Preventable hospitalizations from ambulatory care sensitive conditions in nursing homes: evidence from Switzerland

International Journal of Public Health https://doi.org/10.1007/s00038-019-01294-1 (0123456789().,-volV)(0123456789(). ,- volV) ORIGINAL ARTICLE Preventable hospitalizations from ambulatory care sensitive conditions in nursing homes: evidence from Switzerland Ulrike Muench1 • Michael Simon2,3 • Raphaëlle-Ashley Guerbaai2 • Carlo De Pietro4 • Andreas Zeller5,6 • Reto W. Kressig5,7 • Franziska Zúñiga2 • For the INTERCARE Research Group Received: 17 October 2018 / Revised: 24 August 2019 / Accepted: 27 August 2019  The Author(s) 2019 Abstract Objectives Reducing nursing home hospitalizations for ambulatory care sensitive conditions (ACSC) has been identified as an opportunity to improve patient well-being and reduce costs. The aim of this study was to identify number of hospitalizations for ACSCs for nursing home residents in a Swiss national sample, examine demographic characteristics of nursing home hospitalizations due to ACSCs, and calculate hospital expenses from these hospitalizations. Methods Using merged hospital administrative data with payment data based on diagnosis-related groups (DRGs) for the year 2013, we descriptively examined nursing home residents who were 65 years of age or older and were admitted to an acute care hospital. Results Approximately 42% of all nursing home admissions were due to ACSCs. Payments to Swiss hospitals for ACSCs can be estimated at between 89 and 105 million Swiss francs in 2013. Conclusions A sizable share of hospitalizations for nursing home residents is for ACSCs, and the associated costs are substantial. Programs and policies designed to reduce these potentially avoidable hospitalizations from the nursing home setting could lead to an increased patient well-being and lower costs. Keywords Avoidable hospitalizations
Hospital costs
Nursing homes
Preventable hospitalizations Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00038-019-01294-1) contains supplementary material, which is available to authorized users. & Franziska Zúñiga 1 Department of Social and Behavioural Sciences, University of California San Francisco, School of Nursing, San Francisco, USA 2 Department of Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Bernoullistr. 28, 4056 Basel, Switzerland 3 Nursing and Midwifery Research Unit, Inselspital Bern University Hospital, Bern, Switzerland 4 Department of Business Economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland 5 Faculty of Medicine, University of Basel, Basel, Switzerland 6 Center for Primary Health Care, University of Basel, Basel, Switzerland 7 FELIX PLATTER, University Medicine of Aging, Basel, Switzerland Introduction Reducing preventable hospitalizations of nursing home residents is important to the health and well-being of nursing home residents (Ouslander and Maslow 2012; Walsh et al. 2012). Hospitalizations of frail, elderly persons with multiple chronic conditions are often related to loss of functional ability, delirium, cognitive decline, falls, hospital-acquired infections, and discontinuity of medications (Boockvar et al. 2004; Dwyer et al. 2014; Palese et al. 2016; Zisberg et al. 2016). Several estimates show that in the USA and Canada, between 20 and 60% of hospitalizations from nursing homes are considered preventable (Mcandrew et al. 2016; Ouslander et al. 2010; Walker et al. 2009; Walsh et al. 2012). These hospitalizations are not only a major burden to residents but also a substantial financial burden to the health-care delivery system, with the costs of a hospitalization averaging between $8000 and $20,000 in the USA (Axon et al. 2015; Grabowski et al. 2007; Mcandrew et al. 2016; Walsh et al. 2010; Xing et al. 2013). 123 U. Muench et al. Preventable—avoidable, inappropriate, or unnecessary—hospitalizations fall into two groups: hospitalizations which could have been avoided with evidence-based, chronic disease management, prevention of acute deteriorations of chronic conditions, or hospitalizations for conditions which could have been treated in the nursing home. Ambulatory care sensitive conditions (ACSCs) are a group of conditions which include pneumonia, chronic obstructive pulmonary disease (COPD), or congestive heart failure (CHF), among others, and are one of the approaches to measure preventability. Research conducted in the USA suggests that this set of conditions can be effectively and safely managed in the primary care setting when early detection and adequate chronic disease management are in place (Mcandrew et al. 2016; Walsh et al. 2012). Identifying ACSCs can serve as an approximation of potentially preventable hospitalizations, although the effective management of these conditions outside the hospital setting depends on a variety of factors. For example, the decision for or against an ED visit or hospitalization is guided by residents’ and families’ preferences, the presence of advance care planning, do-not hospitalize and do-not resuscitate orders, timely availability of qualified staff, availability of diagnostic and therapeutic interventions in the nursing home, and the acuteness and severity of the condition (Ouslander and Maslow 2012; Renom-Guiteras et al. 2014). Finally, reimbursement policies might favor hospitalizations (Ashton 2014). ACSCs were developed for the primary care setting and have been used for both research and policy analysis (Billings et al. 1993; Purdy et al. 2009; Weissman et al. 1992). Several approaches exist in the literature as to which conditions are considered sensitive to ambulatory care (Ansari et al. 2012; Billings et al. 1993; Millman 1993; Purdy et al. 2009; Weissman et al. 1992). Recently, expert panels in the USA and Canada developed groups of conditions specifically for nursing home residents (Walker et al. 2009; Walsh et al. 2012). While there were some inconsistencies in the groups of ACSCs identified, consensus was reached regarding the inclusion of asthma, cellulitis, CHF, COPD, dehydration, gastroenteritis, diabetes complications, hypertension, pneumonia, urinary tract infection (UTI), seizures, and injuries from falls/ fractures. Typically, in case of exacerbation of any of these conditions, many residents would need to be treated in the hospital. However, preventing ACSCs is achieved through effective monitoring of resident symptoms in nursing homes, in combination with an interprofessional approach to discuss treatment goals and procedures, to avoid exacerbations when possible. For example, in case of an acute situation, the resident might remain in the nursing home for palliative care. Similarly, residents with a tentative diagnosis of fracture will go to the ED; however, an effective 123 fall management program might prevent fall-related injuries. While ACSCs do not capture all the factors which contribute to a decision to hospitalize (...truncated)