title: Prevalence and patterns of potentially avoidable hospitalizations in the US long-term care setting.
abstract: OBJECTIVE
  We examined the magnitude and related costs of potentially avoidable hospitalizations including re-hospitalizations for long-stay residents in nursing homes.
  
  
  METHODS
  We conducted our investigation as a retrospective cohort study where the cohort comprised individuals who were eligible for Medicare and had spent at least 120 uninterrupted days in a nursing home in New York State between 2004 and 2007. To conduct the study, we linked the Minimum Data Set, Medicare Provider Assessment File and Provider of Service File.
  
  
  METHODS
  We defined a potentially avoidable hospitalization as one where a resident was admitted to a hospital for which the principle diagnosis was 1 of 15 ambulatory care sensitive (ACS) conditions.
  
  
  RESULTS
  Although the percentage of total hospitalizations for ACS conditions declined during the study period, 20% or more of annual hospitalizations were for ACS conditions entailing Medicare payments in excess of $450 million. Approximately 40% of the residents who were hospitalized once for an ACS condition were re-hospitalized during the study period for the same or different ACS condition.
  
  
  CONCLUSIONS
  During the study period, potentially avoidable hospitalizations from nursing homes were a common occurrence in New York. A substantial percentage of such hospitalizations involved residents who had been previously hospitalized, in some cases multiple times, for an ACS condition. Although the observed decline in ACS-related hospitalizations suggests improvements in nursing home care, various policy and managerial-level initiatives may be needed to ensure that nursing home residents are not exposed to a substantial risk of avoidable hospitalizations in the future.
authors.affiliation: Northeastern University Center for Health Policy and Healthcare Research, Boston, USA.
authors.forename: Rosemary M
authors.initials: RM
authors.lastname: Mcandrew
authors.affiliation: Harvard Medical School, Boston, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.affiliation: Northeastern University Center for Health Policy and Healthcare Research, Boston, USA.
authors.forename: Ankit
authors.initials: A
authors.lastname: Dangi
authors.affiliation: Northeastern University Center for Health Policy and Healthcare Research, Boston, USA D'Amore-McKim School of Business, Northeastern University, Boston, USA Bouvé College of Health Sciences, Northeastern University, Boston, USA.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Young
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D006278:Medicare / Q000191:economics*; D009518:New York; D009735:Nursing Homes; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States
keywords: long-term care; nursing homes; potentially avoidable hospitalizations