The Relationship between Nursing Home Quality of Care and Potentially Preventable Hospitalization

Thumbnail Image

Persistent link to this item

View Statistics

Journal Title

Journal ISSN

Volume Title


The Relationship between Nursing Home Quality of Care and Potentially Preventable Hospitalization

Published Date




Thesis or Dissertation


Hospitalizations are very common among nursing home (NH) residents. Unfortunately many of these are deemed inappropriate or preventable. There is great variation in rates of potentially preventable hospitalization (PPH) across NHs beyond what can be explained by resident heterogeneity. Little is known about how NH quality of care is related to hospitalization, especially PPH. The purpose of this study was to examine the relationship between available quality indicators (QIs) and hospitalization and PPH among Medicaid beneficiaries aged 65 years and older receiving care at NHs in Minnesota. Twenty three risk-adjusted QIs were used to assess NH quality of care. Quality indicators and other facility-level variables from the Minnesota Nursing Home Report Card were merged with resident level variables from the Minimum Data Set. This merged data was linked with Medicaid claims to obtain the hospitalization information during the 2011 to 2012 period. Adjusted analyses controlled for resident and facility characteristics using the Generalized Linear Mixed Model. The results showed that about 44% of hospitalizations were PPHs. Available QIs were not strongly or consistently associated with the risk of hospitalization (neither overall nor PPH). Among these 23 QIs, only 6 QIs were related to hospitalization or death and only 4 were related to PPH. Most QIs did not capture the aspects of quality that directly related to hospitalization. Quality indicators and hospitalizations may tap different aspects of NH quality. Quality reform efforts based on improving performance on QIs may fail to result in large-scale reductions in hospitalization.



University of Minnesota Ph.D. dissertation.July 2016. Major: Health Services Research, Policy and Administration. Advisor: Robert Kane. 1 computer file (PDF); v, 84 pages.

Related to




Series/Report Number

Funding information

Isbn identifier

Doi identifier

Previously Published Citation

Suggested citation

Xu, Dongjuan. (2016). The Relationship between Nursing Home Quality of Care and Potentially Preventable Hospitalization. Retrieved from the University Digital Conservancy,

Content distributed via the University Digital Conservancy may be subject to additional license and use restrictions applied by the depositor. By using these files, users agree to the Terms of Use. Materials in the UDC may contain content that is disturbing and/or harmful. For more information, please see our statement on harmful content in digital repositories.