Nursing Home Medical Staff Organization and 30-Day Rehospitalizations

• Published in: Journal of the American Medical Directors Association Vol. 13; no. 6; pp. 552 - 557
• Main Authors: Lima, Julie C., PhD, Intrator, Orna, PhD, Karuza, Jurgis, PhD, Wetle, Terrie, PhD, Mor, Vincent, PhD, Katz, Paul, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2012
• Subjects: Aged; Cross-Sectional Studies; Female; Hospitalization - statistics & numerical data; Humans; Internal Medicine; Logistic Models; Male; Medical Education; Medical Staff - organization & administration; medical staff organization; Medicare; Nursing home; Nursing Homes - organization & administration; physicians; Quality of Health Care; rehospitalizations; United States; United States; physicians; Nursing home; medical staff organization; rehospitalizations
• ISSN: 1525-8610; 1538-9375
• DOI: 10.1016/j.jamda.2012.04.009

Abstract Objectives To examine the relationship between features of nursing home (NH) medical staff organization and residents' 30-day rehospitalizations. Design Cross-sectional study combining primary data collected from a survey of medical directors, NH resident assessment data (minimum data set), Medicare claims, and the Online Survey Certification and Reporting (OSCAR) database. Setting A total of 202 freestanding US nursing homes. Participants Medicare fee-for-service beneficiaries who were hospitalized and subsequently admitted to a study nursing home. Measurements Medical staff organization dimensions derived from the survey, NH residents' characteristics derived from minimum data set data, hospitalizations obtained from Part A Medicare claims, and NH characteristics from the OSCAR database and from www.ltcfocus.org . Study outcome defined within a 30-day window following an index hospitalization: rehospitalized, otherwise died, otherwise survived and not rehospitalized. Results Thirty-day rehospitalizations occurred for 3788 (20.3%) of the 18,680 initial hospitalizations. Death was observed for 884 (4.7%) of residents who were not rehospitalized. Adjusted by hospitalization, resident, and NH characteristics, nursing homes having a more formal appointment process for physicians were less likely to have 30-day rehospitalization (b = –0.43, SE = 0.17), whereas NHs in which a higher proportion of residents were cared for by a single physician were more likely to have rehospitalizations (b = 0.18, SE = 0.08). Conclusion This is the first study to show a direct relationship between features of NH medical staff organization and resident-level process of care. The relationship of a more strict appointment process and rehospitalizations might be a consequence of more formalized and dedicated medical practice with a sense of ownership and accountability. A higher volume of patients per physician does not appear to improve quality of care.