Patient Safety/Quality of Care

Residents are more likely to transfer out of nursing homes with low quality of care

The health of nursing home residents changes over time, sometimes making another nursing home—for example, one that specializes in rehabilitative therapies or that has Alzheimer's units—more appropriate. However, residents are also more likely to transfer out of nursing homes with low quality of care, finds a study by University of Michigan Researchers.

Consumer responsiveness to nursing home quality is encouraging. However, the 3 percent transfer rate shown in the study suggests that significant barriers to transfer exist, comments Richard A. Hirth, Ph.D. In the study supported by the Agency for Healthcare Research and Quality (HS10118), Dr. Hirth and his colleagues modeled the likelihood of transfer between nursing homes as a function of attributes of residents (clinical status and changes in functioning), nursing homes, and local nursing home markets among nursing home residents in Maine, Mississippi, New York, and Ohio.

Among 498,025 nursing home stays, the overall rate of transfers per year was 3.3 percent. Residents were more likely to leave lower quality homes, as indicated by both resident and facility level measures. For example, the relative risk (RR) of transferring increased for residents with a urinary tract infection (14.9 percent higher RR) and for residents for whom physical or chemical restraints were used (4.1 percent and 11.8 percent higher RR, respectively).

Worsening pressure ulcers were significantly associated with transfers in the non-Medicare population (5 percent higher RR per one-point increase in ulcer severity), an association not significant in the overall model. In the overall model, there was a 2.9 percent higher RR of transfer out of facilities with twice as many deficiencies as the State average (5.2 percent when restricted to non-Medicare residents). Staffing was not significant in the overall model but was significant among the non-Medicare subpopulation. Fewer of these residents transferred out of facilities with higher staffing levels. Changing care needs were generally associated with a greater likelihood of transfer, but the magnitude of the effect was fairly small.

See "Does quality influence consumer choice of nursing homes? Evidence from nursing home to nursing home transfers," by Dr. Hirth, Jane C. Banaszak-Holl, Ph.D., Brant E. Fries, Ph.D., and Marc N. Turenne, Ph.D., in the Winter 2003/2004 Inquiry 40, pp. 343-361.

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