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Journal of Aging and Health
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Factors Associated with Ambulatory Care—Sensitive Hospitalizations among Nursing Home Residents

Mary W. Carter

West Virginia University School of Medicine

Objectives: 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.

Key Words: ambulatory care-sensitive hospitalizations

Journal of Aging and Health, Vol. 15, No. 2, 295-331 (2003)
DOI: 10.1177/0898264303015002001
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