Negligence: Nursing homes that employ physician extenders and provide training for nurses' aides have fewer hospitalizations

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Provision of high quality care hinges on the ability of nursing homes to manage the increasing clinical complexity of the residents they serve and to prevent the acute worsening of chronic conditions that trigger hospitalizations. These ambulatory care-sensitive (ACS) conditions range from asthma and congestive heart failure to hypertension, diabetes, pneumonia, and urinary tract infections. Nursing homes that employ a physician extender (nurse practitioner or physician assistant), provide intravenous therapy, and operate a certified nurses' aide training program appear to have fewer ACS hospitalizations, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality.

Orna Intrator, Ph.D., of Brown University, and her colleagues used data from assessments of nursing home residents' health (Minimum Data Set, MDS), Medicare and Medicaid inpatient claims and eligibility records, On-line Survey Certification Automated Records (OSCAR), and the Area Resource File to examine the association between nursing home characteristics and the rate of potentially preventable/avoidable hospitalizations of non-HMO long-stay (160 days or more) residents of 663 nursing homes in 1997.

Nursing homes with physician extenders (23 percent) were associated with 17 percent lower hospitalization rates for ACS conditions but not with other hospitalizations. Facilities that had more physicians (i.e., more than one half full-time equivalent hours of physicians' time, not including the medical director; 26 percent of facilities) appeared to have higher odds of both ACS and non-ACS hospitalizations. Facilities providing intravenous therapy (23 percent) and those that operated a training program for nurses' aides (36 percent) were associated with fewer hospitalizations of both types.

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