Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

TLDR

Support for nursing‑home infrastructure, clinical practice and communication tools, and incentives for facilities and hospitals is needed to reduce medically futile care and avoid unnecessary expenditures. The study aimed to examine the frequency and reasons for potentially avoidable hospitalizations among nursing‑home residents. Researchers reviewed medical records from 20 Georgia nursing homes—10 with high and 10 with low hospitalization rates—randomly selecting 10 hospitalizations per facility and rating them with a structured expert review to identify avoidable admissions. Of 200 hospitalizations examined, 67% were judged potentially avoidable, mainly due to lack of on‑site primary care, delayed laboratory and intravenous fluid access, poor acute‑change assessment, and uncertain benefits of admission, underscoring clinicians’ frequent perception of avoidability.

Abstract

OBJECTIVES: To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents. DESIGN: Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization. SETTING: NHs in Georgia. PARTICIPANTS: In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long‐ and short‐stay residents. MEASUREMENTS: Ratings using a structured review by expert NH clinicians. RESULTS: Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on‐site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations. CONCLUSION: In this sample of NH residents, experienced long‐term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population.