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Hospital Variation in Rates of New Institutionalizations Within 6 Months of Discharge
Author(s) -
Middleton Addie,
Zhou Jie,
Ottenbacher Kenneth J.,
Goodwin James S.
Publication year - 2017
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.14760
Subject(s) - medicine , medicaid , odds ratio , residence , institutionalisation , retrospective cohort study , odds , case mix index , demography , nursing homes , long term care , skilled nursing facility , cohort , gerontology , emergency medicine , logistic regression , health care , nursing , psychiatry , sociology , economics , economic growth
Objectives Hospitalization in community‐dwelling elderly is often accompanied by functional loss, increasing the risk for continued functional decline and future institutionalization. The primary objective of our study was to examine the hospital‐level variation in rates of new institutionalizations among Medicare beneficiaries. Design Retrospective cohort study. Setting Hospitals and nursing homes. Participants Medicare fee‐for‐service beneficiaries discharged from 4,469 hospitals in 2013 (N = 4,824,040). Measurements New institutionalization, defined as new long term care nursing home residence (not skilled nursing facility) of at least 90 days duration within 6 months of hospital discharge. Results The overall observed rate of new institutionalizations was 3.6% (N = 173,998). Older age, white race, Medicaid eligibility, longer hospitalization, and having a skilled nursing facility stay over the 6 months before hospitalization were associated with higher adjusted odds. Observed rates ranged from 0.9% to 5.9% across states. The variation in rates attributable to the hospital after adjusting for case‐mix and state was 5.1%. Odds were higher for patients treated in smaller ( OR = 1.36, 95% CI : 1.27–1.45, ≤50 vs >500 beds), government owned ( OR = 1.15, 95% CI : 1.09–1.21 compared to for‐profit), limited medical school affiliation ( OR = 1.13, 95% CI : 1.07–1.19 compared to major) hospitals and lower for patients treated in urban hospitals ( OR = 0.79, 95% CI : 0.76–0.82 compared to rural). Higher Summary Star ratings ( OR = 0.75, 95% CI : 0.67–0.93, five vs one stars) and Overall Hospital Rating ( OR = 0.62, 95% CI : 0.57–0.67, ratings of 9–10 vs 0) were associated with lower odds of institutionalization. Conclusion Hospitalization may be a critical period for preventing future institutionalization among elderly patients. The variation in rates across hospitals and its association with hospital quality ratings suggest some of these institutionalizations are avoidable and may represent targets for care improvement.