Hospitalizations Of Nursing Home Residents Research Articles

Ten-year trends in end-of-life hospitalizations of nursing home residents in Germany, 2006–2015

ObjectivesWe investigated trends in end-of-life hospitalizations among nursing home residents (NHR) over 10 years and looked at differences between age groups and sexes as well as the length of terminal hospital stays. Study designRetrospective cohort study based on health insurance claims data of the AOK Bremen/Bremerhaven. All NHR aged 65 years or more who died between 2006 and 2015 were included. Main outcome measuresWe assessed the proportions of decedents who were in hospital on the day of death and during the last 3, 7, 14 and 30 days of life, stratified by two-year periods. Multiple logistic regressions were conducted to study changes over time, adjusting for covariates. ResultsA total of 10,781 decedents were included (mean age 86.1 years, 72.1 % females). Overall, 29.2 % died in hospital, with a slight decrease from 30.3 % in 2006–2007 to 28.3 % in 2014–2015 (OR 0.86; 95 % CI 0.75–0.98). Of the 3150 terminal hospitalizations, 35.5 % lasted up to 3 days and the mean length of stay decreased from 9.0 (2006–2007) to 7.5 days (2014–2015). When looking at the last 7, 14 and 30 days of life, no changes over time were found. Male sex and younger age were associated with a higher chance of end-of-life hospitalization in almost all analyses. ConclusionsEnd-of-life hospitalizations of NHR are common in Germany. There has been a small decrease during recent years in the proportion of in-hospital deaths, but not of hospitalizations during the last 7, 14 and 30 days of life. This might be explained by shorter durations of hospital stays.

Hospitalization at the end of life among nursing home residents with dementia: a systematic review

BackgroundHalf of nursing home residents (NHR) suffer from dementia. End-of-life hospitalizations are often burdensome in residents with dementia. A systematic review was conducted to study the occurrence of hospitalizations at the end of life in NHR with dementia and to compare these figures to NHR without dementia.MethodsA systematic literature search in MEDLINE, CINAHL and Scopus was conducted in May 2018. Studies were included if they reported proportions of in-hospital deaths or hospitalizations of NHR with dementia in the last month of life. Two authors independently selected studies, extracted data, and assessed quality of studies.ResultsNine hundred forty-five citations were retrieved; 13 studies were included. Overall, 7 studies reported data on in-hospital death with proportions ranging between 0% in Canada and 53.3% in the UK. Studies reporting on the last 30 days of life (n = 8) varied between 8.0% in the Netherlands and 51.3% in Germany. Two studies each assessed the influence of age and sex. There seem to be fewer end-of-life hospitalizations in older age groups. The influence of sex is inconclusive. All but one study found that at the end of life residents with dementia were hospitalized less often than those without (n = 6).ConclusionsWe found large variations in end-of-life hospitalizations of NHR with dementia, probably being explained by differences between countries. The influence of sex and age might differ when compared to residents without dementia. More studies should compare NHR with dementia to those without and assess the influence of sex and age.Trial registrationPROSPERO registration number CRD42018104263.

IMPACT OF NURSE PRACTITIONER CARE OF NURSING HOME RESIDENTS ON EMERGENCY ROOM USE AND HOSPITALIZATIONS

The acuity and complexity of the nursing home (NH) population has increased causing greater use of the emergency department (ED) and more acute hospitalizations. Simultaneously, CMS has emphasized the need to reduce ED use and avoidable hospitalizations. Nurse practitioners (NPs) have been shown to provide high quality care in NHs at equivalent or lower costs; however, there is significant variability in scope of practice between states. Little is known about how NPs impact ED visits and hospitalizations of NH residents or if practice restrictions change outcomes. The purpose of this study was to examine whether a higher prevalence of NP care in NHs was associated with fewer ED visits and hospitalizations in this frail population and whether there were further differences in states where NPs have full practice authority. We used administrative data from the CMS Chronic Condition Warehouse to examine the impact of NP care on ED visits and acute hospitalization. In a 5% random sample of all NH residents in U.S. (n=187,789), NPs and primary care physicians provided 87% of all NH visits. Patients with NP involvement had fewer ED visits (mean, 2.01 vs. 2.26, p=.007) compared with physician only care and there were fewer acute hospitalizations (mean, 3.08 vs 3.32 p=.02) when NPs provided care. States where NPs had full practice authority had better outcomes compared with states that did not. NPs can significantly reduce NH residents’ use of the ED and acute hospitalizations, which endorses the need for policy changes to support NP full practice authority.

Nursing Home Provider Perceptions of Telemedicine for Reducing Potentially Avoidable Hospitalizations

ObjectivePotentially avoidable hospitalizations (PAHs) of nursing home (NH) residents are common, costly, and can have significant economic consequences. Telemedicine has been shown to reduce emergency department and hospitalization of NH residents, yet adoption has been limited and little is known about provider's perceptions and desired functionality for a telemedicine program. The goal of this study was to survey a nationally representative sample of NH physicians and advanced practice providers to quantify provider perceptions and desired functionality of telemedicine in NHs to reduce PAHs. Design/Setting/Participants/MeasurementWe surveyed physicians and advanced practice providers who attended the 2015 AMDA–The Society for Post-Acute and Long-Term Care Medicine Annual Conference about their perceptions of telemedicine and desired attributes of a telemedicine program for managing acute changes of condition associated with PAHs. ResultsWe received surveys from 435 of the 947 conference attendees for a 45.9% response rate. Providers indicated strong agreement with the potential for telemedicine to improve timeliness of care and fill existing service gaps, while disagreeing most with the ideas that telemedicine would reduce care effectiveness and jeopardize resident privacy. Responses indicated clear preferences for the technical requirements of such a program, such as high-quality audio and video and inclusion of an electronic stethoscope, but with varying opinions about who should be performing the consults. ConclusionAmong NH providers, there is a high degree of confidence in the potential for a telemedicine solution to PAHs in NHs, as well as concrete views about features of such a solution. Such consensus could be used to drive an approach to telemedicine for PAHs in NHs that retains the theoretical strengths of telemedicine and reflects the needs of facilities, providers, and patients. Further research is needed to objectively study the impact of successful telemedicine implementations on patient, provider, and economic outcomes.

Hospice Enrollment and Evaluation of Its Causal Effect on Hospitalization of Dying Nursing Home Patients

To examine the patient, nursing home (NH), hospice provider, and local market factors associated with the selection of the Medicare hospice benefit by eligible NH residents, and evaluate the causal effect of hospice on end-of-life hospitalization rates. Secondary data for 1995-1997 for NH residents. This retrospective cohort study includes NH residents in five states (Kansa, Maine, New York, Ohio, South Dakota) who died in the years 1995-1997. Medicare claims identified hospice enrollment and hospitalizations. Geocoding of NHs, hospice providers, and hospitals was used to identify local markets. The two outcome measures are hospice enrollment and hospitalization of NH residents in their last 30 days of life. A file was constructed linking MDS assessments to Medicare claims and denominator files, NH provider files (OSCAR), hospice provider of service files, and the area resource file. Twenty-six percent of hospice and 44 percent of nonhospice residents were hospitalized in their last 30 days of life (odds ratio [OR] 0.45; 95 percent confidence interval [CI]: 0.42-0.48). Adjusting for confounders, hospice patients were less likely than nonhospice residents to be hospitalized (OR 0.47; 95 percent CI: 0.45-0.50). Adding inverse propensity score weighting, hospice patients were still less likely than nonhospice residents to be hospitalized (OR 0.56; 95 percent CI: 0.53-0.61). Hospice selection introduces some bias in the evaluation of the causal effect of hospice on end-of-life hospitalization rates. However, even after adjusting for selection bias, hospice does have a powerful effect in reducing end-of-life hospitalization rates.