Avoiding Hospitalizations From Nursing Homes for Potentially Burdensome Care: Results of a Qualitative Study | Geriatrics | JAMA Internal Medicine | JAMA Network
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Research Letter
Less Is More
January 2017

Avoiding Hospitalizations From Nursing Homes for Potentially Burdensome Care: Results of a Qualitative Study

Author Affiliations
  • 1Department of Medicine, Yale School of Medicine, New Haven, Connecticut
  • 2Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, Connecticut
  • 3Clinical Epidemiology Research Center, VA Connecticut Health System, West Haven
JAMA Intern Med. 2017;177(1):137-139. doi:10.1001/jamainternmed.2016.7128

Nursing home residents are often hospitalized for care that has the potential to be burdensome, in the sense that the risks outweigh the expected benefits.1 These hospitalizations offer little hope of improving quality of life or changing the course of illness and usually involve residents close to death who are vulnerable to iatrogenic harms. Certain facilities are more successful than others at preventing potentially burdensome hospitalizations. The reasons for their success, however, are poorly understood. We sought to explore the causes of these transfers and identify practices that help facilities avoid them.

We conducted a qualitative study involving Connecticut nursing homes with hospitalization rates in the top or bottom 10% from 2008 to 2010. We identified facilities using publicly available data (http://www.ltcfocus.org) and conducted in-depth, semistructured interviews with key staff members, using a standard interview guide, until theoretical saturation was reached; this occurred after the eighth facility visit and 31 interviews. Transcripts were analyzed according to the principles of grounded theory, using the constant comparative method.2

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