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]
Article first published online: 1 APR 2010
© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 58, Issue 4, pages 627–635, April 2010
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
- Issue published online: 1 APR 2010
- Article first published online: 1 APR 2010
- nursing homes;
- avoidable hospitalizations;
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.