Objective: Identify clinical and organizational factors associated with potentially preventable ambulatory care sensitive (ACS) hospitalization among nursing home residents with chronic kidney disease.
Methods: New York State Nursing home residents (n = 5449) age 60+ with chronic kidney disease and were hospitalized in 2007. Data included residents' sociodemographic and clinical characteristics, nursing home organizational factors, and ACS hospitalizations. Multivariate logistic regression quantified the association between potential determinants and ACS hospitalizations (yes versus no).
Results: Prevalence of chronic kidney disease among nursing home residents is 24%. Potentially avoidable ACS hospitalization among older nursing home residents with chronic kidney disease is 27%. Three potentially modifiable factors associated with significantly higher odds of ACS hospitalization include the following: presence of congestive heart failure (OR = 1.4; 95% CI 1.24-1.65), excessive medication use (OR = 1.3; 95% CI 1.11-1.48), and the lack of training provided to nursing staff on how to communicate effectively with physician about the resident's condition. (OR = 1.3; 95% CI 0.59-0.96).
Conclusion: To reduce potentially preventable ACS hospitalization among chronic kidney disease patients, congestive heart failure and excessive medication use can be kept stable using relatively simple interventions by periodic multidisciplinary review of medications and assessing appropriate response to therapy; and communication training be provided to nursing staff on how to articulate to the responsible physician important changes in the patients' condition.
Published by Elsevier Inc.