Hospital admissions of nursing home patients declined after ACA quality initiatives


Background: Following the ACA’s implementation, several measures were introduced to reduce unnecessary admissions of long-term nursing home residents to hospitals. These measures included an initiative to enhance a nursing home’s on-site capability to handle target populations; the accountable care organization payment model; and the Hospital Readmissions Reduction Program.

Dr. Josephine Cool

Study design: Cross-sectional study using the claims-based nationwide Minimum Data Set during 2011-2016.

Setting: Federally licensed nursing homes in the United States.

Synopsis: The authors examined the number of transfers between federally funded nursing homes and the hospital settings (EDs, observation, or inpatient hospitalizations) for greater than 460,000 long term–stay patients with advanced dementia, advanced heart failure, and/or advanced chronic obstructive pulmonary disease (COPD). A risk-adjusted model showed that, during 2011-2016, there were significant decreases in transfers rates for potentially avoidable conditions, measured as the mean number of transfers per person-year alive, for patients with advanced dementia (2.4 vs. 1.6), heart failure (8.5 vs. 6.7), and COPD (7.8 vs 5.5). Most of this decrease was linked to reductions in acute hospitalizations. Notably, hospice enrollment remained low throughout this time period, despite a high 1-year mortality.

Bottom line: During the 2011-2016 period, transfer rates for patients with advanced dementia, heart failure, and/or COPD from nursing homes to the hospital setting decreased.

Citation: McCarthy EP et al. Hospital transfer rates among U.S. nursing home residents with advanced illness before and after initiatives to reduce hospitalizations. JAMA Intern Med. 2019 Dec 30. doi: 10.1001/jamainternmed.2019.6130.

Dr. Cool is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.

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