title: Association between proportion of provider clinical effort in nursing homes and potentially avoidable hospitalizations and medical costs of nursing home residents.
abstract: OBJECTIVE
  To assess potential avoidable hospitalizations of nursing home (NH) residents as a function of the percentage of clinical effort their primary care provider (PCP) devotes to NH practice.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  NHs in Texas.
  
  
  METHODS
  Residents newly admitted to long-term NHs in 2006 to 2008 were identified by linking the Minimum Data Set to 100% Texas Medicare claims data (N = 12,249).
  
  
  METHODS
  The care that residents received over successive 6-month periods was measured as a time-dependent covariate. Potentially avoidable hospitalizations and Medicare costs were assessed over 6 to 48 months.
  
  
  RESULTS
  Seventy percent of NH residents had a physician as their major PCP, 25% had an advance practice nurse (APN), and 5% had a physician assistant (PA). Physician PCPs who derived less than 20% of their Medicare billings from NH residents cared for 36% of all NH residents. Most NH residents with APN or PA PCPs had providers with 85% or more of Medicare billings generated in NHs. Residents with PCPs who devoted less than 5% of their clinical effort to NH care were at 52% higher risk of potentially avoidable hospitalization than those whose PCPs devoted 85% or more of their clinical effort to NHs (hazard ratio = 1.52, 95% confidence interval = 1.25-1.83) and had $2,179 higher annual Medicare spending, controlling for PCP discipline.
  
  
  CONCLUSIONS
  The percentage of clinical effort that providers devote to NHs is associated with risk of avoidable hospitalization.
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Mukaila A
authors.initials: MA
authors.lastname: Raji
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006282:Health Personnel / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D009735:Nursing Homes / Q000191:economics*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D014481:United States
keywords: Minimum Data Set; avoidable hospitalization; nursing home; primary care