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Potentially avoidable hospitalisations of German nursing home patients? A cross-sectional study on utilisation patterns and potential consequences for healthcare
  1. Rüdiger Leutgeb,
  2. Sarah Jane Berger,
  3. Joachim Szecsenyi,
  4. Gunter Laux
  1. Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
  1. Correspondence to Dr Rüdiger Leutgeb; ruediger.leutgeb{at}


Objectives Demand for nursing home (NH) care is soaring due to gains in life expectancy and people living longer with chronic illness and disability. This is dovetailing with workforce shortages across the healthcare profession. Access to timely and appropriate medical care for NH residents is becoming increasingly challenging and can result in potentially avoidable hospitalisations (PAHs). In light of these factors, we analysed PAHs comparing NH patients with non-NH patients.

Design Cross-sectional study with claims data from 2015 supplied by a large German health insurance company within the federal state of Baden-Wuerttemberg.

Setting One-year observation of hospitalisation patterns for NH and non-NH patients.

Participants 3 872 245 of the 10.5million inhabitants of Baden-Wuerttemberg were covered.

Methods Patient data about hospitalisation date, sex, age, nationality, level of care and diagnoses were available. PAHs were defined based on international classification of diseases (ICD-10) diagnoses belonging to ambulatory care sensitive conditions (ACSCs). Adjusted ORs for PAHs for NH patients in comparison with non-NH patients were calculated with multivariable regression models.

Results Of the 933 242 hospitalisations in 2015, there were 23 982 for 13 478 NH patients and 909 260 for 560 998 non-NH patients. Mean age of hospitalised NH patients and level of care were significantly higher than those of non-NH patients. 6449 PAHs (29.6%) for NH patients and 136 543 PAHs (15.02%) for non-NH patients were identified. The adjusted OR for PAHs was significantly heightened for NH patients in comparison with non-NH patients (OR: 1.22, CI (1.18 to 1.26), p<0.0001). Moreover, we could observe that more than 90% of PAHs with ACSCs were unplanned hospitalisations (UHs).

Conclusions Large numbers of PAHs for NH patients calls for improved coordination of medical care, especially general practitioner service provision. Introduction of targeted training programmes for physicians and NH staff on health problem management for NH patients could perhaps contribute to reduction of PAHs, predominantly UHs.

  • primary care
  • geriatric medicine
  • human resource management
  • quality in health care

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  • Patient consent for publication Not required.

  • Contributors GL, JS and RL initiated and designed the study. GL and RL coordinated the study. GL carried out data analysis. RL, SJB (native English speaker) and GL wrote the manuscript. All authors (RL, SJB, JS and GL) commented on the draft and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethical approval for the study was given by the University Hospital Heidelberg Ethics Committee (No. S-359/2013).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data used in this analysis are not in the public domain and use is covered by data sharing agreements with the AOK Baden-Wuerttemberg.

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