Relationship between nursing home quality indicators and potentially preventable hospitalisation

Abstract

BackgroundHospitalisations are very common among nursing home residents and many of these are deemed inappropriate or preventable. Little is known about whether clinical care quality is related to hospitalisation, especially potentially preventable hospitalisations (PPHs). Among the few studies that have been conducted, the findings have been inconsistent. The objective of this study was to examine the relationship between quality indicators and overall and PPHs among Medicaid beneficiaries aged 65 years and older receiving care at nursing homes in Minnesota.Methods23 risk-adjusted quality indicators were used to assess nursing home quality of care. Quality indicators and other facility-level variables from the Minnesota Nursing Home Report Card were merged with resident-level variables from the Minimum Data Set. These merged data were linked with Medicaid claims to obtain hospitalisation rates during the 2011–2012 period. The sample consisted of a cohort of 20 518 Medicaid beneficiaries aged 65 years and older who resided in 345 Minnesota nursing homes. The analyses controlled for resident and facility characteristics using the generalised linear mixed model.ResultsThe results showed that about 44 % of hospitalisations were PPHs. Available quality indicators were not strongly or consistently associated with the risk of hospitalisation (neither overall nor PPH). Among these 23 quality indicators, five quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, pressures sores, bladder continence and activities of daily living [ADL] dependence) were related significantly to hospitalisation and only four quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, ADL dependence and urinary tract infections) were related to PPH.ConclusionAlthough general quality indicators can be informative about overall nursing home performance, only selected quality indicators appear to tap dimensions of clinical quality directly related to hospitalisations.

Quality measurement and nursing homes: measuring what matters

“…One consistent message from the many studies that have examined nursing home quality is that our quality measures do not always measure what matters. In this issue of BMJ Quality & Safety , Xu and colleagues2 provide more evidence of the weak and unpredictable relationship between nursing home quality measures and an important patient outcome that does matter—hospitalisation. Using an expanded set of quality measures collected in Minnesota nursing homes, the authors find that the 23 metrics they examine showed neither strong nor consistent associations with risk of hospitalisation in a population of Medicaid residents—neither the overall rate of hospitalisation nor potentially preventable hospitalisations 2.…”

“…In this issue of BMJ Quality & Safety , Xu and colleagues2 provide more evidence of the weak and unpredictable relationship between nursing home quality measures and an important patient outcome that does matter—hospitalisation. Using an expanded set of quality measures collected in Minnesota nursing homes, the authors find that the 23 metrics they examine showed neither strong nor consistent associations with risk of hospitalisation in a population of Medicaid residents—neither the overall rate of hospitalisation nor potentially preventable hospitalisations 2. Further, while some associations were expected (eg, nursing homes with lower usage of urinary catheters had fewer hospitalisations for urinary tract infections), some were not.…”

Nobody ever questions—Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative

“…Both inappropriate-and under-prescribing increase mortality rates and hospital admissions [10]. Up to 92% of ADEs, adverse drug reactions (ADRs), and medicines' mismanagement (including patient safety incidents where patients and professionals contribute) are preventable [11][12][13][14]; more are due to poor monitoring than poor prescribing [15][16][17][18][19] and are dose-related [20,21]. Enhanced patient monitoring and/or reviewing would enhance efforts to ameliorate, if not resolve, the situation [9,16,17,19,22].…”

Staff nurses' evaluation of care process quality and patient outcomes in long‐term care hospitals: A cross‐sectional questionnaire survey

“…Nevertheless, we continue to have major quality‐related concerns (Burke & Werner, 2019). In previous long‐term care studies, there have been numerous conceptualisations and measurements of care quality, and while some of the measures were associated with client outcomes, others were not (Werner, Konetzka, & Kim, 2013; Xu, Kane, & Arling, 2019). Burke and Werner (2019) called for further determination on the factors that should be measured; in other words, they stressed the importance of measuring what mattered and realistically affected patient outcomes.…”