PMID- 24219191
OWN - NLM
STAT- MEDLINE
DCOM- 20140106
LR  - 20211021
IS  - 1532-5415 (Electronic)
IS  - 0002-8614 (Print)
IS  - 0002-8614 (Linking)
VI  - 61
IP  - 11
DP  - 2013 Nov
TI  - Hospitalizations of nursing home residents in the last year of life: nursing home 
      characteristics and variation in potentially avoidable hospitalizations.
PG  - 1900-8
LID - 10.1111/jgs.12517 [doi]
AB  - OBJECTIVES: To examine the incidence of, variations in, and costs of potentially 
      avoidable hospitalizations (PAHs) of nursing home (NH) residents at the end of 
      life and to identify the association between NH characteristics and a 
      facility-level quality measure (QM) for PAH. DESIGN: Retrospective. SETTING: 
      Hospitalizations originating from NHs. PARTICIPANTS: Long-term care NH residents 
      who died in 2007. MEASUREMENTS: A risk-adjusted QM was constructed for PAH. A 
      Poisson regression model was used to predict the count of PAH given residents' 
      risk factors. For each facility, the QM was defined as the difference between the 
      observed facility-specific rate (per 1,000 person-years) of PAH (O) and the 
      expected risk-adjusted rate (E). A logistic regression model with state 
      fixed-effects was then fit to examine the association between facility 
      characteristics and the likelihood of having higher-than-expected rates of PAH 
      (O-E > 0). QM values greater than 0 indicate worse-than-average quality. RESULTS: 
      Almost 50% of hospital admissions for NH residents in their last year of life 
      were for potentially avoidable conditions, costing Medicare $1 billion. Five 
      conditions were responsible for more than 80% of PAHs. PAH QM across facilities 
      showed significant variation (mean 12.0 +/- 142.3 per 1,000 person-years, range 
      -399.48 to 398.09 per 1,000 person-years). Chain and hospital-based facilities 
      were more likely to exhibit better performance (O-E < 0). Facilities with higher 
      nursing staffing were more likely to have better performance, as were facilities 
      with higher skilled staff ratio, those with nurse practitioners or physician 
      assistants, and those with on-site X-ray services. CONCLUSION: Variations in 
      facility-level PAHs suggest that a potential for reducing hospital admissions for 
      these conditions may exist. Presence of modifiable facility characteristics 
      associated with PAH performance could help us formulate interventions and 
      policies for reducing PAHs at the end of life.
CI  - (c) 2013, Copyright the Authors Journal compilation (c) 2013, The American Geriatrics 
      Society.
FAU - Xing, Jingping
AU  - Xing J
AD  - Department of Public Health Sciences, University of Rochester Medical Center, 
      Rochester, New York.
FAU - Mukamel, Dana B
AU  - Mukamel DB
FAU - Temkin-Greener, Helena
AU  - Temkin-Greener H
LA  - eng
GR  - R01 NR010727/NR/NINR NIH HHS/United States
GR  - NR010727/NR/NINR NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20131105
PL  - United States
TA  - J Am Geriatr Soc
JT  - Journal of the American Geriatrics Society
JID - 7503062
SB  - IM
MH  - Aged, 80 and over
MH  - Costs and Cost Analysis
MH  - *Homes for the Aged
MH  - Hospitalization/*economics/*statistics & numerical data
MH  - Humans
MH  - *Nursing Homes
MH  - Retrospective Studies
MH  - Time Factors
PMC - PMC3827689
MID - NIHMS517986
OTO - NOTNLM
OT  - end of life
OT  - nursing homes
OT  - potentially avoidable hospitalizations
COIS- Conflict of Interest: The editor in chief has reviewed the conflict of interest 
      checklist provided by the authors and has determined that the authors have no 
      financial or any other kind of personal conflicts with this paper.
EDAT- 2013/11/14 06:00
MHDA- 2014/01/07 06:00
PMCR- 2014/11/05
CRDT- 2013/11/14 06:00
PHST- 2013/11/14 06:00 [entrez]
PHST- 2013/11/14 06:00 [pubmed]
PHST- 2014/01/07 06:00 [medline]
PHST- 2014/11/05 00:00 [pmc-release]
AID - 10.1111/jgs.12517 [doi]
PST - ppublish
SO  - J Am Geriatr Soc. 2013 Nov;61(11):1900-8. doi: 10.1111/jgs.12517. Epub 2013 Nov 
      5.