The Long-Term Care Patients Who Are at Highest Risk for Hospitalization

By Jane Farrell

Long-term services and supports are provided to 12 million people who live in nursing home and assisted living facilities, as well as their own homes. Within that group, New York University researchers found, people who have a high probability of suffering from cardiopulmonary disease are hospitalized more often than people with other kinds of conditions.

The study was published in Nursing Research. NYU Rory Meyers College of Nursing (NYU Meyers) Assistant Professor Janet H. Van Cleave, PhD, RN and her study team found that persons with a high probability of being in the “cardiopulmonary” class had statistically greater number of hospitalizations compared to persons with high probability of being in the “all other conditions” class.

The researchers also found that persons most likely to be in the “cardiopulmonary class” or “cerebrovascular/paralysis class” were more likely to be male, Black/Other race, and reside in a nursing home. Medicaid patients were overrepresented in the “cardiopulmonary class” compared to the “cerebrovascular disease/paralysis class” or the “all other conditions class.”

The investigators concluded that effective care management strategies are needed for early identification and intervention to prevent hospitalizations in chronically ill older adults, especially those with multiple cardiopulmonary conditions. These strategies include the use of sophisticated analyses for early identification and intervention in populations at risk for hospitalization. Interventions that need further exploration include prevention and management of transitional care from hospital to residences.

“Ultimately, new care management strategies are needed to meet the desires and needs of persons living with multiple chronic conditions that limit their capacity for self-care,” Van Cleave said.