Over the last several decades, most states have increasingly shifted their Medicaid long-term care (LTC) expenditures away from primarily institutional services toward more home and community-based services (HCBS). Despite the increase in HCBS, the risk for potentially preventable hospitalizations among elderly Medicaid HCBS users is largely unknown. Given the health implications and the high cost of hospitalizations, it is important to better understand potentially preventable hospitalizations among these LTC users. This dissertation research empirically examined potentially preventable hospitalizations among elderly Medicaid LTC users in community and institutional settings. Specifically this research aimed to (1) identify the factors associated with potentially preventable hospitalizations among elderly Medicaid HCBS users, (2) compare the risk for a potentially preventable hospitalization between elderly Medicaid HCBS users and nursing home residents, and (3) compare the risk for a potentially preventable hospitalization between elderly Medicaid LTC users who transition from a nursing home to a home or community LTC setting and those who remain in a nursing home. Results from these analyses found that potentially preventable hospitalizations were frequent among elderly Medicaid HCBS recipients, and a few conditions accounted for the majority of these hospitalizations. Several characteristics were significantly associated with an increased risk for a potentially preventable hospitalization suggesting that there is variation in preventable hospitalizations among the elderly Medicaid HCBS population and improvements could be made in reducing this variation. After controlling for a number of characteristics and correcting for endogeneity, HCBS users had an increased risk for a preventable hospitalization compared to nursing home residents. More proactive medical care and policies focusing on reducing hospitalizations may be needed for the HCBS population, as well as better aligned incentives for providers to coordinate care. Elderly Medicaid LTC users who transitioned from a nursing home to using HCBS had an increased but non-significant risk for a preventable hospitalization compared with individuals who remained in the nursing home. The medical care and continuity of providers within the nursing home setting are likely important factors in keeping nursing home residents out of the hospital.
University of Minnesota Ph.D. dissertation. August 2012. Major: Health Services Research, Policy and Administration. Advisor: Robert L. Kane, MD. 1 computer file (PDF); ix, 149 pages, appendices 1-33.
Wysocki, Andrea Jeanne.
Potentially preventable hospitalizations among elderly medicaid long-term care users.
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