TY - JOUR
T1 - Long-Stay Nursing Home Residents' Hospitalizations in the VHA
T2 - The Potential Impact of Aligning Financial Incentives on Hospitalizations
AU - French, Dustin D.
AU - Campbell, Robert R.
AU - Rubenstein, Laurence Z.
N1 - Funding Information:
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.
PY - 2008/9
Y1 - 2008/9
N2 - Objectives: The aim of this study was to provide national annualized descriptive statistics of the hospital admissions for long-stay nursing home residents. Design: National, descriptive, secondary data analysis. Setting: National, Veterans Health Administration (VHA), 136 VHA nursing homes. Participants: Our study population consisted of 6554 VHA long-stay nursing home residents who had an annual assessment during FY 2005, identified from the Minimum Data Set (MDS). These residents were linked with the national VHA discharge dataset. Measurement: We provide descriptive statistics of the major diagnostic categories (MDC) and diagnosis related groups (DRG) for long-stay residents admitted to a VHA hospital where the source of admission was from the VHA nursing home. Results: Overall, 28.57% (1873/6554) of VHA long-stay residents were hospitalized. The top 5 MDC accounted for over 70% of the hospitalizations. The frequency of MDC associated with hospital admissions, in descending order, were respiratory system (25.33%), kidney and urinary tract (15.88%), circulatory (14.65%), digestive system (9.39%), and nervous system (5.16%). Nearly 25,000 bed days of care (BDC) were associated with these hospitalizations. The top 3 DRG (DRG 320- Med kidney & urinary tract, 89-Med simple pneumonia & pleurisy, 79-Med respiratory infections & inflammations) accounted for nearly 25% of all the hospitalizations and approximately 23% of the BDC. Conclusions: VHA nursing homes do not have the financial incentives that impact the decision to hospitalize that exist in the non-VHA sector. This unique feature of the VHA's nursing homes would allow one to study the issue of potentially preventable hospitalizations in long-stay residents without the confounding impact of Medicare and Medicaid payment incentives. Because of the importance of this policy issue in the national long-term care debate, further VHA studies may provide important empirically based policy input.
AB - Objectives: The aim of this study was to provide national annualized descriptive statistics of the hospital admissions for long-stay nursing home residents. Design: National, descriptive, secondary data analysis. Setting: National, Veterans Health Administration (VHA), 136 VHA nursing homes. Participants: Our study population consisted of 6554 VHA long-stay nursing home residents who had an annual assessment during FY 2005, identified from the Minimum Data Set (MDS). These residents were linked with the national VHA discharge dataset. Measurement: We provide descriptive statistics of the major diagnostic categories (MDC) and diagnosis related groups (DRG) for long-stay residents admitted to a VHA hospital where the source of admission was from the VHA nursing home. Results: Overall, 28.57% (1873/6554) of VHA long-stay residents were hospitalized. The top 5 MDC accounted for over 70% of the hospitalizations. The frequency of MDC associated with hospital admissions, in descending order, were respiratory system (25.33%), kidney and urinary tract (15.88%), circulatory (14.65%), digestive system (9.39%), and nervous system (5.16%). Nearly 25,000 bed days of care (BDC) were associated with these hospitalizations. The top 3 DRG (DRG 320- Med kidney & urinary tract, 89-Med simple pneumonia & pleurisy, 79-Med respiratory infections & inflammations) accounted for nearly 25% of all the hospitalizations and approximately 23% of the BDC. Conclusions: VHA nursing homes do not have the financial incentives that impact the decision to hospitalize that exist in the non-VHA sector. This unique feature of the VHA's nursing homes would allow one to study the issue of potentially preventable hospitalizations in long-stay residents without the confounding impact of Medicare and Medicaid payment incentives. Because of the importance of this policy issue in the national long-term care debate, further VHA studies may provide important empirically based policy input.
KW - Medicaid
KW - Medicare
KW - Nursing homes
KW - health care finance
KW - hospitalizations
KW - veterans
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U2 - 10.1016/j.jamda.2008.03.015
DO - 10.1016/j.jamda.2008.03.015
M3 - Article
C2 - 18755423
AN - SCOPUS:49849105606
SN - 1525-8610
VL - 9
SP - 499
EP - 503
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 7
ER -
