High-risk medication use by nursing home residents before and after hospitalization

Abstract

Background: Two prominent challenges in nursing home care are ensuring appropriate medication use and achieving high-quality care as residents transition from the hospital to the nursing home. Research about prescribing practices at this important clinical juncture is limited.

Objective: To analyze the use of high-risk medications by nursing home residents before and after being hospitalized. We define high-risk medications using the Beers criteria for potentially inappropriate medication use.

Research design, subjects, measures: Using a dataset with Medicare claims for inpatient and skilled nursing facility stays and pharmacy claims for all medications dispensed in the nursing home setting, we examine high-risk medication use for hospitalized nursing home residents before and after being hospitalized. Our study population includes 52,559 dual-eligible nursing home residents aged 65 and older who are hospitalized and then readmitted to the same nursing home in 2008. Our primary outcome of interest is the use of high-risk medications in the 30 days before hospitalization and the 30 days following readmission to the same nursing home.

Results: Around 1 in 5 (21%) hospitalized nursing home residents used at least 1 high-risk medication the day before hospitalization. Among individuals with high-risk medication use at hospitalization, the proportion using these medications dropped to 45% after nursing home readmission but increased thereafter, to 59% by the end of the 30-day period.

Conclusion: We found moderate levels of high-risk medication use by hospitalized nursing home residents before and after their hospital stays, constituting an important clinical and policy challenge.

Figure 1. High-Risk Medication Use among Hospitalized Nursing Home Residents Readmitted to the Same Nursing Home, 30 Days Pre/Post, 2008

This figure shows high-risk medication use 30 days before a hospitalization and 30 days after readmission to the same nursing home, among all hospitalized residents.

Figure 2. High-Risk Medication Use among Hospitalized NH Residents Readmitted to the Same NH, 30 Days Pre/Post, by Pre-Hospitalization HRM Use Status (Y/N) 2008

This figure displays high-risk medication use 30 days before hospitalization and 30 days after readmission to the same nursing home, presented separately for people with and without high-risk medication use on the day before hospitalization.