title: Predictors of avoidable hospitalizations among assisted living residents.
abstract: OBJECTIVE
  Hospitalizations for long term care residents, including those from assisted living facilities (ALFs), are very costly, often traumatic, and increase risk for iatrogenic disorders for those involved. Currently, hospital expenditures account for approximately one-third of total national health care spending. Hospitalizations for ambulatory care-sensitive (ACS) conditions are considered potentially avoidable, as these are physical health conditions that can often be treated safely at a lower level of care or occur as a result of lack of timely, adequate treatment at a lower level of care. The goal was to examine risk factors for hospitalization for an ACS condition of Medicaid-enrolled younger and older ALF residents during 2003-2008.
  
  
  METHODS
  This is a retrospective cohort study that used 5 years of Medicaid enrollment and fee-for-service claims data.
  
  
  METHODS
  The study sample included 16,208 Medicaid-enrolled ALF residents in Florida, 7991 (49%) of whom were 65 years of age or older.
  
  
  RESULTS
  In total, study participants had 22,114 hospitalizations, 3759 (17%) of which were for an ACS condition. Sixteen percent of all ALF residents (n = 2587), about 12% of the younger residents and 20% of the older residents, had at least one ACS hospitalization. ACS hospitalizations constitute 13% of all hospitalizations for the younger residents and 22% of all hospitalizations for the older residents. Using Cox proportional hazard regression, we found that for both age groups, increased age, being Hispanic or of other race/ethnicity, and having comorbid physical health conditions were associated with a higher risk of ACS hospitalization. For older residents, having a dementia diagnosis and being African American reduced the risk of ACS hospitalization, whereas for younger residents having a major psychotic disorder reduced the risk of ACS hospitalization.
  
  
  CONCLUSIONS
  The results highlight the need for increased education, communication, and future research on these predictive factors. The increased frequency of hospitalization for ACS conditions among ALF residents with minority status and older age may well indicate that their more complex health care needs are not being adequately addressed. The role of serious mental illness and dementia in risk for ACS hospitalization also deserves further attention.
authors: University of South Florida, College of Behavioral and Community Sciences, Louis de la Parte Florida Mental Health Institute, Department of Aging and Mental Health Disparities, Tampa, FL 33612-3807, USA. becker@fmhi.usf.edu
authors: Marion
authors: M
authors: Becker
authors: Timothy
authors: T
authors: Boaz
authors: Ross
authors: R
authors: Andel
authors: Anne
authors: A
authors: DeMuth
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006305:Health Status Indicators; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000458:organization & administration; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D014481:United States