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Relationship between nursing home quality indicators and potentially preventable hospitalisation
Dongjuan Xu1, Robert Kane2, Greg Arling3
1School of Nursing, Purdue University, West Lafayette, Indiana, USA xu976@purdue.edu.
BMJ Quality & Safety
|March 15, 2019
Summary
Hospitalizations in nursing homes are common, with many preventable. This study found few general quality indicators strongly linked to overall or preventable hospitalizations, suggesting specific indicators are more relevant for clinical quality.
Area of Science:
- Gerontology
- Health Services Research
- Clinical Quality Measurement
Background:
- Hospitalizations are frequent among nursing home residents, with many deemed preventable.
- Existing research on the link between clinical care quality and hospitalizations, particularly preventable ones, is inconsistent.
Purpose of the Study:
- To investigate the association between nursing home quality indicators and overall hospitalizations.
- To examine the relationship between quality indicators and potentially preventable hospitalizations (PPHs) in older Medicaid beneficiaries.
Main Methods:
- Utilized 23 risk-adjusted quality indicators from the Minnesota Nursing Home Report Card.
- Merged facility-level quality data with resident-level Minimum Data Set information.
- Linked merged data with Medicaid claims to analyze hospitalization rates from 2011-2012 for 20,518 residents in 345 nursing homes.
Main Results:
- Approximately 44% of hospitalizations were classified as potentially preventable.
- Most quality indicators showed no strong or consistent association with overall or PPH risk.
- Specific indicators like antipsychotic use without psychosis, unexplained weight loss, pressure sores, bladder continence, ADL dependence, and UTIs showed significant relationships with hospitalizations.
Conclusions:
- General nursing home quality indicators may not fully capture clinical quality related to hospitalizations.
- Selected quality indicators are more directly associated with hospitalizations, highlighting their importance for targeted quality improvement.
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