Home and Community Care Digest

Home and Community Care Digest 7(1) March 2008

Preventing Admissions to Acute Care from Nursing Homes - Potential Savings

Abstract

Healthcare savings may be achieved by lowering admission rates to acute care hospitals for residents of nursing homes. In 2004, aggregate spending in New York State on all acute care hospital admissions for nursing home residents was $972 million (USD). For the period between 1999 and 2004, preventable hospitalizations were estimated to cost $1.24 billion (USD), accounting for 31.3% of total hospitalization costs. Five conditions - pneumonia ($456.6 million), congestive heart failure ($210.8 million), kidney/urinary tract infection ($200.9 million), chronic obstructive pulmonary disease ($98.3 million) and dehydration ($89.1 million) - accounted for 85% of the costs for preventable conditions over this period.
Background: Healthcare savings may be achieved by lowering admission rates to acute care hospitals for residents of nursing homes. In 2004, total spending in New York State on all acute in-patient care for nursing home residents was $972 million (USD). To estimate potential cost savings, the authors identified 14 ambulatory care sensitive (ACS) conditions for which better management in nursing homes may prevent hospitalizations.

Methods: Using merged hospital and nursing home administrative data from New York State, the authors estimated the cost of acute care hospitalizations for nursing homes residents. Because emergency and outpatients interactions were not captured, costs reflect only in-patient hospital costs. To identify the level of possible cost saving associated with better management of residents' health in nursing homes, the authors separated out the costs associated with the 14 ACS conditions. A hospitalization was considered an ACS condition if the primary diagnosis on admission was one of the following: asthma; cellulitis; chronic obstructive pulmonary disease; congestive heart failure; dehydration; diabetes mellitus; gastro-enteritis; epilepsy; hypertension; hypoglycemia; urinary tract infections; pneumonia; and severe ear, nose, and throat infections.

Findings: Between 1999 and 2004, the noted ACS conditions resulted in $1.24 billion (USD) in acute care costs, accounting for 31.3% of total hospitalization costs. The majority of ACS costs (85.1%) were associated with five conditions: pneumonia ($456.6 million), congestive heart failure ($210.8 million), kidney/urinary tract infection ($200.9 million), chronic obstructive pulmonary disease ($98.3 million) and dehydration ($89.1 million). Inflation-adjusted spending on acute care hospital admissions for nursing home residents increased 29 % from 1999 to 2004. While the average length of stay decreased by over a day during the study period, the rate of hospitalizations for nursing homes residents increased from 24.2% to 28.8% over the five year period. The authors suggest that this increase may be the result of residents being in worse health when they are initially admitted to nursing homes or due to staff shortages. By 2004, aggregate spending on hospitalizations for nursing home residents totaled $972 million (USD), with ACS conditions accounting for 29% of spending.

Conclusions: Substantial healthcare savings can be achieved by limiting preventable hospitalizations from nursing home residents. Focus should be placed on better management of pneumonia, congestive heart failure, kidney/urinary tract infection, chronic obstructive pulmonary disease and dehydration within nursing homes.

Reference: Grabowski DC, O'Malley J, Barhydt, N. The Costs and Potential Savings Associated With Nursing Home Hospitalizations. Health Affairs. 2007; 26 (6): 1753-1761.

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