Nursing home characteristics and potentially preventable hospitalizations of long-stay residents

J Am Geriatr Soc. 2004 Oct;52(10):1730-6. doi: 10.1111/j.1532-5415.2004.52469.x.


Objectives: To examine the association between having a nurse practitioner/physician assistant (NP/PA) on staff, other nursing home (NH) characteristics, and the rate of potentially preventable/avoidable hospitalizations of long-stay residents, as defined using a list of ambulatory care-sensitive (ACS) diagnoses.

Design: Cross-sectional prospective study using Minimum Data Set (MDS) assessments, Centers for Medicare and Medicaid Services inpatient claims and eligibility records, On-line Survey Certification Automated Records, (OSCAR) and Area Resource File (ARP).

Setting: Freestanding urban NHs in Maine, Kansas, New York, and South Dakota.

Participants: Residents of 663 facilities with a quarterly or annual MDS assessment in the 2nd quarter of 1997, who had a prior MDS assessment at least 160 days before, and who were not health maintenance organization members throughout 1997 (N=54,631).

Measurements: A 180-day multinomial outcome was defined as having any hospitalization with primary ACS diagnosis, otherwise having been hospitalized, otherwise died, and otherwise remained in the facility.

Results: Multilevel models show that facilities with NP/PAs were associated with lower hospitalization rates for ACS conditions (adjusted odds ratio (AOR)=0.83), but not with other hospitalizations. Facilities with more physicians were associated with higher ACS hospitalizations (ACS, AOR=1.14, and non-ACS, AOR=1.10). Facilities providing intravenous therapy, and those that operate a nurses' aide training program were associated with fewer hospitalizations of both types.

Conclusion: Employment of NP/PAs in NHs, the provision of intravenous therapy, and the operation of certified nurse assistant training programs appear to reduce ACS hospitalizations, and may be feasible cost-saving policy interventions.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care Facilities / organization & administration*
  • Ambulatory Care Facilities / statistics & numerical data
  • Cross-Sectional Studies
  • Data Collection / methods
  • Female
  • Geriatric Assessment / methods*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Long-Term Care / organization & administration*
  • Long-Term Care / statistics & numerical data
  • Male
  • Nursing Care / organization & administration*
  • Nursing Homes / organization & administration*
  • Nursing Homes / statistics & numerical data
  • Prospective Studies
  • Quality of Health Care*
  • United States