Vulnerable populations at risk of potentially avoidable hospitalizations: the case of nursing home residents with Alzheimer's disease.

This study explores whether nursing home residents with Alzheimer's disease and related dementias (ADRD) are affected differently by facility-level risk factors of ambulatory care-sensitive (ACS) conditions, a measure of timely access to medical care. Three years of quarterly Medicaid reimbursement data from over 525 Massachusetts nursing homes were linked with four years of Medical Provider Analysis and Review hospital claims data and facility-level attribute data to investigate whether facility effects differed by resident ADRD status. The findings suggest that nursing home residents with ADRD are more likely to be hospitalized for certain ACS conditions, including gastroenteritis and kidney/ urinary tract infections. Availability of increased registered nurse staffing levels and on-site nurse practitioners appears to attenuate this risk. Although findings suggest that ACS hospitalization measures may represent a useful approach to monitoring nursing home care, additional effort is needed to understand the extent to which severity of illness and/or comorbidities affect the measurement of these hospitalizations.