Facility characteristics associated with hospitalization of nursing home residents - Results of a national study
Facility characteristics associated with hospitalization of nursing home residents - Results of a national study
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DOI：
10.1097/00005650-199903000-00003
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发表时间：
1999-03-01
期刊：
影响因子：
3
通讯作者：
Mor, V
中科院分区：
文献类型：
--
作者：
Intrator, O;Castle, NG;Mor, V
目标。测试设施特征对疗养院居民住院概率的影响，控制居民特征和死亡竞争风险。研究设计。研究数据来源于对1993年居民评估工具——最小数据集（MDS）实施情况的评估。数据包括253个NH的2080名居民以及年度自动记录在线调查认证（OSCAR）措施。使用多项逻辑回归来确定所选居民和设施特征对基线 6 个月内住院或死亡的影响，并针对复杂抽样设计进行调整（使用 SUDAAN）。结果。通过控制居民人口统计、预先指示、诊断、选定的临床症状和付款人类型，我们发现设有特殊护理病房、更多医生（工作人员或合同制 FTE 医生中位数超过 0.08 名）以及任何医生延伸人员（执业护士或医师助理）的家庭不太可能让居民住院。超过 3.6% 的居民接受呼吸治疗的家庭更有可能让居民住院。结论。研究结果表明，医疗保险 HMO 应考虑护理设施的能力，特别是医疗护理能力和临床资源，以限制住院人数。
Objectives. TO test the effect of facility characteristics on the probability of hospitalization of nursing home residents, controlling for resident characteristics and the competing risk of death.Research design. Study data were derived from the evaluation of the implementation of the Resident Assessment Instrument, the Minimum Data Set (MDS) in 1993. The data consisted of 2080 residents in 253 NHs as well as the annual On-Line Survey Certification of Automated Records (OSCAR).Measures. Multinomial logistic regression was used to determine the effects of selected resident and facility characteristics on hospitalization or death within 6 months of baseline, adjusting for the complex sampling design (using SUDAAN).Results. By controlling for resident demographics, advance directives, diagnoses, selected clinical signs, and type of payer, we found that homes with special care units, more physicians (above the median 0.08 FTE physicians on staff or contract), and any physician extenders (nurse practitioners or physician assistants) were less likely to hospitalize their residents. Homes in which over 3.6% of the residents received respiratory treatment were more likely to hospitalize their residents.Conclusions. Findings suggest that Medicare HMOs should consider the capacity of nursing facilities, especially in terms of medical care capacity and clinical resources, to limit hospital admissions.