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Am J Geriatr Psychiatry. 2010 Jun;18(6):475-82. doi: 10.1097/JGP.0b013e3181b2145a.

Predictors of preventable nursing home hospitalizations: the role of mental disorders and dementia.

Author information

1
Department of Aging and Mental Health Disparities, Louis de la Parte Mental Health Institute, University of South Florida, Tampa, FL, USA. becker@fmhi.usf.edu

Abstract

OBJECTIVES:

Nursing home (NH) hospitalizations place an enormous economic burden on an already overtaxed American healthcare system. Hospitalizations for "ambulatory care-sensitive" (ACS) conditions are considered preventable, as these are physical health conditions that can potentially be treated safely in a NH. The authors examined risk factors, including mental disorders and dementia, for hospitalization of Medicaid-enrolled NH residents with ACS conditions during fiscal year 2003-2006.

METHODS:

The authors merged Medicaid claims and enrollment data and Online Survey Certification and Reporting information for 72,251 Medicaid-enrolled NH residents in 647 NHs in Florida. The authors identified at least one ACS hospitalization in 8,382 residents for a total of 10,091 hospital admissions (18.5% of all hospitalizations). The authors used Cox proportional hazard regression to assess time to the first ACS hospitalization.

RESULTS:

In a fully adjusted model, younger age, non-white race, dementia, and serious mental disorder were associated with greater risk of ACS hospitalization. In addition, residents with a diagnosed mental disorder and no dementia incurred relatively high expenditures for ACS hospitalizations. Among facility characteristics, participants from for-profit facilities, facilities that were not a member of a chain, had more Medicaid recipients, and fewer than 120 beds had greater risk of ACS hospitalizations.

CONCLUSIONS:

Attention to the identified predictors of hospitalization for ACS conditions, which are potentially preventable, could reduce the risk and cost of these hospitalizations among Medicaid-enrolled NH residents. The need to reduce unnecessary hospitalization will become only more urgent as the population ages and healthcare expenses continue to escalate.

PMID:
21217558
DOI:
10.1097/JGP.0b013e3181b2145a
[Indexed for MEDLINE]
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