Carter Mary W
West Virginia University School of Medicine, USA.
J Aging Health. 2003 May;15(2):295-331. doi: 10.1177/0898264303015002001.
This study examined patient-level, facility-level, and area market-level factors affecting ambulatory care-sensitive hospitalization (ACSH) rates among nursing home residents. Although ACSH has long been used to monitor accessibility to health care services among community-dwelling populations, the use of ACSH rates as an indicator of potential quality-of-care problems affecting nursing home residents has not been employed. METHODS. Three years of quarterly Medicaid reimbursement data from more than 500 nursing homes were linked to 4 years of Medicare Provider Analysis and Review hospital claims data, nursing facility attribute data, and Area Resource File data to investigate the relative contribution of patient-, facility-, and market-level risk factors to ACSH among nursing home residents. RESULTS. Logistic regression results indicate that facility-level factors and nursing home quality-of-care indicators significantly contribute to the risk of ACSH. DISCUSSION. Findings underscore the need for continuing efforts to improve quality-of-care practices in nursing homes, particularly with respect to associations between quality-of-care indicators and facility structural/organizational characteristics with ACSHs.
本研究考察了影响疗养院居民门诊医疗敏感型住院（ACSH）率的患者层面、机构层面和地区市场层面的因素。尽管ACSH长期以来一直用于监测社区居民获得医疗服务的可及性，但尚未将ACSH率用作影响疗养院居民潜在护理质量问题的指标。方法。来自500多家疗养院的三年季度医疗补助报销数据与四年的医疗保险提供者分析与审查医院理赔数据、护理机构属性数据以及地区资源文件数据相关联，以调查患者、机构和市场层面的风险因素对疗养院居民ACSH的相对贡献。结果。逻辑回归结果表明，机构层面的因素和疗养院护理质量指标对ACSH风险有显著影响。讨论。研究结果强调了持续努力改善疗养院护理质量实践的必要性，特别是在护理质量指标与机构结构/组织特征和ACSH之间的关联方面。
