Abstract
Objectives
From 2013 to 2016, the Centers for Medicare and Medicaid Services Initiative to Reduce
Avoidable Hospitalizations among Nursing Facility Residents (“the Initiative”) tested
a series of clinical interventions and care models, through organizations called Enhanced
Care and Coordination Providers (ECCPs), with the goal of reducing avoidable inpatient
hospital admissions among long-stay nursing home residents. We identify the effect
of the Initiative on the probability and count of acute care transfers [capturing
any transfer to the hospital, including hospitalizations (inpatient stays), emergency
department visits, and observation stays].
Design
We evaluate the effect of the Initiative on the probability and count of all-cause
acute care transfers and potentially avoidable acute care transfers and estimate the
average effect of the Initiative per resident per year.
Setting and Participants
We use 2011–2016 data from the Centers for Medicare and Medicaid Services Minimum
Data Set, version 3.0, nursing home resident assessments linked with Medicare eligibility
and enrollment data and Medicare inpatient and outpatient hospital claims. Our sample
is limited to Medicare fee-for-service beneficiaries in participating ECCP facilities
and a comparison group of long-stay nursing facility residents.
Methods
We evaluate the effect of the Initiative on both the probability and count of all-cause
acute care transfers and potentially avoidable acute care transfers using difference-in-differences
regression models controlling for both resident-level clinical and demographic characteristics
as well as facility-level characteristics.
Results
We found statistically significant evidence of a reduction in both the probability
and count of all-cause and potentially avoidable acute care transfers among long-stay
nursing facility residents who participated in the Initiative, relative to comparison
group residents.
Conclusions and Implications
The clinical interventions and care models implemented by the ECCPs show that by using
staff education, facility leadership and physician engagement, and/or clinical assessment
and treatment of residents who experienced a change in condition, it is possible to
reduce acute care transfers of nursing facility residents. This could lead to better
outcomes and reduced cost of care for this vulnerable patient population.
Keywords
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References
- Medicare nursing home resident hospitalization rates merit additional monitoring.(2013. Available at:)
- The costs and potential savings associated with nursing home hospitalizations.Health Affairs (Millwood). 2007; 26: 1753-1761
- Potentially avoidable hospitalizations of nursing home residents: Frequency, causes, and costs: [see editorial comments by Drs. Jean F. Wyman and William R. Hazzard, pp 760-761].J Am Geriatr Soc. 2010; 58: 627-635
- Potentially avoidable hospitalizations for elderly long-stay residents in nursing homes.Med Care. 2013; 51: 673-681
- Potentially avoidable hospitalizations of dually eligible Medicare and Medicaid beneficiaries from nursing facility and home- and community-based services waiver programs.J Am Geriatr Soc. 2012; 60: 821-829
- Appropriateness of the decision to transfer nursing facility residents to the hospital.J Am Geriatr Soc. 2000; 48: 154-163
- Hazards of hospitalization of the elderly.Ann Intern Med. 1993; 118: 219-223
- Inappropriate hospitalization of nursing facility residents: A symptom of a sick system of care for frail older people.J Am Geriatr Soc. 2000; 48: 230-231
- Functional outcomes of acute medical illness and hospitalization in older persons.Arch Intern Med. 1996; 156: 645-652
- Nursing home resident symptomatology triggering transfer: Avoiding unnecessary hospitalizations.Nurs Res Pract. 2012; 2012: 495103
- Validity of the nursing diagnosis of relocation stress syndrome.Nurs Res. 2000; 49: 97-100
- Report to the Congress: Medicare Payment Policy; Chapter 3 Hospital inpatient and outpatient services.MedPAC, Washington, DC2018
- Nursing facilities can reduce avoidable hospitalizations without increasing mortality risk for residents.Health Affairs (Project Hope). 2018; 37: 1640-1646
- Evaluation of the Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents: Final Report (Prepared for the Centers for Medicare and Medicaid Services).RTI International, Research Triangle Park, NC2017 (2017. Available at:) (Accessed February 21, 2020)
- Initiative to reduce avoidable hospitalizations among nursing facility residents shows promising results.Health Affairs (Millwood). 2017; 36: 441-450
- Successfully reducing hospitalizations of nursing home residents: Results of the Missouri Quality Initiative.J Am Med Dir Assoc. 2017; 18: 960-966
- Cost Drivers for Dually Eligible Beneficiaries: Potentially Avoidable Hospitalizations from Nursing Facility, Skilled Nursing Facility, and Home and Community Based Services Waiver Programs.RTI International, Waltham (MA)2010
- Stata Statistical Software: Release 15.StataCorp LLC, College Station, TX2017
- Trends in emergency department visits for ambulatory care sensitive conditions by elderly nursing home residents, 2001 to 2010.JAMA Intern Med. 2014; 174: 156-158
Article info
Publication history
Published online: March 04, 2020
Footnotes
This research was funded by the Centers for Medicare and Medicaid Services (CMS) Contract No. HHSM500-2010-00021I. Ms Vreeland was employed by RTI International as of the writing of this manuscript and subsequently moved to the Congressional Budget Office. The statements contained in this article are solely those of the authors and do not necessarily reflect the views or policies of CMS, RTI International, or the Congressional Budget Office.
The authors declare no conflicts of interest.
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