Association Between Proportion of Provider Clinical Effort in Nursing Homes and Potentially Avoidable Hospitalizations and Medical Costs of Nursing Home Residents
Article first published online: 3 SEP 2013
© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 61, Issue 10, pages 1750–1757, October 2013
How to Cite
J Am Geriatr Soc 61:1750–1757, 2013.
- Issue published online: 11 OCT 2013
- Article first published online: 3 SEP 2013
- Healthcare Research and Quality. Grant Number: R01-HS020642
- National Institute. Grant Numbers: R01-AG033134, P30-AG024832
- National Cancer Institute. Grant Number: K05-CA134923
- National Center for Research Resources, National Institutes of Health. Grant Number: UL1-RR029876
- nursing home;
- primary care;
- Minimum Data Set;
- avoidable hospitalization
To assess potential avoidable hospitalizations of nursing home (NH) residents as a function of the percentage of clinical effort their primary care provider (PCP) devotes to NH practice.
Retrospective cohort study.
NHs in Texas.
Residents newly admitted to long-term NHs in 2006 to 2008 were identified by linking the Minimum Data Set to 100% Texas Medicare claims data (N = 12,249).
The care that residents received over successive 6-month periods was measured as a time-dependent covariate. Potentially avoidable hospitalizations and Medicare costs were assessed over 6 to 48 months.
Seventy percent of NH residents had a physician as their major PCP, 25% had an advance practice nurse (APN), and 5% had a physician assistant (PA). Physician PCPs who derived less than 20% of their Medicare billings from NH residents cared for 36% of all NH residents. Most NH residents with APN or PA PCPs had providers with 85% or more of Medicare billings generated in NHs. Residents with PCPs who devoted less than 5% of their clinical effort to NH care were at 52% higher risk of potentially avoidable hospitalization than those whose PCPs devoted 85% or more of their clinical effort to NHs (hazard ratio = 1.52, 95% confidence interval = 1.25–1.83) and had $2,179 higher annual Medicare spending, controlling for PCP discipline.
The percentage of clinical effort that providers devote to NHs is associated with risk of avoidable hospitalization.