Prevalence and patterns of potentially avoidable hospitalizations in the US long-term care setting

Int J Qual Health Care. 2016 Feb;28(1):104-9. doi: 10.1093/intqhc/mzv110. Epub 2015 Dec 23.


Objective: We examined the magnitude and related costs of potentially avoidable hospitalizations including re-hospitalizations for long-stay residents in nursing homes.

Design: We conducted our investigation as a retrospective cohort study where the cohort comprised individuals who were eligible for Medicare and had spent at least 120 uninterrupted days in a nursing home in New York State between 2004 and 2007. To conduct the study, we linked the Minimum Data Set, Medicare Provider Assessment File and Provider of Service File.

Measurements: We defined a potentially avoidable hospitalization as one where a resident was admitted to a hospital for which the principle diagnosis was 1 of 15 ambulatory care sensitive (ACS) conditions.

Results: Although the percentage of total hospitalizations for ACS conditions declined during the study period, 20% or more of annual hospitalizations were for ACS conditions entailing Medicare payments in excess of $450 million. Approximately 40% of the residents who were hospitalized once for an ACS condition were re-hospitalized during the study period for the same or different ACS condition.

Conclusion: During the study period, potentially avoidable hospitalizations from nursing homes were a common occurrence in New York. A substantial percentage of such hospitalizations involved residents who had been previously hospitalized, in some cases multiple times, for an ACS condition. Although the observed decline in ACS-related hospitalizations suggests improvements in nursing home care, various policy and managerial-level initiatives may be needed to ensure that nursing home residents are not exposed to a substantial risk of avoidable hospitalizations in the future.

Keywords: long-term care; nursing homes; potentially avoidable hospitalizations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Health Services Research
  • Hospitalization / economics*
  • Humans
  • Long-Term Care*
  • Male
  • Medicare / economics*
  • New York
  • Nursing Homes*
  • Prevalence
  • Retrospective Studies
  • United States