Potentially avoidable hospitalizations of nursing home residents: Frequency, causes, and costs

Journal of the American Geriatrics Society

Volumn 58, Issue 4, 2010, Pages 627-635

  Ouslander, Joseph G ^a,b,h   Lamb, Gerri ^c   Perloe, Mary ^d   Givens, Jovonn H ^d   Kluge, Linda ^d   Rutland, Tracy ^d   Atherly, Adam ^e   Saliba, Debra ^f,g  

^a FLORIDA ATLANTIC UNIVERSITY   (United States)

^b UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE   (United States)

^c ARIZONA STATE UNIVERSITY   (United States)

^d Georgia Medical Care Foundation   (United States)

^e EMORY UNIVERSITY   (United States)

^f VETERANS AFFAIRS MEDICAL CENTER   (United States)

^g UNIVERSITY OF CALIFORNIA   (United States)

^h Boca Raton Community Hospital   (United States)

Author keywords

Avoidable hospitalizations; Nursing homes; Quality; Transfers

Indexed keywords

ARTICLE; CARDIOVASCULAR DISEASE; CONTROLLED STUDY; DEHYDRATION; FALLING; FEVER; HEALTH CARE AVAILABILITY; HEALTH CARE QUALITY; HEALTH CARE UTILIZATION; HOSPITAL ADMISSION; HOSPITALIZATION COST; HUMAN; INTRAVENOUS ADMINISTRATION; LABORATORY TEST; MENTAL DISEASE; METABOLIC DISORDER; MUSCULOSKELETAL PAIN; NEUROLOGIC DISEASE; NURSING HOME PATIENT; PRIMARY MEDICAL CARE; RESPIRATORY TRACT DISEASE; SEPSIS; SKIN DISEASE; UNITED STATES; URINARY TRACT INFECTION;

AGED; DIAGNOSIS-RELATED GROUPS; FEMALE; GEORGIA; GERIATRIC ASSESSMENT; HEALTH CARE COSTS; HEALTH SERVICES ACCESSIBILITY; HEALTH SERVICES MISUSE; HEALTH SERVICES RESEARCH; HOSPITALIZATION; HUMANS; INSURANCE CLAIM REPORTING; MALE; MEDICAID; MEDICAL AUDIT; MEDICARE; NEEDS ASSESSMENT; NURSING HOMES; PHYSICIAN'S PRACTICE PATTERNS; PRIMARY HEALTH CARE; TOTAL QUALITY MANAGEMENT; UNITED STATES; UTILIZATION REVIEW;

EID: 77950417880     PISSN: 00028614     EISSN: 15325415     Source Type: Journal    
DOI: 10.1111/j.1532-5415.2010.02768.x     Document Type: Article

References (48)

1. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med 1993 118:219 223.
2. Grabowski DC, O'Malley AJ, Barhydt NR. The costs and potential savings associated with nursing home hospitalizations. Health Aff 2007 26:1753 1761.
3. Appendix B. Ambulatory Care Sensitive Conditions [on-line]. Available at Accessed July 11, 2009.
4. Walker JD, Teare GF, Hogan DB et al. Identifying potentially avoidable hospital admissions from Canadian long-term care facilities. Med Care 2009 47:250 254.
5. Saliba D, Kington R, Buchanan J et al. Appropriateness of the decision to transfer nursing facility residents to hospital. J Am Geriatr Soc 2000 48:154 163. (Pubitemid 30106519)
6. Department of Health & Human Services, Centers for Medicare and Medicaid Services. Medicare Nursing Home Value-Based Purchasing Initiative. SMDL 08-009, Baltimore, MD, November 14, 2008.
7. Briesacher B, Field T, Baril J et al. Can pay-for-performance take nursing home care to the next level? J Am Geriatr Soc 2008 56:1937 1939.
8. Ouslander JG. Paying for performance in nursing homes: Don't throw the baby out with the bathwater. J Am Geriatr Soc 2008 56:1959 1962.
9. Carter MW. Variations in hospitalization rates among nursing home residents: The role of discretionary hospitalizations. Health Serv Res 2003 38:1177 1206. (Pubitemid 37048306)
10. Carter MW. Factors associated with ambulatory care-sensitive hospitalizations among nursing home residents. J Aging Health 2003 15:295 331. (Pubitemid 36438234)
11. Boockvar KS, Gruber-Baldini AL, Stuart B et al. Medicare expenditures for nursing home residents triaged to nursing home or hospital for acute infection. J Am Geriatr Soc 2008 56:1206 1212.
12. Konetzka RT, Spector W, Limcangco RM. Reducing hospitalizations from long-term care settings. Med Care Res Rev 2008 65:40 66.
13. 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. (Pubitemid 28237120)
14. Reuben D, Buchanan J, Farley D et al. Primary care of long-stay nursing home residents: A comparison of 3 HMO programs with fee-for-service care. J Am Geriatr Soc 1999 47:131 138.
15. Buchanan J, Murkofsly RL, O'Malley AJ et al. Nursing home capabilities and decisions to hospitalize: A survey of medical directors and directors of nursing. J Am Geriatr Soc 2006 54:458 465. (Pubitemid 43327158)
16. Intrator O, Grabowski DC, Zinn J et al. Hospitalization of nursing home residents: The effects of states' Medicaid payment and bed-hold policies. Health Serv Res 2007 42:1651 1671. (Pubitemid 47024846)
17. Gruneir A, Miller SC, Feng Z et al. Relationship between state Medicaid policies, nursing home racial composition, and the risk of hospitalization for black and white residents. Health Serv Res 2008 43:869 881. (Pubitemid 351623956)
18. Grabowski DC, Stewart KA, Broderick SM et al. Predictors of nursing home hospitalization: A review of the literature. Med Care Res Rev 2008 65:3 39.
19. Grabowski DC. Medicare and Medicaid: Conflicting incentives for long-term care. Milbank Q 2007 85:579 610.
20. Zimmer JG, Eggert GM, Treat A et al. Nursing homes as acute care providers. A pilot study of incentives to reduce hospitalizations. J Am Geriatr Soc 1988 36:124 129. (Pubitemid 18039556)
21. Ouslander JG. Reducing the hospitalization of nursing home patients. J Am Geriatr Soc 1988 36:171 173.
22. Ouslander JG, Weinberg AD, Phillips V. Inappropriate hospitalization of nursing facility residents: A symptom of a sick system of care for frail older people. J Am Geriatr Soc 2000 48:230 231. (Pubitemid 30106532)
23. Wieland D, Lamb VL, Sutton SR et al. Hospitalization in the Program of All-Inclusive Care for the Elderly (PACE): Rates, concomitants, and predictors. J Am Geriatr Soc 2000 48:1373 1380.
24. Kane RL, Keckhafer G, Flood S et al. The effect of Evercare on hospital use. J Am Geriatr Soc 2003 51:1427 1434. (Pubitemid 37259872)
25. Intrator O, Zinn J, Mor V. Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. J Am Geriatr Soc 2004 52:1730 1736. (Pubitemid 41709929)
26. Coleman EA, Parry C, Chalmers S et al. The care transitions intervention: Results of a randomized controlled trial. Arch Intern Med 2006 166:1822 1828. (Pubitemid 44455163)
27. Naylor M, Brooten D, Campbell R et al. Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial. J Am Geriatr Soc 2004 52:675 684. (Pubitemid 38596483)
28. Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce.
29. Katz PR, Karuza J, Intrator O et al. Nursing home physician specialists: A response to the workforce crisis in long-term care. Ann Intern Med 2009 150:411 413.
30. Boockvar K, Brodie HD, Lachs M. Nursing Assistants detect behavior changes in nursing home residents that precede acute illness: Development and validation of an illness warning instrument. J Am Geriatr Soc 2000 48:1086 1091.
31. High KP, Bradley DF, Gravenstein S et al. Clinical practice guidelines for evaluation of fever and infection of older residents of long-term care facilities: A 2008 Update by the Infectious Disease Society of America. Clin Infect Dis 2009 48:149 171.
32. American Medical Directors Association (AMDA): Clinical Practice Guideline on "Acute Change in Condition in the Long-Term Care Setting", Columbia, MD, 2003.
33. Carusone SC, Loeb M, Lohfield L. A Clinical pathway for treating pneumonia in the nursing home: Part I: The nursing perspective. J Am Med Dir Assoc 2004 5:271 278. (Pubitemid 43827462)
34. Carusone SC, Loeb M, Lohfield L. A clinical pathway for treating pneumonia in the nursing home: Part II: The administrator's perspective and how it differs from nurses' views. J Am Med Dir Assoc 2004 5:279 286. (Pubitemid 43827463)
35. Hutt E, Ruscin JM, Corbett K et al. A multifaceted intervention to implement guidelines improved treatment of nursing home-acquired pneumonia in a state veterans home. J Am Geriatr Soc 2006 54:1694 1700. (Pubitemid 44665208)
36. 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. (Pubitemid 43854965)
37. Tools: INTERACT - Reducing Avoidable Hospitalizations of Nursing Home Residents [on-line]. Available at Accessed December 7, 2008.
38. Remington R, Hultman T. Hypodermoclysis to treat dehydration: A review of the evidence. J Am Geriatr Soc 2007 55:2051 2055. (Pubitemid 350230946)
39. Molloy DW, Guyatt GH, Russo R et al. Systematic implementation of an advance directive program in nursing homes: A randomized controlled trial. JAMA 2000 283:1437 1444. (Pubitemid 30151822)
40. Tulsky JA. Beyond advance directives - importance of communication skills at the end of life. JAMA 2005 294:359 365. (Pubitemid 41043780)
41. Mitchell SL, Teno JM, Intrator O et al. Decisions to forgo hospitalization in advanced dementia: A nationwide study. J Am Geriatr Soc 2007 55:432 438. (Pubitemid 46328121)
42. Colon-Emeric CS, Lekan D, Utley-Smith Q et al. Barriers to and facilitators of clinical practice guideline use in nursing homes. J Am Geriatr Soc 2007 55:1404 1409. (Pubitemid 47329237)
43. Casarett DJ, Quill TE. I'm not ready for hospice: Strategies for timely and effective hospice discussions. Ann Intern Med 2007 146:443 449. (Pubitemid 351650577)
44. Eleazer GP, Horning CA, Egbert CB et al. The relationship between ethnicity and advance directives in a frail older population. J Am Geriatr Soc 1996 44:938 943.
45. Waters CM. End-of-life care directives among African Americans: Lessons learned - a need for community-centered discussion and education. J Commun Health Nurs 2000 17:25 37.
46. Bullock K. Promoting advance directives among African Americans: A faith-based model. J Palliat Care 2006 9:183 195. (Pubitemid 43201781)
47. Davis K. Paying for care episodes and care coordination. N Engl J Med 2007 356:1166 1168. (Pubitemid 46425603)
48. Medicare Payment Advisory Commission. A Path to Bundled Payment Around a Hospitalization. Report to the Congress: Reforming the Delivery System, Chapter 4, pp 83-103, Washington, DC, June 2008.