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Objectives: To describe characteristics of New York State nursing homes and identify factors associated with potentially preventable hospitalization in nursing home residents., Design: Cross-sectional survey., Setting: Randomly selected nursing homes in New York State., Participants: One hundred forty-seven directors of nursing (DONs)., Measurements: Data were collected using a Web-based survey completed in January 2008. Variables included specific aspects of facility environment, nurse and aide services, resource availability, perceived determinants of hospitalization, and nursing home practice. Stepwise multivariate linear regression examined the associations between perceived determinants and potentially preventable hospitalization., Results: Factors associated with potentially preventable hospitalization included presence of nursing staff trained to communicate effectively with physicians (P<.001); easy access to urgent laboratory results in less than 4 hours on weekends (P=.03); that physicians attempt to treat patients within the nursing home and admit to the hospital as a last resort (P<.001); higher reported proportion of residents enrolled in managed care plans for regular medical care (P=.04); higher perceived likelihood that illness will cause death (P=.03); perceived inadequate access by physicians to residents' and prior medical history, laboratory results, and electrocardiograms (ECGs) (P=.02), as reported by DONs., Conclusion: Efficient and effective care depends on continuity of communication between nurses and physicians and adequate access to patients' medical history, laboratory results, and ECGs. The following operational strategies may help institutions reduce potentially preventable hospitalizations: ensure effective communication between nursing staff and physicians regarding patients' condition; provide physicians with easy access to stat laboratory results in less than 4 hours on weekends and adequate access to the patient's medical history, laboratory results, and ECGs; and motivate physicians to treat residents within the nursing home whenever possible.

Objective: To compare the perception of the determinants of preventable hospitalization among nursing home residents by surveying medical directors (MDs) and directors of nursing (DONs)., Methods: A survey (N = 52) was completed in January 2008. Data included resource availability, determinants of hospitalization, and nursing home practice. Multivariate linear regression examined the associations between potential determinants and preventable hospitalization., Results: Four significant determinants perceived by MDs to influence preventable hospitalization: MD/nurse practitioner (NP) access by pager, family preferences, access to medical history and lab/ electrocardiograph (EKG) reports, and physicians better paid to manage acutely ill residents (R(2) = .58). None of these factors were echoed by DONs (R(2) = .15). Whereas DONs perceived stat lab results on weekends were associated with increased hospitalization (p = .03), MDs did not (p = .28)., Conclusions: Our analysis showed that communication and consensus are important factors in the hospital transfer decision and that the discord in perceptions among MDs and DONs may complicate interventions to reduce preventable hospitalization.

Reducing nursing home hospitalizations has been identified as a possible area for cost savings, but little is known about the magnitude of spending associated with these hospitalizations. Using merged hospital and nursing home administrative files from New York State, we found that inflation-adjusted spending on nursing home hospitalizations increased 29 percent from 1999 through 2004. By 2004, aggregate spending totaled roughly $972 million, of which 23 percent was attributable to ambulatory care-sensitive conditions. These data highlight the potential for cost savings associated with programs designed to reduce these potentially avoidable hospitalizations from the nursing home setting.