Factors associated with ambulatory care—Sensitive hospitalizations among nursing home residents

Objectives: This study examined patient-level, facility-level, and area market–level factors affecting ambulatory care–sensitive hospitalization (ACSH) rates among nursing home residents. Although ACSH has long been used to monitor accessibility to health care services among community-dwelling populations, the use of ACSH rates as an indicator of potential quality-of-care problems affecting nursing home res-idents has not been employed. Methods: Three years of quarterly Medicaid reim-bursement data from more than 500 nursing homes were linked to 4 years of Medicare Provider Analysis and Review hospital claims data, nursing facility attribute data, and Area Resource File data to investigate the relative contribution of patient-, facility-, and market-level risk factors to ACSH among nursing home residents.Results: Logis-tic regression results indicate that facility-level factors and nursing home quality-of-care indicators significantly contribute to the risk of ACSH. Discussion: Findings underscore the need for continuing efforts to improve quality-of-care practices in nursing homes, particularly with respect to associations between quality-of-care indi-cators and facility structural/organizational characteristics with ACSHs