期刊
HEALTH SERVICES RESEARCH
卷 38, 期 4, 页码 1177-1206出版社
WILEY
DOI: 10.1111/1475-6773.00169
关键词
discretionary hospitalizations; nursing home transfers
资金
- AHRQ HHS [1 R01 HS07587-01A1] Funding Source: Medline
- NIA NIH HHS [AG00198-10, T32 AG000198] Funding Source: Medline
Objective. To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices. Data Sources. Quarterly Medicaid case-mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility-level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market-level attributes. Data spans three years (1991-1993) to produce a longitudinal analytical file containing 72,319 person-quarter-level observations. Study Design. Two-step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion. Principal Findings. Findings indicate that facility case-mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions. Conclusions. Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据