Nursing home medical staff organization and 30-day rehospitalizations.
OBJECTIVE
To examine the relationship between features of nursing home (NH) medical staff organization and residents' 30-day rehospitalizations.


METHODS
Cross-sectional study combining primary data collected from a survey of medical directors, NH resident assessment data (minimum data set), Medicare claims, and the Online Survey Certification and Reporting (OSCAR) database.


METHODS
A total of 202 freestanding US nursing homes.


METHODS
Medicare fee-for-service beneficiaries who were hospitalized and subsequently admitted to a study nursing home.


METHODS
Medical staff organization dimensions derived from the survey, NH residents' characteristics derived from minimum data set data, hospitalizations obtained from Part A Medicare claims, and NH characteristics from the OSCAR database and from www.ltcfocus.org. Study outcome defined within a 30-day window following an index hospitalization: rehospitalized, otherwise died, otherwise survived and not rehospitalized.


RESULTS
Thirty-day rehospitalizations occurred for 3788 (20.3%) of the 18,680 initial hospitalizations. Death was observed for 884 (4.7%) of residents who were not rehospitalized. Adjusted by hospitalization, resident, and NH characteristics, nursing homes having a more formal appointment process for physicians were less likely to have 30-day rehospitalization (b = -0.43, SE = 0.17), whereas NHs in which a higher proportion of residents were cared for by a single physician were more likely to have rehospitalizations (b = 0.18, SE = 0.08).


CONCLUSIONS
This is the first study to show a direct relationship between features of NH medical staff organization and resident-level process of care. The relationship of a more strict appointment process and rehospitalizations might be a consequence of more formalized and dedicated medical practice with a sense of ownership and accountability. A higher volume of patients per physician does not appear to improve quality of care.
Center for Gerontology and Health Care Research, Alpert Medical School of Brown University, Providence, RI 02903, USA. Julie_Lima@brown.edu
Julie C
JC
Lima
Orna
O
Intrator
Jurgis
J
Karuza
Terrie
T
Wetle
Vincent
V
Mor
Paul
P
Katz
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008503:Medical Staff / Q000458:organization & administration*; D006278:Medicare; D009735:Nursing Homes / Q000458:organization & administration*; D011787:Quality of Health Care; D014481:United States