Preventable Hospitalizations Among Nursing Home Residents With Dementia and Behavioral Health Disorders
Nursing home (NH) residents with Alzheimer's disease/related dementias (ADRD) and/or behavioral health disorders (BHD) are at high risk of hospitalizations, many of which are potentially avoidable. Empirical evidence regarding potentially avoidable hospitalizations (PAHs) among these residents...
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| Veröffentlicht in: | Journal of the American Medical Directors Association 2019-10, Vol.20 (10), p.1280-1286.e1 |
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| creator | Temkin-Greener, Helena Cen, Xi Hasselberg, Michael J. Li, Yue |
| description | Nursing home (NH) residents with Alzheimer's disease/related dementias (ADRD) and/or behavioral health disorders (BHD) are at high risk of hospitalizations, many of which are potentially avoidable. Empirical evidence regarding potentially avoidable hospitalizations (PAHs) among these residents is quite sparse and mixed. The objectives of this study were to (1) examine the risk of PAH among residents with ADRD only, BHD only, ADRD and BHD compared to residents with neither and (2) identify associations between individual- and facility-level factors and PAH in these subgroups.
Retrospective, CY2014-2015.
Long-term residents age 65+ (N = 807,630) residing in 15,234 NHs.
We employed the Minimum Data Set, MedPAR, Medicare beneficiary summary, and Nursing Home Compare. Hospitalization risk was the outcome of interest. Individual-level covariates were used to adjust for health conditions. Facility-level covariates and state dummies were included. Multinomial logistic regression models were fit to estimate the risk of PAH and non–potentially avoidable hospitalizations (N-PAH).
Compared to residents without ADRD or BHD, those with ADRD had at least a 10% lower relative risk ratio (RRR) of N-PAH and a significantly lower risk of PAH, at 16% (P |
| doi_str_mv | 10.1016/j.jamda.2019.03.006 |
| format | Article |
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Retrospective, CY2014-2015.
Long-term residents age 65+ (N = 807,630) residing in 15,234 NHs.
We employed the Minimum Data Set, MedPAR, Medicare beneficiary summary, and Nursing Home Compare. Hospitalization risk was the outcome of interest. Individual-level covariates were used to adjust for health conditions. Facility-level covariates and state dummies were included. Multinomial logistic regression models were fit to estimate the risk of PAH and non–potentially avoidable hospitalizations (N-PAH).
Compared to residents without ADRD or BHD, those with ADRD had at least a 10% lower relative risk ratio (RRR) of N-PAH and a significantly lower risk of PAH, at 16% (P < .0001). Residents with BHD only had a statistically higher, but clinically very modest (RRR = 1.03) risk of N-PAH, with no difference in the risk of PAH. Focusing on specific BHD conditions, we found no difference in N-PAH or PAH among residents with depression, lower PAH risk among those with schizophrenia/psychosis (RRR = 0.92), and an increased risk of both N-PAH (RRR = 1.15) and PAH (RRR = 1.09) among residents with bipolar disorders.
We observed a lower risk of PAH and N-PAH among residents with ADRD, with the risk for residents with BHD varying by condition. Substantial variations in PAH and N-PAH were evident across states. Future research is needed to identify state-level modifiable factors that explain these variations.</description><identifier>ISSN: 1525-8610</identifier><identifier>EISSN: 1538-9375</identifier><identifier>DOI: 10.1016/j.jamda.2019.03.006</identifier><identifier>PMID: 31043354</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Attention Deficit and Disruptive Behavior Disorders ; Avoidable hospitalizations ; behavioral disorders ; Databases, Factual ; Dementia ; Female ; Hospitalization - trends ; Humans ; Male ; Middle Aged ; Nursing Homes ; Retrospective Studies</subject><ispartof>Journal of the American Medical Directors Association, 2019-10, Vol.20 (10), p.1280-1286.e1</ispartof><rights>2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine</rights><rights>Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-90dc1a506fc394714eaf0f56e18a05bc7f0e6305dfc2a7fafc1c9e58f7332d963</citedby><cites>FETCH-LOGICAL-c359t-90dc1a506fc394714eaf0f56e18a05bc7f0e6305dfc2a7fafc1c9e58f7332d963</cites><orcidid>0000-0001-6372-3183 ; 0000-0001-6113-2953</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jamda.2019.03.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31043354$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Temkin-Greener, Helena</creatorcontrib><creatorcontrib>Cen, Xi</creatorcontrib><creatorcontrib>Hasselberg, Michael J.</creatorcontrib><creatorcontrib>Li, Yue</creatorcontrib><title>Preventable Hospitalizations Among Nursing Home Residents With Dementia and Behavioral Health Disorders</title><title>Journal of the American Medical Directors Association</title><addtitle>J Am Med Dir Assoc</addtitle><description>Nursing home (NH) residents with Alzheimer's disease/related dementias (ADRD) and/or behavioral health disorders (BHD) are at high risk of hospitalizations, many of which are potentially avoidable. Empirical evidence regarding potentially avoidable hospitalizations (PAHs) among these residents is quite sparse and mixed. The objectives of this study were to (1) examine the risk of PAH among residents with ADRD only, BHD only, ADRD and BHD compared to residents with neither and (2) identify associations between individual- and facility-level factors and PAH in these subgroups.
Retrospective, CY2014-2015.
Long-term residents age 65+ (N = 807,630) residing in 15,234 NHs.
We employed the Minimum Data Set, MedPAR, Medicare beneficiary summary, and Nursing Home Compare. Hospitalization risk was the outcome of interest. Individual-level covariates were used to adjust for health conditions. Facility-level covariates and state dummies were included. Multinomial logistic regression models were fit to estimate the risk of PAH and non–potentially avoidable hospitalizations (N-PAH).
Compared to residents without ADRD or BHD, those with ADRD had at least a 10% lower relative risk ratio (RRR) of N-PAH and a significantly lower risk of PAH, at 16% (P < .0001). Residents with BHD only had a statistically higher, but clinically very modest (RRR = 1.03) risk of N-PAH, with no difference in the risk of PAH. Focusing on specific BHD conditions, we found no difference in N-PAH or PAH among residents with depression, lower PAH risk among those with schizophrenia/psychosis (RRR = 0.92), and an increased risk of both N-PAH (RRR = 1.15) and PAH (RRR = 1.09) among residents with bipolar disorders.
We observed a lower risk of PAH and N-PAH among residents with ADRD, with the risk for residents with BHD varying by condition. Substantial variations in PAH and N-PAH were evident across states. Future research is needed to identify state-level modifiable factors that explain these variations.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Attention Deficit and Disruptive Behavior Disorders</subject><subject>Avoidable hospitalizations</subject><subject>behavioral disorders</subject><subject>Databases, Factual</subject><subject>Dementia</subject><subject>Female</subject><subject>Hospitalization - trends</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nursing Homes</subject><subject>Retrospective Studies</subject><issn>1525-8610</issn><issn>1538-9375</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFu1DAQhi1ERUvhCZCQj1wSxvHaiQ8cSgssUgUIgThas_a49SqJFzu7Unl6Erb02NOMNd_v0XyMvRJQCxD67bbe4uCxbkCYGmQNoJ-wM6FkVxnZqqdL36iq0wJO2fNStgALqp-xUylgJaVanbGbb5kONE646YmvU9nFCfv4B6eYxsIvhjTe8C_7XOJc12kg_p1K9HOg8F9xuuVXNMyPiBxHz9_TLR5iytjzNWG_jGNJ2VMuL9hJwL7Qy_t6zn5-_PDjcl1df_30-fLiunJSmaky4J1ABTo4aVatWBEGCEqT6BDUxrUBSEtQPrgG24DBCWdIdaGVsvFGy3P25vjvLqffeyqTHWJx1Pc4UtoX2zSiM8Zo1c6oPKIup1IyBbvLccB8ZwXYxbDd2n-G7aLNgrSz4Tn1-n7BfjOQf8j8VzoD744AzWceImVbXKTRkY-Z3GR9io8u-Atf7I73</recordid><startdate>201910</startdate><enddate>201910</enddate><creator>Temkin-Greener, Helena</creator><creator>Cen, Xi</creator><creator>Hasselberg, Michael J.</creator><creator>Li, Yue</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6372-3183</orcidid><orcidid>https://orcid.org/0000-0001-6113-2953</orcidid></search><sort><creationdate>201910</creationdate><title>Preventable Hospitalizations Among Nursing Home Residents With Dementia and Behavioral Health Disorders</title><author>Temkin-Greener, Helena ; Cen, Xi ; Hasselberg, Michael J. ; Li, Yue</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-90dc1a506fc394714eaf0f56e18a05bc7f0e6305dfc2a7fafc1c9e58f7332d963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Attention Deficit and Disruptive Behavior Disorders</topic><topic>Avoidable hospitalizations</topic><topic>behavioral disorders</topic><topic>Databases, Factual</topic><topic>Dementia</topic><topic>Female</topic><topic>Hospitalization - trends</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nursing Homes</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Temkin-Greener, Helena</creatorcontrib><creatorcontrib>Cen, Xi</creatorcontrib><creatorcontrib>Hasselberg, Michael J.</creatorcontrib><creatorcontrib>Li, Yue</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Medical Directors Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Temkin-Greener, Helena</au><au>Cen, Xi</au><au>Hasselberg, Michael J.</au><au>Li, Yue</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preventable Hospitalizations Among Nursing Home Residents With Dementia and Behavioral Health Disorders</atitle><jtitle>Journal of the American Medical Directors Association</jtitle><addtitle>J Am Med Dir Assoc</addtitle><date>2019-10</date><risdate>2019</risdate><volume>20</volume><issue>10</issue><spage>1280</spage><epage>1286.e1</epage><pages>1280-1286.e1</pages><issn>1525-8610</issn><eissn>1538-9375</eissn><abstract>Nursing home (NH) residents with Alzheimer's disease/related dementias (ADRD) and/or behavioral health disorders (BHD) are at high risk of hospitalizations, many of which are potentially avoidable. Empirical evidence regarding potentially avoidable hospitalizations (PAHs) among these residents is quite sparse and mixed. The objectives of this study were to (1) examine the risk of PAH among residents with ADRD only, BHD only, ADRD and BHD compared to residents with neither and (2) identify associations between individual- and facility-level factors and PAH in these subgroups.
Retrospective, CY2014-2015.
Long-term residents age 65+ (N = 807,630) residing in 15,234 NHs.
We employed the Minimum Data Set, MedPAR, Medicare beneficiary summary, and Nursing Home Compare. Hospitalization risk was the outcome of interest. Individual-level covariates were used to adjust for health conditions. Facility-level covariates and state dummies were included. Multinomial logistic regression models were fit to estimate the risk of PAH and non–potentially avoidable hospitalizations (N-PAH).
Compared to residents without ADRD or BHD, those with ADRD had at least a 10% lower relative risk ratio (RRR) of N-PAH and a significantly lower risk of PAH, at 16% (P < .0001). Residents with BHD only had a statistically higher, but clinically very modest (RRR = 1.03) risk of N-PAH, with no difference in the risk of PAH. Focusing on specific BHD conditions, we found no difference in N-PAH or PAH among residents with depression, lower PAH risk among those with schizophrenia/psychosis (RRR = 0.92), and an increased risk of both N-PAH (RRR = 1.15) and PAH (RRR = 1.09) among residents with bipolar disorders.
We observed a lower risk of PAH and N-PAH among residents with ADRD, with the risk for residents with BHD varying by condition. Substantial variations in PAH and N-PAH were evident across states. Future research is needed to identify state-level modifiable factors that explain these variations.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31043354</pmid><doi>10.1016/j.jamda.2019.03.006</doi><orcidid>https://orcid.org/0000-0001-6372-3183</orcidid><orcidid>https://orcid.org/0000-0001-6113-2953</orcidid></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Aged Aged, 80 and over Attention Deficit and Disruptive Behavior Disorders Avoidable hospitalizations behavioral disorders Databases, Factual Dementia Female Hospitalization - trends Humans Male Middle Aged Nursing Homes Retrospective Studies |
| title | Preventable Hospitalizations Among Nursing Home Residents With Dementia and Behavioral Health Disorders |
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