Relationship between nursing home quality indicators and potentially preventable hospitalisation

Dongjuan Xu, Robert Kane, Gregory Arling

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Hospitalisations are very common among nursing home residents and many of these are deemed inappropriate or preventable. Little is known about whether clinical care quality is related to hospitalisation, especially potentially preventable hospitalisations (PPHs). Among the few studies that have been conducted, the findings have been inconsistent. The objective of this study was to examine the relationship between quality indicators and overall and PPHs among Medicaid beneficiaries aged 65 years and older receiving care at nursing homes in Minnesota. Methods: 23 risk-adjusted quality indicators were used to assess nursing home quality of care. Quality indicators and other facility-level variables from the Minnesota Nursing Home Report Card were merged with resident-level variables from the Minimum Data Set. These merged data were linked with Medicaid claims to obtain hospitalisation rates during the 2011-2012 period. The sample consisted of a cohort of 20 518 Medicaid beneficiaries aged 65 years and older who resided in 345 Minnesota nursing homes. The analyses controlled for resident and facility characteristics using the generalised linear mixed model. Results: The results showed that about 44 % of hospitalisations were PPHs. Available quality indicators were not strongly or consistently associated with the risk of hospitalisation (neither overall nor PPH). Among these 23 quality indicators, five quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, pressures sores, bladder continence and activities of daily living [ADL] dependence) were related significantly to hospitalisation and only four quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, ADL dependence and urinary tract infections) were related to PPH. Conclusion: Although general quality indicators can be informative about overall nursing home performance, only selected quality indicators appear to tap dimensions of clinical quality directly related to hospitalisations.

Original languageEnglish (US)
JournalBMJ Quality and Safety
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Nursing Homes
Hospitalization
Medicaid
Quality of Health Care
Activities of Daily Living
Psychotic Disorders
Antipsychotic Agents
Weight Loss
Pressure Ulcer
Home Care Services
Urinary Tract Infections
Linear Models
Urinary Bladder

Keywords

  • nursing home, potentially preventable hospitalisations, quality indicators

ASJC Scopus subject areas

  • Health Policy

Cite this

Relationship between nursing home quality indicators and potentially preventable hospitalisation. / Xu, Dongjuan; Kane, Robert; Arling, Gregory.

In: BMJ Quality and Safety, 01.01.2019.

Research output: Contribution to journalArticle

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