title: Variations in hospitalization rates among nursing home residents: the role of discretionary hospitalizations.
abstract: OBJECTIVE
  To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices.
  
  
  METHODS
  Quarterly Medicaid case-mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility-level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market-level attributes. Data spans three years (1991-1993) to produce a longitudinal analytical file containing 72,319 person-quarter-level observations.
  
  
  METHODS
  Two-step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion.
  
  
  RESULTS
  Findings indicate that facility case-mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions.
  
  
  CONCLUSIONS
  Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.
authors.affiliation: Center on Aging, School of Medicine, West Virginia University, Morgantown, WV 26506, USA.
authors.forename: Mary W
authors.initials: MW
authors.lastname: Carter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D008484:Medicaid; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States