Nursing home capabilities and decisions to hospitalize: a survey of medical directors and directors of nursing.
OBJECTIVE
To obtain information from decision makers about attitudes toward hospitalization and the factors that influence their decisions to hospitalize nursing home residents.


METHODS
Cross-sectional survey.


METHODS
Four hundred forty-eight nursing homes, 76% of which were nonprofit, from 25 states.


METHODS
Medical directors and directors of nursing (DONs).


METHODS
Participants were surveyed about resource availability, determinants of hospitalization, causes of overhospitalization, and nursing home practice.


RESULTS
The survey response rate was 81%, with at least one survey from 93% of the facilities. Medical directors and DONs agreed that resident preference was the most important determinant in the decision to hospitalize, followed by quality of life. Although both groups ranked on-site doctor/nurse practitioner evaluation within 4 hours as the least accessible resource, they did not rank doctors not being quickly available as an important cause of overhospitalization. Rather, medical directors perceived the lack of information and support to residents and families around end-of-life care and the lack of familiarity with residents by covering doctors as the most important causes of overhospitalization. DONs agreed but reversed the order. Medical directors and DONs expressed confidence in provider and staff ability, although DONs were significantly more positive.


CONCLUSIONS
Medical directors and DONs agree about most factors that influence decisions to hospitalize nursing home residents. Patient-centered factors play the largest roles, and the most important causes of overhospitalization are potentially modifiable.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA. buchanan@hcp.med.harvard.edu
Joan L
JL
Buchanan
Rachel L
RL
Murkofsky
Alistair James
AJ
O'Malley
Sarita L
SL
Karon
David
D
Zimmerman
Daryl J
DJ
Caudry
Edward R
ER
Marcantonio
D001291:Attitude of Health Personnel; D003657:Decision Making; D006306:Health Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D009718:Nurse Administrators; D009735:Nursing Homes / Q000706:statistics & numerical data*; D008486:Physician Executives