Construction and Validation of Risk-adjusted Rates of Emergency Department Visits for Long-stay Nursing Home Residents

Huiwen Xu, John R. Bowblis, Yue Li, Thomas V. Caprio, Orna Intrator

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background:Long-stay nursing home (NH) residents are at high risk of having emergency department (ED) visits, but current knowledge regarding risk-adjusted ED rates is limited.Objectives:To construct and validate 3 quarterly risk-adjusted rates of long-stay residents' ED use: Any ED visit, ED visits without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED).Research Design:The authors calculated quarterly NH risk-adjusted ED rates from 2011 Q2 to 2013 Q3 national Medicare claims and Minimum Data Set data. Using random-effect linear regressions, the authors validated these rates against Nursing Home Compare overall 5-star quality ratings and examined their associations with hospitalization rates to provide a quality context.Subjects:Resident-quarter observations (7.3 million) from 15,235 unique NHs.Results:Risk-adjusted rates of any ED, outpatient ED, and PAED averaged 9.7%, 3.4%, and 3.2%, respectively. Compared with NHs with 1 or 2 stars overall rating, NHs with ≥3 stars were significantly associated with lower rates of any ED visit, outpatient ED, and PAED (β,-0.23%,-0.16%, and-0.11%, respectively; all P<0.01). Pearson Correlation coefficients between hospitalization rates and rates of any ED visit, outpatient ED, and PAED were 0.74, 0.31, and 0.46, respectively.Conclusions:The moderately negative associations of 5-star ratings with ED rates provide supportive evidence to their validity. Outpatient ED and PAED were moderately correlated to hospitalizations suggesting they provided more information about quality than any ED.

Original languageEnglish (US)
Pages (from-to)174-182
Number of pages9
JournalMedical care
Volume58
Issue number2
DOIs
StatePublished - Feb 1 2020
Externally publishedYes

Keywords

  • emergency department visits
  • long-stay resident
  • Nursing Home Compare
  • potentially avoidable emergency department visits
  • risk adjustment

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Fingerprint

Dive into the research topics of 'Construction and Validation of Risk-adjusted Rates of Emergency Department Visits for Long-stay Nursing Home Residents'. Together they form a unique fingerprint.

Cite this