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Journal of Aging and Health, Vol. 18, No. 6, 869-884 (2006)
DOI: 10.1177/0898264306293617

Derivation and Confirmation of Scales Measuring Medical Directors’ Attitudes About the Hospitalization of Nursing Home Residents

Edward R. Marcantonio

Harvard Medical School & Beth Israel Deaconess Medical Center

A. James O’Malley

Harvard Medical School

Rachel L. Murkofsky

University of Hawaii

Daryl J. Caudry

Harvard Medical School

Joan L. Buchanan

Harvard Medical School

Objectives: To derive and confirm scales measuring medical director’s attitudes about hospitalization of nursing home residents.

Method: The authors surveyed nursing facility medical directors about the necessity of hospitalizing residents for eight clinical conditions and compared the ratings to those obtained from an expert panel to derive a relative hospitalization score. They also asked about factors that might influence hospitalization decisions. They performed a factor analysis to derive scales that measure attitudinal determinants of hospitalization and used the relative hospitalization score to confirm the scales.

Results: The survey had a 79% response rate. The relative hospitalization score demonstrated that medical directors were slightly less likely to recommend hospitalization than expert panel physicians. Factor analyses yielded 10 scales focusing on nursing home functioning, economics, resident specific considerations, and physician attitudes. Eight of the 10 scales had significant bivariable associations with the relative hospitalization score, and 6 had significant multivariable associations.

Discussion: Medical directors identify multiple determinants of hospitalization for nursing facility residents across several domains. Hospitalization decisions for nursing facility residents are complex and involve clinical and nonclinical factors.

Key Words: skilled nursing facilities • hospitalization • medical directors • scales


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