title: Factors associated with ambulatory care--sensitive hospitalizations among nursing home residents.
abstract: This study examined patient-level, facility-level, and area market-level factors affecting ambulatory care-sensitive hospitalization (ACSH) rates among nursing home residents. Although ACSH has long been used to monitor accessibility to health care services among community-dwelling populations, the use of ACSH rates as an indicator of potential quality-of-care problems affecting nursing home residents has not been employed. METHODS. Three years of quarterly Medicaid reimbursement data from more than 500 nursing homes were linked to 4 years of Medicare Provider Analysis and Review hospital claims data, nursing facility attribute data, and Area Resource File data to investigate the relative contribution of patient-, facility-, and market-level risk factors to ACSH among nursing home residents. RESULTS. Logistic regression results indicate that facility-level factors and nursing home quality-of-care indicators significantly contribute to the risk of ACSH. DISCUSSION. Findings underscore the need for continuing efforts to improve quality-of-care practices in nursing homes, particularly with respect to associations between quality-of-care indicators and facility structural/organizational characteristics with ACSHs.
authors.affiliation: West Virginia University School of Medicine, USA.
authors.forename: Mary W
authors.initials: MW
authors.lastname: Carter
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005163:Factor Analysis, Statistical; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011787:Quality of Health Care; D012044:Regression Analysis; D012307:Risk Factors; D014481:United States