Variations in Hospitalization Rates Among Nursing Home Residents: The Role of Facility and Market Attributes

Abstract

Variations in hospitalization rates may reflect underutilization, as well as overutilization. Continued efforts toward identifying medically necessary hospitalizations are needed.

The Institutional Practice

“…The majority of research, or what is understood as doxic representations within the research literature, is divided when answering this question: reasons for hospitalization are either connected to patient or facility specific factors (Carter & Porell 2003). Researchers analyzing patient specific factors generally focus on whether or not rates of hospitalization are associated with patient characteristics or patient demographics.…”

“…Even though resident level factors can contribute to a heterogeneous patient demographic and thus can explain some of the variations in rates of hospitalization, especially across large geographical areas, it has been argued that such explanation factors are far from sufficient, in addition to producing contradictory findings (Carter & Porell 2003). The main weakness in arguing exclusively for patient-specific factors as determining rates of hospitalization is that variation in rates of hospitalization occurs within smaller homogeneous geographical areas (Carter 2003a, Carter & Porell 2003.…”

“…The main weakness in arguing exclusively for patient-specific factors as determining rates of hospitalization is that variation in rates of hospitalization occurs within smaller homogeneous geographical areas (Carter 2003a, Carter & Porell 2003. If variations in rates within smaller homogeneous areas, serving the same demographic, are similar to variations across larger areas, variation cannot be exclusively explained by demographic variation.…”

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

“…Facilities with higher percentages of Medicaid residents have been found to be associated with more deficiencies [38][39], higher odds of hospitalization [40][41], more complaints [42], higher likelihood of voluntary or involuntary terminations [39,43], higher rates of antipsychotic medication prescription [39,44], and higher rates of physical restraint use and pressure ulcers [39]. Nursing homes with higher proportions of black residents and rural nursing homes also exhibited worse processes and outcomes [45][46][47].…”

“…Empirical evidence suggests that higher nursing staff levels (hours per resident day) and higher skilled nursing staff mix (proportion of professional nursing staff such as registered nurses) were associated with better quality of care as measured by processes of care and patient outcomes [38,40,[50][51][52][53]. Although the Nursing Home Reform Act required that a nursing facility certified for Medicare and Medicaid had sufficient nursing staff to provide nursing care to all residents in accordance with resident care plans, it did not specify the nurse-to-resident staffing ratios and the adequacy of the federal regulations with regard to nurse staffing has long been criticized [54][55][56].…”