Long-stay nursing home residents' hospitalizations in the VHA: the potential impact of aligning financial incentives on hospitalizations.

摘要

The aim of this study was to provide national annualized descriptive statistics of the hospital admissions for long-stay nursing home residents.National, descriptive, secondary data analysis.National, Veterans Health Administration (VHA), 136 VHA nursing homes.Our study population consisted of 6554 VHA long-stay nursing home residents who had an annual assessment during FY 2005, identified from the Minimum Data Set (MDS). These residents were linked with the national VHA discharge dataset.We provide descriptive statistics of the major diagnostic categories (MDC) and diagnosis related groups (DRG) for long-stay residents admitted to a VHA hospital where the source of admission was from the VHA nursing home.Overall, 28.57% (1873/6554) of VHA long-stay residents were hospitalized. The top 5 MDC accounted for over 70% of the hospitalizations. The frequency of MDC associated with hospital admissions, in descending order, were respiratory system (25.33%), kidney and urinary tract (15.88%), circulatory (14.65%), digestive system (9.39%), and nervous system (5.16%). Nearly 25,000 bed days of care (BDC) were associated with these hospitalizations. The top 3 DRG (DRG 320- Med kidney & urinary tract, 89-Med simple pneumonia & pleurisy, 79-Med respiratory infections & inflammations) accounted for nearly 25% of all the hospitalizations and approximately 23% of the BDC.VHA nursing homes do not have the financial incentives that impact the decision to hospitalize that exist in the non-VHA sector. This unique feature of the VHA's nursing homes would allow one to study the issue of potentially preventable hospitalizations in long-stay residents without the confounding impact of Medicare and Medicaid payment incentives. Because of the importance of this policy issue in the national long-term care debate, further VHA studies may provide important empirically based policy input.