Premium
Hospitalization of Elderly Medicaid Long‐Term Care Users Who Transition from Nursing Homes
Author(s) -
Wysocki Andrea,
Kane Robert L.,
Dowd Bryan,
Golberstein Ezra,
Lum Terry,
Shippee Tetyana
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12614
Subject(s) - medicine , medicaid , nursing homes , hazard ratio , ambulatory , proportional hazards model , confidence interval , retrospective cohort study , cohort , emergency medicine , long term care , ambulatory care , minimum data set , gerontology , health care , nursing , economics , economic growth
Objectives To compare hospitalizations of dually eligible older adults who had an extended M edicaid nursing home ( NH ) stay and transitioned out to receive M edicaid home‐ and community‐based services ( HCBS ) with hospitalizations of those who remained in the NH . Design Retrospective matched cohort study using M edicaid and M edicare claims and NH assessment data. Setting Community (receiving M edicaid HCBS ) or NH . Participants Dually eligible fee‐for‐service beneficiaries aged 65 and older in A rkansas, F lorida, M innesota, N ew M exico, T exas, V ermont, and W ashington from 2003 to 2005. Individuals who had a M edicaid NH stay of at least 90 days and transitioned to M edicaid HCBS (N = 1,169) were matched to individuals who had a M edicaid NH stay of at least 90 days and remained in the NH (N = 1,169). Measurements Potentially preventable hospitalizations (defined according to ambulatory‐care‐sensitive conditions) and all hospitalizations were examined. Results Cox proportional hazards models were used to compare the risk of hospitalization between the groups, accounting for the differing time at risk and censoring. Being a NH transitioner increased the hazard of experiencing a potentially preventable hospitalization by 40% (95% confidence interval ( CI ) = 1.01–1.93) over remaining in the NH . NH transitioners had a 58% (95% CI = 1.32–1.91) greater risk of experiencing any type of hospitalization than NH stayers. Conclusion Individuals who transitioned from the NH to HCBS had a greater risk of hospitalization. Most of the attention in long‐term care transition programs has been focused on NH readmission, but programs encouraging NH transition should recognize that individuals may be at greater risk for hospitalization after returning to the community. Planning for the medical needs of individuals who transition from an extended NH stay may improve their posttransition outcomes.