A. James O'Malley, Ph.D., Daryl J. Caudry, S.M., and David C. Grabowski, Ph.D.
Hospitalizations of nursing home residents are known to be frequent, costly, often preventable, and potentially associated with negative health outcomes. Reducing avoidable hospitalizations is an important policy goal, but in order to design policy—or develop appropriate demonstration projects—researchers must first identify characteristics most often associated with hospitalizations.
Using data from New York State nursing homes from 1998 to 2004, Commonwealth Fund–supported researchers found that residents with pressure ulcers or those with a feeding tube in place were more likely to be hospitalized. In addition to pressure ulcers, chronic conditions like congestive heart failure, diabetes, and cancer were also associated with a shorter time from nursing home entry to hospitalization. Nursing homes that made use of advance directives—in particular, the "do not hospitalize" directive—were associated with fewer hospitalizations, as were homes with more full-time registered nurses per bed. In contrast to some earlier studies, the researchers found no significant association between for-profit ownership of nursing homes and likelihood of hospitalization.
Certain nursing home characteristics—especially having advance directives in place or a higher number of registered nurses—were found to be associated with fewer hospitalizations of residents. This suggests that payment incentives directed at reducing acute hospitalizations may be effective.