Nursing Home Characteristics and Potentially Preventable Hospitalizations of Long‐Stay Residents

Intrator, Orna; Zinn, Jacqueline S.; Mor, Vincent

doi:10.1111/j.1532-5415.2004.52469.x

Cited by 231 publications

(231 citation statements)

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“…Involvement of NPs and PAs in collaboration with primary care physicians has repeatedly been shown to be associated with less hospitalization of NH residents. [12][13][14][23][24][25] Involving these health professionals in care transition interventions in which acute hospitals collaborate with NHs and home health agencies would build upon evolving models, 26,27 but the number of healthcare professionals with special training and interest in geriatrics and long-term care medicine is not increasing rapidly enough to meet this need. 28 Financial incentives to obtain certification in geriatrics or work in NHs, such as loan repayment programs, and the development of a specialty in NH medicine 29 may help in this regard.…”

mentioning

confidence: 99%

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Ouslander

Lamb

Perloe

et al. 2010

J American Geriatrics Society

413

387

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OBJECTIVES:To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents. DESIGN: Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization. SETTING: NHs in Georgia. PARTICIPANTS: In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long-and short-stay residents. MEASUREMENTS: Ratings using a structured review by expert NH clinicians. RESULTS: Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on-site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations. CONCLUSION: In this sample of NH residents, experienced long-term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population. J Am Geriatr Soc 58:627-635, 2010.Key words: nursing homes; avoidable hospitalizations; transfers; quality H ospitalization of nursing home (NH) residents can cause discomfort for residents, anxiety for their loved ones, morbidity due to iatrogenic events, and excess healthcare costs. Many of these hospitalizations may be preventable through better care in the NH or inappropriate, because the transfer exposes NH residents to additional risks associated with hospitalization, 1 without substantial potential benefit for the residents' clinical course or quality of life. Previous in-depth research on the overall frequency and costs of potentially avoidable hospitalizations of nursing home residents is limited. One study found that, in 2004, 23% of the $972 million spent on hospitalizations of long-stay NH residents in the state of New York were for ambulatory care-sensitive diagnoses (ACSDs), a proxy measure for potentially unnecessary hospitalizations. 2ACSDs include diagnoses such as angina pectoris, heart failure, chronic obstructive pulmonary disease, pneumonia, urinary tract infection, cellulitis, diabetes mellitus, and dehydration. 3 This is an underestimate of the overall costs of these hospitalizations, because short-stay residents, in whom hospitalizations are more common than long-stay residents, were excluded from this analysis. A study of hospital admissions from Canadian long-term care facilities found 55% to be due to a modified list of ACSD. 4 In an analysis of hospital transfers from eight Los Angeles NHs, experienced physicians using a structured implicit record re...

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confidence: 99%

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Ouslander

Lamb

Perloe

et al. 2010

J American Geriatrics Society

413

387

View full text Add to dashboard Cite

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“…Some studies have found this association to have some merit (Intrator et al 1999), indicating that more physician hours per resident per day are considered to decrease the chances of hospitalization. However, findings are not always conclusive on this point (Grabowski et al 2008, Jensen et al 2009, Miller & Weissert 2000, or might even be contradictory (Intrator et al 2004). The findings on the effect on hospitalization of having an «on site physician» (as opposed to general practitioners employed on an hourly basis) are similarly inconclusive (Grabowski et al 2008).…”

Section: The Second Answer: Institutions Matter/ Institutional Mattermentioning

confidence: 99%

“…Most research articles answer this question by stating that hospitalization for many patients is not beneficial (Ackermann 2001, Anphalahan & Gibson 2008, Boockvar et al 2005, Creditor 1993, Fried & Mor 1997, Intrator et al 1999, Intrator et al 2004, Konetzka et al 2008, Ouslander & Berenson 2011, Read 1999, and that a significant portion of them should not have taken place. To be specific: in many cases, hospitalization leads to a worsening of functional abilities, even though the specific ailment for which one is hospitalized improves (Creditor 1993 (Grabowski et al 2008) Few articles deal directly with why unwarranted hospitalizations occur (Fried & Mor 1997), but rather focus on the potential occurrence of them.…”

Section: What Is the Problem?mentioning

confidence: 99%

The Institutional Practice

Ågotnes¹

2017

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“…Unplanned acute emergency medical admissions occur in 18% of people with dementia with a 1.66 unadjusted risk of mortality at 6 months [17,18]. Co-morbidity, and poor control of co-morbid conditions, results in an increased burden on the care-giver [10,19,20]. These factors combine to significantly increase health and social care costs [21].…”

Section: Commentarymentioning

confidence: 99%

“…At the core of this should be a comprehensive assessment of needs, difficulties and possible co-morbid symptoms. Timely identification of physical symptoms in those with dementia has been linked to decreased risk of hospitalisation [10], reduced healthcare costs [11] and the maintenance of physical comfort and quality of life [12,13].In addition the diagnosis and management of co-morbid conditions is recognised as being poor, as dementia dominates clinical encounters and shifts attention away from the co-morbidity [14] which can lead to increased morbidity and 741 …”

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confidence: 99%

The importance of detecting and managing comorbidities in people with dementia?

et al. 2014

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CommentaryDementia is a debilitating condition characterised by global loss of cognitive and intellectual functioning, which gradually interferes with social and occupational performance. It is a common worldwide condition with a significant impact on society. There are currently 36 million people worldwide with Alzheimer's disease (AD) and other dementias [1]. This is expected to more than double by 2030 (65 million) and reach 115 million in 2050, unless a major breakthrough is made. The worldwide societal costs were estimated at USD 604 billion in 2010 and rising [2].To date research on the specific physical healthcare needs of people with dementia has been neglected. Yet, physical comorbidities are reported as common in people with dementia [3] and have been shown to lead to increased disability and reduced quality of life for the affected person and their carer [4].Dementia is most frequently associated with older people who often present with other medical conditions, known as co-morbidities. Such co-morbidities include diabetes, chronic obstructive pulmonary disorder, musculoskeletal disorders and chronic cardiac failure and are common, 61% of people with dementia are estimated to have three or more comorbid diagnoses [5]. Musculoskeletal, genitourinary, and ear, nose and throat disorders have been reported as highly prevalent, affecting nearly half of people with dementia [6]. Physical comorbidities are often treatable and some may be reversible. Epilepsy, delirium, falls, oral disease, malnutrition, frailty, incontinence, sleep disorders and visual dysfunction are found to occur more frequently in dementia sufferers and untreated can lead to more severe health problems, pain and distress as well as worsening the symptoms of dementia itself [6]. As the severity of the dementia increases, so does the rate of comorbid conditions such as genitourinary disorders [6]. Pneumonia, urinary tract infection and congestive cardiac failure accounted for two-thirds of preventable admissions in dementia with dehydration and duodenal ulcer the next most important [7]. Healthcare costs for treating these problems are high, estimated at being 34% more costly than in age-matched, non-dementia cases [8]. The annual admission rate is double that of patients without dementia [7].In the UK, NICE guidelines for the treatment of dementia assert that the promotion and maintenance of independence and everyday functioning is a key treatment for those diagnosed with dementia [9]. At the core of this should be a comprehensive assessment of needs, difficulties and possible co-morbid symptoms. Timely identification of physical symptoms in those with dementia has been linked to decreased risk of hospitalisation [10], reduced healthcare costs [11] and the maintenance of physical comfort and quality of life [12,13].In addition the diagnosis and management of co-morbid conditions is recognised as being poor, as dementia dominates clinical encounters and shifts attention away from the co-morbidity [14] which can lead to increased morbidity ...

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Nursing Home Characteristics and Potentially Preventable Hospitalizations of Long‐Stay Residents

Abstract: Employment of NP/PAs in NHs, the provision of intravenous therapy, and the operation of certified nurse assistant training programs appear to reduce ACS hospitalizations, and may be feasible cost-saving policy interventions.

Cited by 231 publications

References 23 publications

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

The Institutional Practice

The importance of detecting and managing comorbidities in people with dementia?

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