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Research on Aging
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Deriving a Model of the Necessity to Hospitalize Nursing Home Residents

A. James O'Malley

Harvard Medical School

Edward R. Marcantonio

Harvard Medical School

Rachel L. Murkofsky

University of Hawaii

Daryl J. Caudry

Harvard Medical School

Joan L. Buchanan

Harvard Medical School

Although often important to recover from acute medical problems and exacerbations of chronic illness, hospitalizations can be traumatic for nursing home residents and costly for payers. It is important that unnecessary hospitalizations are avoided wherever possible. The authors derived and validated a diagnosis-based model to estimate the clinical necessity of hospitalizing nursing home residents with common conditions using data from an expert panel survey. Model validation involved a linked minimum data set—hospitalization claims data set. The expert panel of 12 experienced geriatricians rated the necessity of hospitalization for 1,948 clinical scenarios containing diagnoses, cognitive and functional status, age, gender, and advance directives. Primary diagnoses with the highest average necessity scores were respiratory failure, acute myocardial infarction, hip fracture, and brain injury. The secondary diagnosis-primary diagnosis interaction with the greatest impact was gastrointestinal bleed on gastroenteritis. Poor cognitive function and presence of an advance directive lowered the risk of hospitalization.

Key Words: hierarchical model • model-validity test • nursing home residents • Modified Delphi methods • predicting hospitalization

References

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Research on Aging, Vol. 29, No. 6, 606-625 (2007)
DOI: 10.1177/0164027507305731
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This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
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Citing Articles
Right arrow Citing Articles via Google Scholar
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Right arrow Articles by O'Malley, A. J.
Right arrow Articles by Buchanan, J. L.
Right arrow Search for Related Content
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What's this?