title: Hospitalization of elderly Medicaid long-term care users who transition from nursing homes.
abstract: OBJECTIVE
  To compare hospitalizations of dually eligible older adults who had an extended Medicaid nursing home (NH) stay and transitioned out to receive Medicaid home- and community-based services (HCBS) with hospitalizations of those who remained in the NH.
  
  
  METHODS
  Retrospective matched cohort study using Medicaid and Medicare claims and NH assessment data.
  
  
  METHODS
  Community (receiving Medicaid HCBS) or NH.
  
  
  METHODS
  Dually eligible fee-for-service beneficiaries aged 65 and older in Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington from 2003 to 2005. Individuals who had a Medicaid NH stay of at least 90 days and transitioned to Medicaid HCBS (N = 1,169) were matched to individuals who had a Medicaid NH stay of at least 90 days and remained in the NH (N = 1,169).
  
  
  METHODS
  Potentially preventable hospitalizations (defined according to ambulatory-care-sensitive conditions) and all hospitalizations were examined.
  
  
  RESULTS
  Cox proportional hazards models were used to compare the risk of hospitalization between the groups, accounting for the differing time at risk and censoring. Being a NH transitioner increased the hazard of experiencing a potentially preventable hospitalization by 40% (95% confidence interval (CI) = 1.01-1.93) over remaining in the NH. NH transitioners had a 58% (95% CI = 1.32-1.91) greater risk of experiencing any type of hospitalization than NH stayers.
  
  
  CONCLUSIONS
  Individuals who transitioned from the NH to HCBS had a greater risk of hospitalization. Most of the attention in long-term care transition programs has been focused on NH readmission, but programs encouraging NH transition should recognize that individuals may be at greater risk for hospitalization after returning to the community. Planning for the medical needs of individuals who transition from an extended NH stay may improve their posttransition outcomes.
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wysocki
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Bryan
authors.initials: B
authors.lastname: Dowd
authors.forename: Ezra
authors.initials: E
authors.lastname: Golberstein
authors.forename: Terry
authors.initials: T
authors.lastname: Lum
authors.forename: Tetyana
authors.initials: T
authors.lastname: Shippee
mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D006278:Medicare; D009735:Nursing Homes; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
keywords: dually eligible; home- and community-based services; hospitalization; nursing home; transition