Frequency and costs of hospital transfers for ambulatory care-sensitive conditions

Am J Manag Care. 2015 Jan;21(1):51-9.


Objectives: Nursing home (NH) patients are frequently transferred to emergency departments (EDs) and/or hospitalized in situations in which transfer might have been avoided. This study describes the frequency of NH transfers for ambulatory care-sensitive conditions (ACSCs) and estimates associated expenditures.

Study design: Retrospective cohort study of 62,379 NH patients with Medicare coverage receiving care in South Carolina between 2007 and 2009.

Methods: Subjects were analyzed to determine the frequency of acute ED or hospital care for conditions. Comparison is made to similar patients transferred for acute treatment of non-ACSCs. Generalized linear models were used to estimate the costs attributable to treating ACSCs.

Results: Over 3 years, 20,867 NH subjects were transferred from NHs to acute care facilities, and 85.3% of subjects had at least 1 episode of care for an ACSC. An average of 13,317 subjects per year were transferred for an average of 17,060 episodes of ED or hospital care per year between 2007 and 2009. More ACSC patients transferred to EDs were subsequently admitted to the hospital (50.4% vs 25%; P < .0001). In adjusted analyses, mean ED costs per episode of care ($401 vs $294; P < .0001) were higher, but mean hospitalization costs per episode of care were lower ($8356 vs $10,226; P < .0001) for ACSC patients compared with non-ACSC patients.

Conclusions: A significant proportion of Medicare NH patients are treated acutely for ACSCs, which are associated with higher healthcare utilization and costs. Better access to onsite evaluation might enable significant cost savings and reduce morbidity in this population.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care / organization & administration*
  • Cohort Studies
  • Cost-Benefit Analysis
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Care Costs
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Linear Models
  • Male
  • Medicare / economics
  • Medicare / statistics & numerical data
  • Nursing Homes / economics
  • Nursing Homes / statistics & numerical data
  • Patient Acceptance of Health Care
  • Retrospective Studies
  • South Carolina
  • Transportation of Patients / economics
  • Transportation of Patients / statistics & numerical data*
  • United States
  • Vulnerable Populations / statistics & numerical data*