Research Activities, March 2014
Nursing home residents whose primary care providers devote less time to nursing home care are at higher risk for potentially avoidable hospitalizations
Elderly Health/Long-Term Care
Nursing home (NH) residents are at high risk of avoidable emergency department (ED) visits and hospitalizations. One reason is lack of availability of primary care providers. For the 20 percent of primary care physicians who practice in NHs, NH care accounts for less than 10 percent of their overall work time. Studies in Europe and the United States have found that NHs whose physicians or advance practice nurses devote full time to NH residents have lower rates of hospitalizations and ED visits. A new U.S. study suggests the same. The researchers assessed whether NH residents whose primary care providers (PCPs)—whether physician, physician assistant, or advanced practice nurse—spent most of their clinical effort at NHs would have fewer avoidable hospitalizations and lower Medicare costs.
They found that residents whose PCPs devoted less than 5 percent of their clinical effort to NH care were at 52 percent higher risk of potentially avoidable hospitalizations than those whose PCPs devoted 85 percent or more of their clinical effort to NHs. Those residents also had $2,179 higher annual Medicare spending, controlling for PCP discipline.
The researchers conclude that the effort that providers devote to the NH setting is associated with risk of potential avoidable hospitalization regardless of the discipline of the provider. This result could guide stakeholders in making more informed decisions about cost-effective care for long-term NH residents. This study was supported in part by AHRQ (HS20642).
See "Association between proportion of provider clinical effort in nursing homes and potentially avoidable hospitalizations and medical costs of nursing home residents," by Yong-Fang Kuo, Ph.D., Mukaila A. Raji, M.D., and James S. Goodwin, M.D., in the Journal of the American Geriatric Society 61, pp. 1750-1757, 2013.