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Predictors of preventable nursing home hospitalizations: The role of mental disorders and dementia
American Journal of Geriatric Psychiatry
  • Marion Becker
  • Timothy L. Boaz
  • Ross Andel
  • Amber M. Gum
Document Type
Publication Date
  • Medicaid,
  • nursing homes,
  • dementia,
  • mental disorders,
  • preventable hospitalizations
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.
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Marion Becker, Timothy L. Boaz, Ross Andel and Amber M. Gum. "Predictors of preventable nursing home hospitalizations: The role of mental disorders and dementia" American Journal of Geriatric Psychiatry Vol. 18 Iss. 6 (2010) p. 475 - 482
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