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

Dustin D. French*, Robert R. Campbell, Laurence Z. Rubenstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)499-503
Number of pages5
JournalJournal of the American Medical Directors Association
Issue number7
StatePublished - Sep 2008


  • Medicaid
  • Medicare
  • Nursing homes
  • health care finance
  • hospitalizations
  • veterans

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology


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