Nursing Home Medical Staff Organization and 30-Day Rehospitalizations

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• 作者：Julie C. Lima ; PhD^a ; ^{Julie_Lima@brown.edu} ; Orna Intrator ; PhD^a ; ^b ; ^c ; Jurgis Karuza ; PhD^d ; ^e ; ^f ; ^g ; Terrie Wetle ; PhD^a ; ^h ; Vincent Mor ; PhD^a ; ^b ; Paul Katz ; MD^f ; ^g
• 关键词：Nursing home ; medical staff organization ; rehospitalizations ; physicians
• 刊名：Journal of the American Medical Directors Association
• 出版年：2012
• 出版时间：July, 2012
• 年：2012
• 卷：13
• 期：6
• 页码：552-557
• 全文大小：142 K

文摘

Objectives

To examine the relationship between features of nursing home (NH) medical staff organization and residents' 30-day rehospitalizations.

Design

Cross-sectional study combining primary data collected from a survey of medical directors, NH resident assessment data (minimum data set), Medicare claims, and the Online Survey Certification and Reporting (OSCAR) database.

Setting

A total of 202 freestanding US nursing homes.

Participants

Medicare fee-for-service beneficiaries who were hospitalized and subsequently admitted to a study nursing home.

Measurements

Medical staff organization dimensions derived from the survey, NH residents' characteristics derived from minimum data set data, hospitalizations obtained from Part A Medicare claims, and NH characteristics from the OSCAR database and from . Study outcome defined within a 30-day window following an index hospitalization: rehospitalized, otherwise died, otherwise survived and not rehospitalized.

Results

Thirty-day rehospitalizations occurred for 3788 (20.3 % ) of the 18,680 initial hospitalizations. Death was observed for 884 (4.7 % ) of residents who were not rehospitalized. Adjusted by hospitalization, resident, and NH characteristics, nursing homes having a more formal appointment process for physicians were less likely to have 30-day rehospitalization (b?= -0.43, SE?= 0.17), whereas NHs in which a higher proportion of residents were cared for by a single physician were more likely to have rehospitalizations (b?= 0.18, SE?= 0.08).

Conclusion

This is the first study to show a direct relationship between features of NH medical staff organization and resident-level process of care. The relationship of a more strict appointment process and rehospitalizations might be a consequence of more formalized and dedicated medical practice with a sense of ownership and accountability. A higher volume of patients per physician does not appear to improve quality of care.