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<td><h1><a name="h1" id="h1"></a>Long-term Care </h1>
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<h2><a name="head1">Variations in hospitalization rates for nursing home residents may be due to facility and market characteristics</a></h2>
<p>No benchmarks exist to determine which hospital transfer rates are acceptable for nursing home residents, which vary two- to five-fold across studies. These variations are not due solely to actual differences in resident case mix, but also to facility and market influences, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS07585). </p>
<p>Mary W. Carter, Ph.D., of West Virginia University, and Frank W. Porell, Ph.D., of the University of Massachusetts, analyzed State Medicaid case-mix reimbursement data from 1991 to 1994 from 527 Massachusetts nursing homes. They linked these data with Medicare claims and nursing facility data to produce 72,319 person-quarter observations. The researchers then controlled for individual resident characteristics to estimate the influence of facility-level and market-level factors on variations in hospitalization rates.</p>
<p>Individuals residing in nonprofit facilities, facilities with a patient case mix with heavier care demands, those classified as intermediate care facilities, and those with a greater proportion of resident days reimbursed by Medicare showed a 9 percent, 13 percent, 27 percent, and 11 percent, respectively, lower risk of hospital transfer in the next quarter than otherwise similar residents in other nursing facilities. </p>
<p>In contrast, residents residing in facilities operated by management chains instead of being independently managed, with a greater percentage of Medicaid reimbursed resident days, and that spent a greater proportion of total nursing expenses for licensed practical nurses, appeared to be at 7 percent, 10 percent, and 30 percent, respectively, greater risk of hospitalization in the next quarter than similar residents in other nursing homes. The 2.39-fold difference between counties with the lowest and highest probability of resident hospitalization, after controlling for resident and facility factors, suggests that the likelihood of a resident being hospitalized reflects at least in part, broader hospital bed and physician supply factors.
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<p>See "Variations in hospitalization rates among nursing home residents: The role of facility and market attributes," by Drs. Carter and Porell, in the <em>Gerontologist</em> 43(2), pp. 175-191, 2003. </p>
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