JAMDA
Volume 9, Issue 7 , Pages 499-503 , September 2008

Long-Stay Nursing Home Residents' Hospitalizations in the VHA: The Potential Impact of Aligning Financial Incentives on Hospitalizations

  • Dustin D. French, PhD

      Affiliations

    • VISN-8 Patient Safety Center of Inquiry, James A Haley VAMC, Tampa, FL
    • Corresponding Author InformationAddress correspondence to Dustin D. French, PhD, VISN-8 Patient Safety Center of Inquiry, 13000 Bruce B. Downs Blvd. (118M), Tampa, FL 33612
    • ,
  • Robert R. Campbell, JD, MPH, PhD

      Affiliations

    • VISN-8 Patient Safety Center of Inquiry, James A Haley VAMC, Tampa, FL
    • ,
  • Laurence Z. Rubenstein, MD, MPH

      Affiliations

    • UCLA David Geffen School of Medicine and the VA Greater Los Angeles Healthcare System (GLAHS) Geriatric Research, Education and Clinical Center (GRECC), Sepulveda and West Los Angeles Divisions, CA

References 

  1. HCUPnet, Healthcare Cost and Utilization Project (Agency for Healthcare Research and Quality, Rockville, MD). http://hcupnet.ahrq.gov/Accessed March 13, 2008
  2. Grabowski DC, Stewart KA, Broderick SM, et al. Predictors of nursing home hospitalization: A review of the literature. Med Care Res Rev. 2008;65:3–39
  3. French DD, Werner DC, Campbell RR, et al. A multivariate fall risk assessment model for VHA nursing homes using the Minimum Data Set. J Am Med Dir Assoc. 2007;8:115–122
  4. Department of Veterans Affairs. VHA Directive 2005-060, December 7, 2005 (Implementation of the Medicare Prospective Payment System (PPS) assessment form (MPAF)). http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=1356Accessed March 20, 2008
  5. Department of Veterans Affairs. VHA Directive 2005-061, December 7, 2005 (VA nursing home care unit (NHCU) admission criteria, service codes, and discharge criteria). http://www1.va.gov/geriatricsshg/docs/VANHCUadmission05.pdfAccessed March 20, 2008
  6. Centers for Medicare & Medicaid Services. Revised long-term facility resident assessment instrument user's manual verions 2.0. Revised June 2006 http://www.cms.hhs.gov/NursingHomeQualityInits/20_NHQIMDS20.asp#TopOfPageAccessed March 20, 2008
  7. Morris J, Murphy K, Nonemaker S. Long Term Care Resident Assessment Instrument User's Manual for Version 2.0. U.S. Department of Health and Human Services, Health Care Financing Administration. Distributed through National Technical Information Service, Springfield, Virginia, October 1995.
  8. Nonemaker S, Murphy K, Morris J. Long Term Care Resident Assessment Instrument Training Materials for Version 2.0 (standardized training package), November 1995. http://www.interrai.org/section/view/?fnode=17Accessed January 12, 2007
  9. GAO. VA long term care: Trends and planning challenges to providing nursing home care to veterans. GAO-06-333T; January http://www.gao.gov/new.items/d06333t.pdf2006;Accessed March 20, 2008
  10. GAO. VA long-term care: Oversight of nursing home program impeded by data gaps. GAO-05-65; November http://www.gao.gov/new.items/d0565.pdf2004;Accessed March 20, 2008
  11. French DD, Campbell RR, Spehar AM, et al. Drug costs and use in VHA nursing homes: A national overview of long-stay residents. J Am Med Dir Assoc. 2007;8:515–518
  12. SAS Language. Reference, Versions 9. Cary, NC: SAS Institute; 2007;
  13. Intrator O, Zinn J, Mor V. Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. J Am Geriatr Soc. 2004;52:1730–1736
  14. U.S. Department of Health and Human Services. A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002: Final Report. http://aspe.hhs.gov/daltcp/reports/2008/profileMAX.htmAccessed March 13, 2008
  15. Centers for Medicare and Medicaid Services. National Health Expenditure Data. http://www.cms.hhs.gov/NationalHealthExpendData/01_Overview.asp#TopOfPageAccessed March 13, 2008
  16. Rubenstein LZ, Ouslander JG, Wieland D. Dynamics and clinical implications of the nursing home-hospital interface. Clin Geriatr Med. 1988;4:471–491
  17. MedPac Report to Congress June 2004 (Chapter 3 Dual eligible beneficiaries: An overview). http://www.medpac.gov/publications/congressional_reports/June04_ch3.pdfAccessed March 13, 2008
  18. Grabowski DC. Medicare and Medicaid: Conflicting incentives for long-term care. Milbank Q. 2007;85:579–610

 The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration (VHA). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Dr. French took the lead in preparing and analyzing all data. He prepared the draft manuscript after consultation with the co-authors who assisted in the study design, literature review, and manuscript preparation. Dr. French was responsible for the final draft submitted. Dr. French is a full-time employee of the Department of Veterans Affairs, Veterans Integrated System Network 8 (VISN-8). This research was supported by the VISN 8 Patient Safety Center of Inquiry. Dr. Campbell assisted in conceptual layout of paper, interpretation of data, literature review, discussion, and health policy implications. Research support was provided by the VISN 8 Patient Safety Center of Inquiry. Dr. Rubenstein provided a clinician's perspective as a leading expert in the area of nursing homes. He served as a reviewer of the final manuscript to ensure clinical relevance. Research support provided by the VISN 8 Patient Safety Center of Inquiry and VA Greater Los Angeles Healthcare System (GLAHS) Geriatric Research, Education and Clinical Center (GRECC), Sepulveda and West Los Angeles Divisions.

PII: S1525-8610(08)00123-0

doi: 10.1016/j.jamda.2008.03.015

JAMDA
Volume 9, Issue 7 , Pages 499-503 , September 2008

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