Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs: [see editorial comments by Drs. Jean F. Wyman and William R. Hazzard, pp 760-761].
OBJECTIVE
To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents.


METHODS
Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization.


METHODS
NHs in Georgia.


METHODS
In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long- and short-stay residents.


METHODS
Ratings using a structured review by expert NH clinicians.


RESULTS
Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on-site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations.


CONCLUSIONS
In this sample of NH residents, experienced long-term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population.
Ouslander
Joseph G
JG
Charles E. Schmidt College of Biomedical Sciences and Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA. joseph.ouslander@fau.edu
Lamb
Gerri
G
Perloe
Mary
M
Givens
JoVonn H
JH
Kluge
Linda
L
Rutland
Tracy
T
Atherly
Adam
A
Saliba
Debra
D
D000368:Aged; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D005845:Georgia; D015577:Geriatric Assessment; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008485:Medical Audit; D006278:Medicare / Q000706:statistics & numerical data; D020380:Needs Assessment; D009735:Nursing Homes / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care; D017749:Total Quality Management; D014481:United States; D014600:Utilization Review