Avoidable All-Cause Hospitalization, ED Visits Common in Nursing Homes
MONDAY, Aug. 4, 2025 -- Among severely impaired and terminally ill nursing home (NH) residents, all-cause hospitalizations (ACH) and emergency department visits without hospitalization are common, and many are potentially avoidable, according to a study published in the September issue of the Journal of the American Medical Directors Association.
Joseph G. Ouslander, M.D., from the Charles E. Schmidt College of Medicine at Florida Atlantic University in Boca Raton, and colleagues conducted a secondary analysis of a trial that implemented a 12-month quality improvement program to reduce potentially avoidable hospitalizations (PAH) and emergency department visits of NH residents. Hospital diagnoses for ACH, PAH, emergency department visits without hospitalization, and potentially avoidable emergency department visits were identified using Medicare claims data.
Overall, 34 percent of the 6,011 severely impaired residents of the 264 nursing homes had one or more ACH; one-third met the criteria for PAH. Eighteen percent had at least one emergency department visit without hospitalization; 70 percent were potentially avoidable. The researchers found that 14 percent of the 5,810 residents identified as terminally ill had at least one ACH, of which 31 percent were PAH; 8 percent had at least one emergency department visit, 80 percent of which were potentially avoidable. Pneumonia and other infections, shortness of breath/respiratory failure, and altered mental status were the most common diagnoses associated with PAH. Problems with feeding tubes and fall-related trauma were the most common diagnoses associated with potentially avoidable emergency department visits in the severely impaired group and the terminally ill group, respectively.
"To reduce potentially avoidable hospital transfers, we need to strengthen the capabilities of nursing home staff and ensure active involvement from skilled medical directors and clinicians," Ouslander said in a statement.
One author disclosed ties to PointClickCare, Medline Industries, Think Research, and Pathway Health.
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