Referrals from nursing home to hospital: Reasons, appropriateness and costs

Abstract

Stavanger had a lower referral rate than the surrounding municipalities. The results also show that the in-hospital mortality rate and the share of inappropriate referrals were low compared to other studies in the field. Further research is needed in order to evaluate which interventions are effective in improving medical care at nursing homes and thus reduce referral rates.

The Institutional Practice

“…Median stay at hospitals for those hospitalized was three days (Graverholt et al 2011), while the hospital mortality rate was reported to be 16 percent (Ibid.) and 7.8 percent (Vossius et al 2013). The most common diagnoses for hospitalization were similar among the studies: respiratory diseases, fall-related and circulatory diseases (Graverholt et al 2011), infections, fractures, cardiovascular and gastro-related diagnoses , and falls, infection and respiratory problems (Vossius et al 2013).…”

“…Institutional rates of hospitalization from within the same municipality have been shown to vary considerably: from 0.16 to 1.49 hospitalizations per person per year on average (Graverholt et al 2013), a variation higher than comparable international studies (see Chapter 4). Rate variation between urban centers (the municipality of Stavanger) and rural areas (surrounding municipalities) has also been shown, averaging 0.38 and 0.60 referrals per person per year, respectively (Vossius et al 2013). The difference in institutional rates of hospitalization is, it is argued, exceptional, considering the relatively small geographical area and assumed heterogeneity of the patient population (Graverholt et al 2013).…”

“…Instead, the institutions are, by law, obligated to offer physicians' services to its residents by having a physician «connected to the nursing home», in some form. This arrangement is contrasted to practices where residents' private physicians follow them into the nursing homes, as seen in many countries such as Denmark and Germany (Vossius et al 2013), as well as a combination of the two arrangements. Consequently, physicians «connected» to nursing homes are either employed and work for the institution directly (typically for private institutions) or are general practitioners often required by the municipalities (for instance through operation agreements) to work in nursing homes or other institutions (typically for public and private institutions).…”

“…The definition of what constitutes an «avoidable» or «potentially preventable» hospitalization and which conditions are included in such a definition differ between researchers (Grabowski et al 2008, Vossius et al 2013. Also the occurrence of such hospitalizations varies in the literature.…”

“…Also the occurrence of such hospitalizations varies in the literature. Despite such a variation, ranging from 7.8 percent (Vossius et al 2013) to 67 percent (Ouslander et al 2010), the research literature seems to concur that the occurrence of avoidable hospitalizations is unwarrantedly high, with very few exceptions (Jensen et al 2009). There is also relative agreement on which conditions are the most likely to lead to an avoidable hospitalization.…”