusions The population-based design of the RHF makes it possible to conduct policy relevant research to examine the variation in the rate and type of health care transitions across the United States.
Daily nonmalignant pain is prevalent among nursing home residents and is often associated with impairments in ADL, mood, and decreased activity involvement. Even when pain was recognized, men, racial minorities, and cognitively impaired residents were at increased risk for undertreatment. More education and research is necessary to improve the recognition and management of pain in the nursing home, remembering that attention should be paid to populations at increased risk for underrecognition and undertreatment.
Objective. Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. Data Sources/Study Setting. Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. Study Design. Prospective cohort study of 570,614 older ( ! 65-year-old), non-MCO (Medicare Managed Care), long-stay ( ! 90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. Principal Findings. Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). Conclusions. State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.
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