Nursing home-sensitive conditions: analysis of routine health insurance data and modified Delphi analysis of potentially avoidable hospitalizations

doi:10.12688/f1000research.73875.2

. 2021 Dec 1:10:1223.

doi: 10.12688/f1000research.73875.2. eCollection 2021.

Nursing home-sensitive conditions: analysis of routine health insurance data and modified Delphi analysis of potentially avoidable hospitalizations

Sabine Bohnet-Joschko¹, Maria Paula Valk-Draad¹, Timo Schulte^{1

2}, Oliver Groene²

Affiliations

¹ Chair of Management and Innovation in Health Care, Witten/Herdecke University, Witten, 58448, Germany.
² OptiMedis AG, Hamburg, 20095, Germany.

PMID: 35464174
PMCID: PMC9021670
DOI: 10.12688/f1000research.73875.2

Nursing home-sensitive conditions: analysis of routine health insurance data and modified Delphi analysis of potentially avoidable hospitalizations

Sabine Bohnet-Joschko et al. F1000Res. 2021.

. 2021 Dec 1:10:1223.

doi: 10.12688/f1000research.73875.2. eCollection 2021.

Authors

Sabine Bohnet-Joschko¹, Maria Paula Valk-Draad¹, Timo Schulte^{1

2}, Oliver Groene²

Affiliations

¹ Chair of Management and Innovation in Health Care, Witten/Herdecke University, Witten, 58448, Germany.
² OptiMedis AG, Hamburg, 20095, Germany.

PMID: 35464174
PMCID: PMC9021670
DOI: 10.12688/f1000research.73875.2

Abstract

Background: Hospitalizations of nursing home residents are associated with various health risks. Previous research indicates that, to some extent, hospitalizations of this vulnerable population may be inappropriate and even avoidable. This study aimed to develop a consensus list of hospital discharge diagnoses considered to be nursing home-sensitive, i.e., avoidable. Methods: The study combined analyses of routine data from six statutory health insurance companies in Germany and a two-stage Delphi panel, enhanced by expert workshop discussions, to identify and corroborate relevant diagnoses. Experts from four different disciplines estimated the proportion of hospitalizations that could potentially have been prevented under optimal conditions. Results: We analyzed frequencies and costs of data for hospital admissions from 242,236 nursing home residents provided by statutory health insurance companies. We identified 117 hospital discharge diagnoses, which had a frequency of at least 0.1%. We recruited experts (primary care physicians, hospital specialists, nursing home professionals and researchers) to estimate the proportion of potentially avoidable hospitalizations for the 117 diagnoses deemed avoidable in two Delphi rounds (n=107 in Delphi Round 1 and n=96 in Delphi Round 2, effective response rate=91%). A total of 35 diagnoses with high and consistent estimates of the proportion of potentially avoidable hospitalizations were identified as nursing home-sensitive. In an expert workshop (n=16), a further 25 diagnoses were discussed that had not reached the criteria, of which another 23 were consented to be nursing home-sensitive conditions. Extrapolating the frequency and mean costs of these 58 diagnoses to the national German context yielded total potentially avoidable care costs of €768,304,547, associated with 219,955 nursing home-sensitive hospital admissions. Conclusion: A total of 58 nursing home-relevant diagnoses (ICD-10-GM three-digit level) were classified as nursing home-sensitive using an adapted Delphi procedure. Interventions should be developed to avoid hospital admission from nursing homes for these diagnoses.

Keywords: geriatrics; health services research; hospitalization; long-term care; nursing home-sensitive conditions; nursing homes; potentially avoidable hospitalization.

PubMed Disclaimer

Conflict of interest statement

No competing interests were disclosed.

Figures

Figure 1.. RAND/UCLA-appropriateness method in the nursing home-sensitive conditions study: Delphi expert panel management combined with expert workshop.*
*Source: Delphi funnel ; minimum group size. ^–

**Figure 2.. Relevance of nursing home-sensitive conditions for the German health care setting.**

See this image and copyright information in PMC

Cited by

Big Data Analytics to Reduce Preventable Hospitalizations-Using Real-World Data to Predict Ambulatory Care-Sensitive Conditions.
Schulte T, Wurz T, Groene O, Bohnet-Joschko S. Schulte T, et al. Int J Environ Res Public Health. 2023 Mar 7;20(6):4693. doi: 10.3390/ijerph20064693. Int J Environ Res Public Health. 2023. PMID: 36981600 Free PMC article.
Effects of an interprofessional care concept in nursing homes evaluated in the SaarPHIR project: A cluster-randomized controlled trial.
Tönnies L, Zimmer V, Piotrowski A, Lehr T, Laag S, Köberlein-Neu J. Tönnies L, et al. PLoS One. 2025 May 15;20(5):e0321118. doi: 10.1371/journal.pone.0321118. eCollection 2025. PLoS One. 2025. PMID: 40373071 Free PMC article. Clinical Trial.
Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study.
Martin T, Veldeman S, Großmann H, Fuchs-Frohnhofen P, Czaplik M, Follmann A. Martin T, et al. JMIR Aging. 2024 Jun 6;7:e55471. doi: 10.2196/55471. JMIR Aging. 2024. PMID: 38842915 Free PMC article.
Nursing Home-Sensitive Hospitalizations and the Relevance of Telemedicine: A Scoping Review.
Valk-Draad MP, Bohnet-Joschko S. Valk-Draad MP, et al. Int J Environ Res Public Health. 2022 Oct 10;19(19):12944. doi: 10.3390/ijerph191912944. Int J Environ Res Public Health. 2022. PMID: 36232255 Free PMC article.
Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol of a prospective non-randomized complex intervention study with a pragmatic approach, Stay@Home - Treat@Home.
Müller D, Jachan DE, Stahl M, Rosenbusch ML, Liersch-Mazan D, Lippert P, Hinricher N, Ivanova M; STH Research Group; Schulz M, Lahmann N. Müller D, et al. BMC Geriatr. 2024 Dec 2;24(1):987. doi: 10.1186/s12877-024-05553-6. BMC Geriatr. 2024. PMID: 39623305 Free PMC article.

See all "Cited by" articles

References

1. Palleschi L, De Alfieri W, Salani B, et al. : Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria Study. J. Am. Geriatr. Soc. 2011;59(2):193–199. 10.1111/j.1532-5415.2010.03239.x - DOI - PubMed
1. Page DB, Donnelly JP, Wang HE: Community-, Healthcare-, and Hospital-Acquired Severe Sepsis Hospitalizations in the University Health System Consortium. Crit. Care Med. 2015;43(9):1945–1951. 10.1097/CCM.0000000000001164 - DOI - PMC - PubMed
1. O'Hara DA, Carson NJ: Reporting of adverse events in hospitals in Victoria, 1994-1995. Med. J. Aust. 1997;166(9):460–463. 10.5694/j.1326-5377.1997.tb123216.x - DOI - PubMed
1. Palese A, Gonella S, Moreale R, et al. : Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: Findings from a multicentre longitudinal study. Geriatr. Nurs. 2016;37(3):192–199. 10.1016/j.gerinurse.2016.01.001 - DOI - PubMed
1. Purdy S, Griffin T, Salisbury C, et al. : Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health .2009;123(2):169–173. 10.1016/j.puhe.2008.11.001 - DOI - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

[1] Palleschi L, De Alfieri W, Salani B, et al. : Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria Study. J. Am. Geriatr. Soc. 2011;59(2):193–199. 10.1111/j.1532-5415.2010.03239.x - DOI - PubMed

[2] Palleschi L, De Alfieri W, Salani B, et al. : Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria Study. J. Am. Geriatr. Soc. 2011;59(2):193–199. 10.1111/j.1532-5415.2010.03239.x - DOI - PubMed

[3] Page DB, Donnelly JP, Wang HE: Community-, Healthcare-, and Hospital-Acquired Severe Sepsis Hospitalizations in the University Health System Consortium. Crit. Care Med. 2015;43(9):1945–1951. 10.1097/CCM.0000000000001164 - DOI - PMC - PubMed

[4] Page DB, Donnelly JP, Wang HE: Community-, Healthcare-, and Hospital-Acquired Severe Sepsis Hospitalizations in the University Health System Consortium. Crit. Care Med. 2015;43(9):1945–1951. 10.1097/CCM.0000000000001164 - DOI - PMC - PubMed

[5] O'Hara DA, Carson NJ: Reporting of adverse events in hospitals in Victoria, 1994-1995. Med. J. Aust. 1997;166(9):460–463. 10.5694/j.1326-5377.1997.tb123216.x - DOI - PubMed

[6] O'Hara DA, Carson NJ: Reporting of adverse events in hospitals in Victoria, 1994-1995. Med. J. Aust. 1997;166(9):460–463. 10.5694/j.1326-5377.1997.tb123216.x - DOI - PubMed

[7] Palese A, Gonella S, Moreale R, et al. : Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: Findings from a multicentre longitudinal study. Geriatr. Nurs. 2016;37(3):192–199. 10.1016/j.gerinurse.2016.01.001 - DOI - PubMed

[8] Palese A, Gonella S, Moreale R, et al. : Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: Findings from a multicentre longitudinal study. Geriatr. Nurs. 2016;37(3):192–199. 10.1016/j.gerinurse.2016.01.001 - DOI - PubMed

[9] Purdy S, Griffin T, Salisbury C, et al. : Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health .2009;123(2):169–173. 10.1016/j.puhe.2008.11.001 - DOI - PubMed

[10] Purdy S, Griffin T, Salisbury C, et al. : Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health .2009;123(2):169–173. 10.1016/j.puhe.2008.11.001 - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Nursing home-sensitive conditions: analysis of routine health insurance data and modified Delphi analysis of potentially avoidable hospitalizations

Affiliations

Nursing home-sensitive conditions: analysis of routine health insurance data and modified Delphi analysis of potentially avoidable hospitalizations

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical