title: Maintaining continuity of care for nursing home residents: effect of states' Medicaid bed-hold policies and reimbursement rates.
abstract: OBJECTIVE
  Recent public concern in response to states' intended repeal of Medicaid bed-hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies.
  
  
  METHODS
  Minimum Data Set assessments of long-stay nursing home residents in April-June 2000 linked to Medicare claims enabled tracking residents' hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics.
  
  
  RESULTS
  Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52-0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer.
  
  
  CONCLUSIONS
  Bed-hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective.
authors.affiliation: Brown University, Box G-S121-6, Providence, RI 02912, USA. Orna_Intrator@brown.edu
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.forename: Mark
authors.initials: M
authors.lastname: Schleinitz
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Zinn
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D003266:Continuity of Patient Care / Q000191:economics*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000191:economics; D015233:Models, Statistical; D009735:Nursing Homes / Q000191:economics / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014481:United States
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