Infections in nursing homes: assessing quality of care.

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Abstract
Background. Each year more than 25% of nursing home patients are taken to the hospital emergency room or hospitalized for the evaluation and treatment of infections. These transfers may have an adverse impact on the quality and the cost of patient care. Methods. Using both Medicare and Medicaid records from a sample of dually eligible elderly people in Ohio, we identified patients receiving antibiotic prescriptions in the nursing home and measured the frequency of nursing home physician visits and the hospital transfer rate. Results. Among the study sample (N = 1306), two thirds experienced a total of 3685 episodes of infections. Just under 5% of the sample were hospitalized as a result of the infection. In one third of the episodes, physicians saw the resident in person within 5 days (before or after) of the initiation of the medication. The hospital transfer rate was slightly higher (7% vs 3.5%) for those patients directly evaluated by a physician before receiving the prescription. Conclusions. A majority of prescriptions were written without direct physician examination, raising key questions about practice patterns and the effect on patient care and costs.