PMID- 30670526
OWN - NLM
STAT- MEDLINE
DCOM- 20200219
LR  - 20200309
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 9
IP  - 1
DP  - 2019 Jan 21
TI  - Potentially avoidable hospitalisations of German nursing home patients? A 
      cross-sectional study on utilisation patterns and potential consequences for 
      healthcare.
PG  - e025269
LID - 10.1136/bmjopen-2018-025269 [doi]
LID - e025269
AB  - OBJECTIVES: Demand for nursing home (NH) care is soaring due to gains in life 
      expectancy and people living longer with chronic illness and disability. This is 
      dovetailing with workforce shortages across the healthcare profession. Access to 
      timely and appropriate medical care for NH residents is becoming increasingly 
      challenging and can result in potentially avoidable hospitalisations (PAHs). In 
      light of these factors, we analysed PAHs comparing NH patients with non-NH 
      patients. DESIGN: Cross-sectional study with claims data from 2015 supplied by a 
      large German health insurance company within the federal state of 
      Baden-Wuerttemberg. SETTING: One-year observation of hospitalisation patterns for 
      NH and non-NH patients. PARTICIPANTS: 3 872 245 of the 10.5million inhabitants of 
      Baden-Wuerttemberg were covered. METHODS: Patient data about hospitalisation 
      date, sex, age, nationality, level of care and diagnoses were available. PAHs 
      were defined based on international classification of diseases (ICD-10) diagnoses 
      belonging to ambulatory care sensitive conditions (ACSCs). Adjusted ORs for PAHs 
      for NH patients in comparison with non-NH patients were calculated with 
      multivariable regression models. RESULTS: Of the 933 242 hospitalisations in 
      2015, there were 23 982 for 13 478 NH patients and 909 260 for 560 998 non-NH 
      patients. Mean age of hospitalised NH patients and level of care were 
      significantly higher than those of non-NH patients. 6449 PAHs (29.6%) for NH 
      patients and 136 543 PAHs (15.02%) for non-NH patients were identified. The 
      adjusted OR for PAHs was significantly heightened for NH patients in comparison 
      with non-NH patients (OR: 1.22, CI (1.18 to 1.26), p<0.0001). Moreover, we could 
      observe that more than 90% of PAHs with ACSCs were unplanned hospitalisations 
      (UHs). CONCLUSIONS: Large numbers of PAHs for NH patients calls for improved 
      coordination of medical care, especially general practitioner service provision. 
      Introduction of targeted training programmes for physicians and NH staff on 
      health problem management for NH patients could perhaps contribute to reduction 
      of PAHs, predominantly UHs.
CI  - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Leutgeb, Rudiger
AU  - Leutgeb R
AD  - Department of General Practice and Health Services Research, University Hospital 
      Heidelberg, Heidelberg, Germany.
FAU - Berger, Sarah Jane
AU  - Berger SJ
AD  - Department of General Practice and Health Services Research, University Hospital 
      Heidelberg, Heidelberg, Germany.
FAU - Szecsenyi, Joachim
AU  - Szecsenyi J
AD  - Department of General Practice and Health Services Research, University Hospital 
      Heidelberg, Heidelberg, Germany.
FAU - Laux, Gunter
AU  - Laux G
AD  - Department of General Practice and Health Services Research, University Hospital 
      Heidelberg, Heidelberg, Germany.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20190121
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cross-Sectional Studies
MH  - Female
MH  - Germany
MH  - *Homes for the Aged
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - *Nursing Homes
MH  - Regression Analysis
PMC - PMC6347959
OTO - NOTNLM
OT  - geriatric medicine
OT  - human resource management
OT  - primary care
OT  - quality in health care
COIS- Competing interests: None declared.
EDAT- 2019/01/24 06:00
MHDA- 2020/02/20 06:00
PMCR- 2019/01/21
CRDT- 2019/01/24 06:00
PHST- 2019/01/24 06:00 [entrez]
PHST- 2019/01/24 06:00 [pubmed]
PHST- 2020/02/20 06:00 [medline]
PHST- 2019/01/21 00:00 [pmc-release]
AID - bmjopen-2018-025269 [pii]
AID - 10.1136/bmjopen-2018-025269 [doi]
PST - epublish
SO  - BMJ Open. 2019 Jan 21;9(1):e025269. doi: 10.1136/bmjopen-2018-025269.