title: Hospitalization of nursing home residents with cognitive impairments: the influence of organizational features and state policies.
abstract: OBJECTIVE
  The purpose of this study was to quantify the effect of specific nursing home features and state Medicaid policies on the risk of hospitalization among cognitively impaired nursing home residents.
  
  
  METHODS
  We used multilevel logistic regression to estimate the odds of hospitalization among long-stay (>90 days) nursing home residents against the odds of remaining in the nursing home over a 5-month period, controlling for covariates at the resident, nursing home, and county level. We stratified analyses by resident diagnosis of dementia.
  
  
  RESULTS
  Of 359,474 cognitively impaired residents, 49% had a diagnosis of dementia. Of those, 16% were hospitalized. The probability of hospitalization was negatively associated with the presence of a dementia special care unit (adjusted odds ratio [AOR] = 0.90, 95% confidence interval [CI] = 0.86-0.94) and with a high prevalence of dementia in the nursing home (AOR = 0.96, 95% CI = 0.88-1.03). Higher Medicaid payment rates were associated with reduced likelihood of hospitalization (AOR = 0.95, 95% CI = 0.90-1.00), whereas any bed-hold policy substantially increased that likelihood (AOR = 1.44, 95% CI = 1.12-1.86). We observed similar results for residents without a dementia diagnosis.
  
  
  CONCLUSIONS
  Directed management of chronic conditions, as indicated by facilities' investment in special care units, reduces the risk of hospitalization, but the effect of bed-hold policies illustrates how fragmentation in the financing system impedes these efforts.
authors.affiliation: Department of Community Health, Brown Medical School, Box G-S120, Providence, RI 02912, USA. Andrea_Gruneir@brown.edu
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000191:economics / Q000453:epidemiology*; D016208:Databases, Factual; D005260:Female; D006291:Health Policy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000458:organization & administration*; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D016134:Organizational Policy; D015995:Prevalence; D018570:Risk Assessment; D013221:State Health Plans; D014481:United States / Q000453:epidemiology