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]

Authors

  • Joseph G. Ouslander MD,

    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.
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  • Gerri Lamb PhD, RN, FAAN,

    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.
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  • Mary Perloe MS, GNP,

    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.
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  • JoVonn H. Givens MPH,

    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.
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  • Linda Kluge RD, LD, CPHQ,

    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.
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  • Tracy Rutland MBA, MHA,

    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.
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  • Adam Atherly PhD,

    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.
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  • Debra Saliba MD, MPH

    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.
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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

Abstract

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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