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Hospitalizations, ED Visits & Nursing Home Quality

Ian Breunig, Qing Zheng, Alan White, Christianna Williams, Allison Muma


November 16, 2019

One of CMS’s ongoing initiatives is to reduce the costs and improve the quality of care for nursing home  residents by reducing the number of transfers from facilities for acute care. A national database of Medicare claims is linked to Minimum Data Set clinical assessment data to capture nursing home stays at Medicare-certified nursing homes in the U.S. at any time between July 1, 2017 and June 30, 2018, and identify dates of hospital admissions and emergency department visits among nursing home residents. We identify rates of unplanned hospitalizations and emergency department visits not resulting in hospital admission among short-stay rehabilitation and long-stay residents. We examine whether the measures are associated with Five-Star ratings obtained from, and other provider characteristics identified in Medicare administrative data. We also compare short-stay measures to long-stay measures. Rates vary widely across nursing homes, and better rates are strongly associated with staffing levels, quality of care, health inspection ratings, and other nursing homes characteristics. This suggest that it is possible to reduce acute care transfers among nursing home residents.

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Hospitalizations, ED Visits & Nursing Home Quality