Medicare expenditures for nursing home residents triaged to nursing home or hospital for acute infection

Journal of the American Geriatrics Society

Volumn 56, Issue 7, 2008, Pages 1206-1212

  Boockvar, Kenneth S ^a   Gruber Baldini, Ann L ^b   Stuart, Bruce ^c   Zimmerman, Sheryl ^d   Magaziner, Jay ^b  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

^b UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE   (United States)

^c UNIVERSITY OF MARYLAND SCHOOL OF PHARMACY   (United States)

^d UNIVERSITY OF NORTH CAROLINA   (United States)

Author keywords

Health expenditures; Infection; Medicare; Nursing homes

Indexed keywords

AGED; ARTICLE; CONFIDENCE INTERVAL; CONTROLLED STUDY; COST CONTROL; DEMOGRAPHY; EMERGENCY HEALTH SERVICE; EMERGENCY WARD; FEMALE; GASTROINTESTINAL INFECTION; HEALTH CARE COST; HOSPITAL ADMISSION; HUMAN; INFECTION; INTERVIEW; MAJOR CLINICAL STUDY; MALE; MEDICAL FEE; MEDICAL RECORD REVIEW; MEDICARE; NURSING HOME; NURSING HOME PATIENT; OBSERVATIONAL STUDY; PATIENT CARE; PROSPECTIVE PAYMENT; SKIN INFECTION; STANDARD; UNITED STATES; UROGENITAL TRACT INFECTION;

AGED, 80 AND OVER; COMMUNICABLE DISEASES; FEMALE; HOSPITALIZATION; HUMANS; MALE; MARYLAND; MEDICARE; NURSING HOMES; TRANSPORTATION OF PATIENTS; TRIAGE; UNITED STATES;

EID: 48449091740     PISSN: 00028614     EISSN: 15325415     Source Type: Journal    
DOI: 10.1111/j.1532-5415.2008.01748.x     Document Type: Article

References (35)

1. Fried T, Gillick M, Lipsitz L. Short-term functional outcomes of long-term care residents with pneumonia treated with and without hospital transfer. J Am Geriatr Soc 1997 45 : 302 306.
2. Dosa D. Should I hospitalize my resident with nursing home-acquired pneumonia? J Am Med Dir Assoc 2005 6 : 327 333.
3. Kruse RL, Mehr DR, Boles KE et al. Does hospitalization impact survival after lower respiratory infection in nursing home residents? Med Care 2004 42 : 860 870.
4. Boockvar KS, Gruber-Baldini AL, Burton L et al. Outcomes of infection in nursing home residents with and without early hospital transfer. J Am Geriatr Soc 2005 53 : 590 596.
5. Loeb M, Carusone SC, Goeree R et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: A randomized controlled trial. JAMA 2006 295 : 2503 2510.
6. Alessi C, Ouslander JG, Maldague S et al. Incidence and costs of acute medical conditions in long-stay incontinent nursing home residents. J Am Med Dir Assoc 2002 3 : 229 241.
7. Kane RL, Keckhafer G, Flood S et al. The effect of Evercare on hospital use. J Am Geriatr Soc 2003 51 : 1427 1434.
8. White A, Hurd D, Moore T et al. Quality Monitoring for Medicare Global Payment Demonstrations: Nursing Home Quality-Based Purchasing Demonstration Final Design Report. Cambridge, MA: Abt Associates Inc.; 2006 [on-line]. Available at Accessed December 10, 2007.
9. Kane RL, Huck S. The implementation of the EverCare demonstration project. J Am Geriatr Soc 2000 48 : 218 223.
10. Ackermann RJ, Kemle KA. The effect of a physician assistant on the hospitalization of nursing home residents. J Am Geriatr Soc 1998 46 : 610 614.
11. Casarett D, Karlawish J, Morales K et al. Improving the use of hospice services in nursing homes: A randomized controlled trial. JAMA 2005 294 : 211 217.
12. Department of Health and Human Services. Medicare program: Care management for high-cost beneficiaries demonstration. Fed Reg 2004 69 : 59929 59930.
13. Magaziner J, German P, Zimmerman SI et al. The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: Diagnosis by expert panel. Epidemiology of dementia in nursing homes research group. Gerontologist 2000 40 : 663 672.
14. Burton LC, German PS, Gruber-Baldini AL et al. Medical care for nursing home residents: Differences by dementia status. Epidemiology of dementia in nursing homes research group. J Am Geriatr Soc 2001 49 : 142 147.
15. Diagnostic and Statistical Manual of Mental Disorders, III-R. Washington, DC : American Psychiatric Association, 1987.
16. Pope GC, Kautter J, Ellis RP et al. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ Rev 2004 25 : 119 141.
17. Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci 1999 54A : M546 M553.
18. Cohen SB, Braden JJ, Ward EP. Enhancing the representation of rural areas in the National Medical Expenditure Survey. J Rural Health 1993 9 : 188 203.
19. Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997 127 : 757 763.
20. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika 1986 73 : 13 22.
21. Williams RL. A note on robust variance estimation for cluster-correlated data. Biometrics 2000 56 : 645 646.
22. Ash AS, Schwartz M. Evaluating the performance of risk-adjustment methods: Dichotomous outcomes. In : Iezzoni LI, ed. Risk Adjustment for Measuring Health Care Outcomes. Chicago : Health Administration Press, 1997.
23. Leuven E, Sianesi B. PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. Statistical Software Components [on-line]. Available at Accessed December 3, 2007.
24. Normand ST, Landrum MB, Guadagnoli E et al. Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: A matched analysis using propensity scores. J Clin Epidemiol 2001 54 : 387 398.
25. Veazie PJ, Manning WG, Kane RL. Improving risk adjustment for Medicare capitated reimbursement using nonlinear models. Med Care 2003 41 : 741 752.
26. Becker S, Ichino A. Estimation of average treatment effects based on propensity scores. Stata J 2002 2 : 358 377.
27. Bureau of Labor Statistics. Consumer Price Indexes [on-line]. Available at Accessed October 15, 2007.
28. Centers for Medicare and Medicaid Services. Correction to Annual Change in Medicaid Hospice Payment Rates 9on-line]. Available at Accessed October 15, 2007.
29. Grabowski DC, O'Malley AJ, Barhydt NR. The costs and potential savings associated with nursing home hospitalizations. Health Aff (Millwood) 2007 26 : 1753 1761.
30. Saliba D, Kington R, Buchanan J et al. Appropriateness of the decision to transfer nursing facility residents to the hospital. J Am Geriatr Soc 2000 48 : 154 163.
31. Feng Z, Grabowski DC, Intrator O et al. The effect of state Medicaid case-mix payment on nursing home resident acuity. Health Serv Res 2006 41 : 1317 1336.
32. Coleman EA. Falling through the cracks: Challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc 2003 51 : 549 555.
33. Steel K, Gertman PM, Crescenzi C et al. Iatrogenic illness on a general medical service at a university hospital. N Engl J Med 1981 304 : 638 642.
34. Konetzka RT, Norton EC, Sloane PD et al. Medicare prospective payment and quality of care for long-stay nursing facility residents. Med Care 2006 44 : 270 276.
35. Grabowski DC. Medicare and medicaid: Conflicting incentives for long-term care. Milbank Q 2007 85 : 579 610.