Resource Factors Associated With Avoidable Transfers in Nursing Homes.

Area of Science:

• Gerontology
• Health Services Research
• Nursing

Background:

• Reducing avoidable hospital transfers from nursing homes (NHs) is a priority, as 20%-67% are potentially preventable.
• Inadequate staffing and diagnostic capabilities in NHs contribute to these transfers, despite evidence that embedded advanced practice registered nurses (APRNs) and enhanced resources can reduce them.

Purpose of the Study:

• To examine resource constraints contributing to avoidable hospital transfers among NH residents with dementia.

Main Methods:

• Cross-sectional analysis of 3683 hospital transfer events from 16 Missouri NHs (2016-2020).
• Data collected via APRN-completed INTERACT surveys on resource availability and transfer context.
• Bayesian generalized linear mixed models assessed associations between resource domains and avoidable transfers.

Main Results:

• 50.2% of transfers were deemed avoidable.
• Limited APRN availability and staff discomfort significantly increased odds of avoidable transfers (OR ≈1.7).
• Lack of on-site clinicians/equipment was associated with non-avoidable transfers (OR ≈0.37); facility-level factors also influenced decisions.

Conclusions:

• Avoidable NH transfers are driven by staff discomfort and limited APRN availability, highlighting gaps in nursing scope and decision-making.
• Policy reforms should enhance APRN access, diagnostic partnerships, telehealth, and closed provider models to improve resident care and reduce transfers.