Determining 'Avoidability' of Nursing Home Transfers Complex
MONDAY, March 5, 2018 -- A substantial proportion of acute transfers from nursing facilities to hospitals are potentially avoidable, but symptoms and risk conditions are only weakly predictive of hospital diagnoses, according to a study published online Feb. 13 in the Journal of the American Geriatrics Society.
Kathleen T. Unroe, M.D., from Indiana University in Indianapolis, and colleagues assessed the relationship between nursing facility resident risk conditions, signs, and symptoms at time of acute transfer and diagnosis of conditions associated with potentially avoidable acute transfers (pneumonia, urinary tract infection, congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD] or asthma, dehydration, pressure sores). Data were included for 1,174 long-stay nursing facility residents who experienced 1,931 acute transfers from November 2014 to July 2016.
The researchers found that 44 percent of acute transfers were associated with one of six potentially avoidable diagnoses. Symptoms before transfer did not easily differentiate hospital diagnoses, as symptoms mapped into multiple diagnoses. Furthermore, most hospital diagnoses had multiple associated symptoms. For example, among residents with a history of CHF and COPD, more than two-thirds of acute transfers were for reasons other than exacerbations of those conditions.
"Although it is widely recognized that many transfers of nursing facility residents are potentially avoidable, determining 'avoidability' at time of transfer is complex," the authors write.
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Posted: March 2018
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