Association between proportion of provider clinical effort in nursing homes and potentially avoidable hospitalizations and medical costs of nursing home residents

J Am Geriatr Soc. 2013 Oct;61(10):1750-7. doi: 10.1111/jgs.12441. Epub 2013 Sep 3.


Objectives: To assess potential avoidable hospitalizations of nursing home (NH) residents as a function of the percentage of clinical effort their primary care provider (PCP) devotes to NH practice.

Design: Retrospective cohort study.

Setting: NHs in Texas.

Participants: Residents newly admitted to long-term NHs in 2006 to 2008 were identified by linking the Minimum Data Set to 100% Texas Medicare claims data (N = 12,249).

Measurements: The care that residents received over successive 6-month periods was measured as a time-dependent covariate. Potentially avoidable hospitalizations and Medicare costs were assessed over 6 to 48 months.

Results: Seventy percent of NH residents had a physician as their major PCP, 25% had an advance practice nurse (APN), and 5% had a physician assistant (PA). Physician PCPs who derived less than 20% of their Medicare billings from NH residents cared for 36% of all NH residents. Most NH residents with APN or PA PCPs had providers with 85% or more of Medicare billings generated in NHs. Residents with PCPs who devoted less than 5% of their clinical effort to NH care were at 52% higher risk of potentially avoidable hospitalization than those whose PCPs devoted 85% or more of their clinical effort to NHs (hazard ratio = 1.52, 95% confidence interval = 1.25-1.83) and had $2,179 higher annual Medicare spending, controlling for PCP discipline.

Conclusion: The percentage of clinical effort that providers devote to NHs is associated with risk of avoidable hospitalization.

Keywords: Minimum Data Set; avoidable hospitalization; nursing home; primary care.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Geriatric Assessment*
  • Health Personnel / statistics & numerical data*
  • Homes for the Aged / economics*
  • Hospitalization / economics*
  • Humans
  • Male
  • Medicaid / economics*
  • Medicare / economics*
  • Nursing Homes / economics*
  • Quality of Health Care
  • Retrospective Studies
  • Texas / epidemiology
  • United States