Deriving a Model of the Necessity to Hospitalize Nursing Home Residents

Abstract

Although often important to recover from acute medical problems and exacerbations of chronic illness, hospitalizations can be traumatic for nursing home residents and costly for payers. It is important that unnecessary hospitalizations are avoided wherever possible. The authors derived and validated a diagnosisbased model to estimate the clinical necessity of hospitalizing nursing home residents with common conditions using data from an expert panel survey. Model validation involved a linked minimum data set-hospitalization claims data set. The expert panel of 12 experienced geriatricians rated the necessity of hospitalization for 1,948 clinical scenarios containing diagnoses, cognitive and functional status, age, gender, and advance directives. Primary diagnoses with the highest average necessity scores were respiratory failure, acute myocardial infarction, hip fracture, and brain injury. The secondary diagnosis-primary diagnosis interaction with the greatest impact was gastrointestinal bleed on gastroenteritis. Poor cognitive function and presence of an advance directive lowered the risk of hospitalization.

Predictors of Nursing Home Residents' Time to Hospitalization

“…Using a model of the clinical necessity of hospitalization (O'Malley et al 2007), we found that the predicted proportion of potentially preventable hospitalizations (those with a low predicted necessity of hospitalization) for a nursing home had little predictive power and we consequently excluded it from the models.…”

The Impact of Nursing Home Pay‐for‐Performance on Quality and Medicare Spending: Results from the Nursing Home Value‐Based Purchasing Demonstration

“…A large literature has suggested that a substantial portion of hospital admissions of nursing home residents can be avoided through careful management of these conditions in the nursing home (O'Malley et al. ; Grabowski et al. ; Ouslander et al.…”

The Impact of Medicaid Payer Status on Hospitalizations in Nursing Homes

“…sepsis, meningitis, endocarditis), gastrointestinal bleeding, and stroke appendectomy. 26,29 The third outcome variable was defined as any discretionary hospitalization from a NH within a 180-day window after the baseline date. We considered a hospitalization as discretionary when there is no clear agreement in the necessity of hospitalization for the medical condition (i.e.…”