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. 2022 May 10;22(1):626.
doi: 10.1186/s12913-022-08036-9.

Repeat hospital transfers among long stay nursing home residents: a mixed methods analysis of age, race, code status and clinical complexity

Amy Vogelsmeier  1 , Lori Popejoy  2 , Elizabeth Fritz  2 , Kelli Canada  3 , Bin Ge  4 , Lea Brandt  4 , Marilyn Rantz  2
Affiliations

Repeat hospital transfers among long stay nursing home residents: a mixed methods analysis of age, race, code status and clinical complexity

Amy Vogelsmeier et al. BMC Health Serv Res. .

Abstract

Background: Nursing home residents are at increased risk for hospital transfers resulting in emergency department visits, observation stays, and hospital admissions; transfers that can also result in adverse resident outcomes. Many nursing home to hospital transfers are potentially avoidable. Residents who experience repeat transfers are particularly vulnerable to adverse outcomes, yet characteristics of nursing home residents who experience repeat transfers are poorly understood. Understanding these characteristics more fully will help identify appropriate intervention efforts needed to reduce repeat transfers.

Methods: This is a mixed-methods study using hospital transfer data, collected between 2017 and 2019, from long-stay nursing home residents residing in 16 Midwestern nursing homes who transferred four or more times within a 12-month timeframe. Data were obtained from an acute care transfer tool used in the Missouri Quality Initiative containing closed- and open-ended questions regarding hospital transfers. The Missouri Quality Initiative was a Centers for Medicare and Medicaid demonstration project focused on reducing avoidable hospital transfers for long stay nursing home residents. The purpose of the analysis presented here is to describe characteristics of residents from that project who experienced repeat transfers including resident age, race, and code status. Clinical, resident/family, and organizational factors that influenced transfers were also described.

Results: Findings indicate that younger residents (less than 65 years of age), those who were full-code status, and those who were Black were statistically more likely to experience repeat transfers. Clinical complexity, resident/family requests to transfer, and lack of nursing home resources to manage complex clinical conditions underlie repeat transfers, many of which were considered potentially avoidable.

Conclusions: Improved nursing home resources are needed to manage complex conditions in the NH and to help residents and families set realistic goals of care and plan for end of life thus reducing potentially avoidable transfers.

Keywords: Advanced practice registered nurses; Hospital transfers; Nursing home residents; Nursing homes.

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Conflict of interest statement

Drs. Vogelsmeier, Popejoy, and Rantz are investors in NewPath Health Solutions, LLC.

Drs. Fritz, Canada, Ge, and Brandt declare no competing interest.

Figures

Fig. 1
Fig. 1
Sample selection flowchart
Fig. 2
Fig. 2
Distribution of all transfers by age. * p < .05; Repeat transfers = 4 or more per year
Fig. 3
Fig. 3
Distribution of all transfers by race. * p < .001; Repeat transfers = 4 or more per year
Fig. 4
Fig. 4
Distribution of repeat transfers by code status and race. *p < .05; Repeat transfers = 4 or more per year
See this image and copyright information in PMC

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References

    1. Mcandrew RM, Grabowski DC, Dangi A, Young GJ. Prevalence and patterns of potentially avoidable hospitalizations in the US long-term care setting. Int J Qual Health Care J Int Soc Qual Health Care. 2016;28(1):104–109. doi: 10.1093/intqhc/mzv110. - DOI - PubMed
    1. Ouslander JG, Lamb G, Perloe M, et al. Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs: [see editorial comments by Drs. Jean F. Wyman and William R. Hazzard, pp 760–761] J Am Geriatr Soc. 2010;58(4):627–635. doi: 10.1111/j.1532-5415.2010.02768.x. - DOI - PubMed
    1. Mor V, Intrator O, Feng Z, Grabowski DC. The Revolving Door of Rehospitalization From Skilled Nursing Facilities. Health Aff Proj Hope. 2010;29(1):57–64. doi: 10.1377/hlthaff.2009.0629. - DOI - PMC - PubMed
    1. Centers for Medicare and Medicaid Services. Initiative to reduce avoidable hospitalizations among nursing facility residents. Accessed 15 Mar 2022. https://innovation.cms.gov/innovation-models/rahnfr
    1. Office of Inspector General. Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring (OEI-06–11–00040; 11/13). Published online November 2013:28.