Selecting long-term care facilities with high use of acute hospitalisations: issues and options

摘要: Background: This paper considers approaches to the question “Which long-term care facilities have residents with high use of acute hospitalisations?” It compares four methods identifying hospitalisations by demonstrating selection methods, identifies key factors be resolved when deciding which employ, and discusses their appropriateness for different research questions. Methods: OPAL was a census-type survey aged in Auckland, New Zealand, 2008. collected information about facility management resident demographics, needs care. Survey records (149 facilities, 6271 residents) were linked hospital mortality routinely assembled health authorities. The main ranking endpoint diagnoses that classified as potentially avoidable. Facilities ranked using 1) simple event counts per person, 2) rates year follow-up, 3) statistical model predictors, 4) change ranks between 3). A generalized mixed used Method 3 handle clustered nature data. Results: 3048 avoidable observed during 22 months’ follow-up. same “top ten” selected Methods 1 2. (Method 3), predicting from characteristics, differently than these two methods. change-in-ranks method identified very set facilities. All showed continuum use, no clear distinction higher use. Conclusion: Choice should depend upon purpose selection. To monitor performance period change, recent rate, count resident, or even bed, may suffice. find high–use regardless needs, history admissions is highly predictive. target few high-use after considering residuals large increase rank preferable.