Diagnoses Associated With Hospitalization of Nursing Home Residents With Severe Functional Impairment and Terminal Illness.

The data are close to 10 years old, so current transfer practices, technologies, and programs may differ. Only 264 of 15,500 US nursing homes were included, so generalizability is uncertain. Outcomes came from Medicare fee-for-service claims and may not capture the full symptoms, signs, or diagnoses behind transfers. The study did not have access to the number or nature of advance directives. Transfer decisions depend on unmeasured factors such as resident preferences, family wishes, staffing, and local resources. The potentially avoidable label was defined from administrative diagnoses, and the authors state the definition is not precise. Impairment status was missing in about 3% of residents and those records were excluded. Specific diagnoses with 10 or fewer events were placed in other categories because of HIPAA limits.

One of the authors received support for related research from the National Institutes of Health, the Centers for Medicare & Medicaid Services, The Commonwealth Fund, the Retirement Research Foundation, the Florida Medical Malpractice Joint Underwriting Association, PointClickCare, Medline Industries, and Think Research. The same author is a paid advisor to and receives licensing royalties from Pathway Health. Work was subject to conflict of interest management plans. Two other authors received support from the Florida Medical Malpractice Joint Underwriting Association and PointClickCare.

Do not conclude that these hospitalizations and ED visits were avoidable because the study did not test interventions. The potentially avoidable label came from administrative diagnosis criteria, and the authors state the definition is not precise.