Organizational Relationships Between Nursing Homes and Hospitals and Quality of Care During Hospital–Nursing Home Patient Transfers


  • Kenneth S. Boockvar MD, MS,

    1. Geriatrics Research, Education, and Clinical Center, J.J. Peters Veterans Affairs Medical Center, Bronx, New York
    2. The Jewish Home and Hospital Lifecare System, New York, New York
    3. Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York.
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  • Orah R. Burack MA

    1. The Jewish Home and Hospital Lifecare System, New York, New York
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Address correspondence to Kenneth Boockvar, MD, MS, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468. E-mail:


OBJECTIVES: To identify organizational factors and hospital and nursing home organizational relationships associated with more-effective processes of care during hospital–nursing home patient transfer.

DESIGN: Mailed survey.

SETTING: Medicare- or Medicaid-certified nursing homes in New York State.

PARTICIPANTS: Nursing home administrators, with input from other nursing home staff.

MEASUREMENTS: Key predictor variables were travel time between the hospital and the nursing home, affiliation with the same health system, same corporate owner, trainees from the same institution, pharmacy or laboratory agreements, continuous physician care, number of beds in the hospital, teaching status, and frequency of geriatrics specialty care in the hospital. Key dependent variables were hospital-to–nursing home communication, continuous adherence to healthcare goals, and patient and family satisfaction with hospital care.

RESULTS: Of 647 questionnaires sent, 229 were returned (35.4%). There was no relationship between hospital–nursing home interorganizational relationships and communication, healthcare goal adherence, and satisfaction measures. Geriatrics specialty care in the hospital (r=0.157; P=.04) and fewer hospital beds (r=−0.194; P=.01) were each associated with nursing homes more often receiving all information needed to care for patients transferred from the hospital. Teaching status (r=0.230; P=.001) and geriatrics specialty care (r=0.185; P=.01) were associated with hospital care more often consistent with healthcare goals established in the nursing home.

CONCLUSION: No management-level organizational relationship between nursing home and hospital was associated with better hospital-to–nursing home transfer process of care. Geriatrics specialty care and characteristics of the hospital were associated with better hospital-to–nursing home transfer processes.