Nursing Home Capabilities and Decisions to Hospitalize: A Survey of Medical Directors and Directors of Nursing

Authors

  • Joan L. Buchanan PhD,

    1. From the *Department of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiCenter for Health Systems Research and Analysis, University of Wisconsin, Madison, Wisconsin§Division of General Medicine and Primary Care and Gerontology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsHebrew Rehabilitation Center for Aged, Boston, Massachusetts.
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  • Rachel L. Murkofsky MD, MPH,

    1. From the *Department of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiCenter for Health Systems Research and Analysis, University of Wisconsin, Madison, Wisconsin§Division of General Medicine and Primary Care and Gerontology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsHebrew Rehabilitation Center for Aged, Boston, Massachusetts.
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  • Alistair James O'Malley PhD,

    1. From the *Department of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiCenter for Health Systems Research and Analysis, University of Wisconsin, Madison, Wisconsin§Division of General Medicine and Primary Care and Gerontology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsHebrew Rehabilitation Center for Aged, Boston, Massachusetts.
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  • Sarita L. Karon PhD,

    1. From the *Department of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiCenter for Health Systems Research and Analysis, University of Wisconsin, Madison, Wisconsin§Division of General Medicine and Primary Care and Gerontology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsHebrew Rehabilitation Center for Aged, Boston, Massachusetts.
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  • David Zimmerman PhD,

    1. From the *Department of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiCenter for Health Systems Research and Analysis, University of Wisconsin, Madison, Wisconsin§Division of General Medicine and Primary Care and Gerontology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsHebrew Rehabilitation Center for Aged, Boston, Massachusetts.
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  • Daryl J. Caudry SM,

    1. From the *Department of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiCenter for Health Systems Research and Analysis, University of Wisconsin, Madison, Wisconsin§Division of General Medicine and Primary Care and Gerontology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsHebrew Rehabilitation Center for Aged, Boston, Massachusetts.
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  • Edward R. Marcantonio MD, SM

    1. From the *Department of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiCenter for Health Systems Research and Analysis, University of Wisconsin, Madison, Wisconsin§Division of General Medicine and Primary Care and Gerontology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsHebrew Rehabilitation Center for Aged, Boston, Massachusetts.
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  • Presented at the Gerontological Society of America annual meeting, San Diego, California, November 2003.

Address correspondence to Joan L. Buchanan, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115. E-mail: buchanan@hcp.med.harvard.edu

Abstract

OBJECTIVES: To obtain information from decision makers about attitudes toward hospitalization and the factors that influence their decisions to hospitalize nursing home residents.

DESIGN: Cross-sectional survey.

SETTING: Four hundred forty-eight nursing homes, 76% of which were nonprofit, from 25 states.

PARTICIPANTS: Medical directors and directors of nursing (DONs).

MEASUREMENTS: Participants were surveyed about resource availability, determinants of hospitalization, causes of overhospitalization, and nursing home practice.

RESULTS: The survey response rate was 81%, with at least one survey from 93% of the facilities. Medical directors and DONs agreed that resident preference was the most important determinant in the decision to hospitalize, followed by quality of life. Although both groups ranked on-site doctor/nurse practitioner evaluation within 4 hours as the least accessible resource, they did not rank doctors not being quickly available as an important cause of overhospitalization. Rather, medical directors perceived the lack of information and support to residents and families around end-of-life care and the lack of familiarity with residents by covering doctors as the most important causes of overhospitalization. DONs agreed but reversed the order. Medical directors and DONs expressed confidence in provider and staff ability, although DONs were significantly more positive.

CONCLUSION: Medical directors and DONs agree about most factors that influence decisions to hospitalize nursing home residents. Patient-centered factors play the largest roles, and the most important causes of overhospitalization are potentially modifiable.

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