PMID- 31043354
OWN - NLM
STAT- MEDLINE
DCOM- 20201210
LR  - 20201214
IS  - 1538-9375 (Electronic)
IS  - 1525-8610 (Linking)
VI  - 20
IP  - 10
DP  - 2019 Oct
TI  - Preventable Hospitalizations Among Nursing Home Residents With Dementia and 
      Behavioral Health Disorders.
PG  - 1280-1286.e1
LID - S1525-8610(19)30271-3 [pii]
LID - 10.1016/j.jamda.2019.03.006 [doi]
AB  - OBJECTIVE: Nursing home (NH) residents with Alzheimer's disease/related dementias 
      (ADRD) and/or behavioral health disorders (BHD) are at high risk of 
      hospitalizations, many of which are potentially avoidable. Empirical evidence 
      regarding potentially avoidable hospitalizations (PAHs) among these residents is 
      quite sparse and mixed. The objectives of this study were to (1) examine the risk 
      of PAH among residents with ADRD only, BHD only, ADRD and BHD compared to 
      residents with neither and (2) identify associations between individual- and 
      facility-level factors and PAH in these subgroups. DESIGN: Retrospective, 
      CY2014-2015. SETTING AND PARTICIPANTS: Long-term residents age 65+ (N = 807,630) 
      residing in 15,234 NHs. METHODS: We employed the Minimum Data Set, MedPAR, 
      Medicare beneficiary summary, and Nursing Home Compare. Hospitalization risk was 
      the outcome of interest. Individual-level covariates were used to adjust for 
      health conditions. Facility-level covariates and state dummies were included. 
      Multinomial logistic regression models were fit to estimate the risk of PAH and 
      non-potentially avoidable hospitalizations (N-PAH). RESULTS: Compared to 
      residents without ADRD or BHD, those with ADRD had at least a 10% lower relative 
      risk ratio (RRR) of N-PAH and a significantly lower risk of PAH, at 16% 
      (P < .0001). Residents with BHD only had a statistically higher, but clinically 
      very modest (RRR = 1.03) risk of N-PAH, with no difference in the risk of PAH. 
      Focusing on specific BHD conditions, we found no difference in N-PAH or PAH among 
      residents with depression, lower PAH risk among those with 
      schizophrenia/psychosis (RRR = 0.92), and an increased risk of both N-PAH 
      (RRR = 1.15) and PAH (RRR = 1.09) among residents with bipolar disorders. 
      CONCLUSIONS AND RELEVANCE: We observed a lower risk of PAH and N-PAH among 
      residents with ADRD, with the risk for residents with BHD varying by condition. 
      Substantial variations in PAH and N-PAH were evident across states. Future 
      research is needed to identify state-level modifiable factors that explain these 
      variations.
CI  - Copyright (c) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine. 
      Published by Elsevier Inc. All rights reserved.
FAU - Temkin-Greener, Helena
AU  - Temkin-Greener H
AD  - Department of Public Health Sciences, University of Rochester School of Medicine 
      and Dentistry, Rochester, NY. Electronic address: 
      helena_temkin-greener@urmc.rochester.edu.
FAU - Cen, Xi
AU  - Cen X
AD  - Department of Public Health Sciences, University of Rochester School of Medicine 
      and Dentistry, Rochester, NY.
FAU - Hasselberg, Michael J
AU  - Hasselberg MJ
AD  - Department of Psychiatry, University of Rochester School of Medicine and 
      Dentistry, Rochester, NY.
FAU - Li, Yue
AU  - Li Y
AD  - Department of Public Health Sciences, University of Rochester School of Medicine 
      and Dentistry, Rochester, NY.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190428
PL  - United States
TA  - J Am Med Dir Assoc
JT  - Journal of the American Medical Directors Association
JID - 100893243
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - *Attention Deficit and Disruptive Behavior Disorders
MH  - Databases, Factual
MH  - *Dementia
MH  - Female
MH  - *Hospitalization/trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nursing Homes
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Avoidable hospitalizations
OT  - behavioral disorders
OT  - dementia
OT  - nursing homes
EDAT- 2019/05/03 06:00
MHDA- 2020/12/15 06:00
CRDT- 2019/05/03 06:00
PHST- 2018/11/29 00:00 [received]
PHST- 2019/02/25 00:00 [revised]
PHST- 2019/03/05 00:00 [accepted]
PHST- 2019/05/03 06:00 [pubmed]
PHST- 2020/12/15 06:00 [medline]
PHST- 2019/05/03 06:00 [entrez]
AID - S1525-8610(19)30271-3 [pii]
AID - 10.1016/j.jamda.2019.03.006 [doi]
PST - ppublish
SO  - J Am Med Dir Assoc. 2019 Oct;20(10):1280-1286.e1. doi: 
      10.1016/j.jamda.2019.03.006. Epub 2019 Apr 28.