Get access

Variations in Hospitalization Rates among Nursing Home Residents: The Role of Discretionary Hospitalizations


  • Mary W. Carter

    Search for more papers by this author
    • Address correspondence to Mary W. Carter, Ph.D., Assistant Professor, Center on Aging, School of Medicine, West Virginia University, Health Sciences Annex, P.O. Box 9127, Morgantown, WV 26506.

  • Support for this research was provided by the Health Care Financing Administration's Dissertation Award under grant no. 30-p91009/01. Data acquisition and cleaning were possible through a grant provided by the Agency for Healthcare Research and Quality, grant no. 1 R01 HS07587-01A1. Support was also provided by the National Institute on Aging, Postdoctoral Fellowship Program (Minnesota Training Grant in Aging no. AG00198-10).


Objective. To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices.

Data Sources. Quarterly Medicaid case-mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility-level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market-level attributes. Data spans three years (1991–1993) to produce a longitudinal analytical file containing 72,319 person-quarter-level observations.

Study Design. Two-step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion.

Principal Findings. Findings indicate that facility case-mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions.

Conclusions. Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.