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Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

[See editorial comments by Drs. Jean F. Wyman and William R. Hazzard, pp 760–761]

  1. Joseph G. Ouslander MD,
  2. Gerri Lamb PhD, RN, FAAN,
  3. Mary Perloe MS, GNP,
  4. JoVonn H. Givens MPH,
  5. Linda Kluge RD, LD, CPHQ,
  6. Tracy Rutland MBA, MHA,
  7. Adam Atherly PhD,
  8. Debra Saliba MD, MPH

Article first published online: 1 APR 2010

DOI: 10.1111/j.1532-5415.2010.02768.x

Issue

Journal of the American Geriatrics Society

Journal of the American Geriatrics Society

Volume 58, Issue 4, pages 627–635, April 2010

Additional Information

How to Cite

Ouslander, J. G., Lamb, G., Perloe, M., Givens, J. H., Kluge, L., Rutland, T., Atherly, A. and Saliba, D. (2010), Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs . Journal of the American Geriatrics Society, 58: 627–635. doi: 10.1111/j.1532-5415.2010.02768.x

Author Information

  1. From the *Charles E. Schmidt College of Biomedical Sciences and Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida; †Division of Gerontology and Geriatric Medicine, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida; ‡College of Nursing and Healthcare Innovation, Arizona State University, Phoenix, Arizona; §Georgia Medical Care Foundation, Atlanta, Georgia; ∥Rollins School of Public Health, Emory University, Atlanta, Georgia; #Veterans Affairs Greater Los Angeles Geriatric Research, Education and Clinical Center and Health Services Research and Development Center of Excellence, Sepulveda, California; and **Borun Center for Gerontological Research, University of California at Los Angeles/Los Angeles Jewish Home, Los Angeles, California.

*Address correspondence to Joseph G. Ouslander, MD, Director, Institute for Quality Aging, Boca Raton Community Hospital, 644 Glades Road, Oaks Plaza, Boca Raton, FL 33486. E-mail: joseph.ouslander@fau.edu

Publication History

  1. Issue published online: 1 APR 2010
  2. Article first published online: 1 APR 2010

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Keywords:

  • nursing homes;
  • avoidable hospitalizations;
  • transfers;
  • quality

OBJECTIVES: To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents.

DESIGN: Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization.

SETTING: NHs in Georgia.

PARTICIPANTS: In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long- and short-stay residents.

MEASUREMENTS: Ratings using a structured review by expert NH clinicians.

RESULTS: Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on-site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations.

CONCLUSION: In this sample of NH residents, experienced long-term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population.

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