The Burden of Infection in Transfers from Nursing Homes to Hospitals

Abstract

Background: The focus on infection prevention in nursing homes is growing, but little is known about the role infections play in transfers from nursing home to hospital. Our goals were (1) to identify rates of infection-related transfers to the hospital and (2) to identify trends in these rates from 2011 to 2014. Methods: Using a nationally representative sample of 2,501 nursing homes (2011–2014), elderly resident data from the Minimum Data Set 3.0 were combined with CMS inpatient data (MedPAR). We classified transfers from nursing home to hospital as caused by infection (1) if infection was the primary diagnosis and present on admission (POA) or (2) if infection was indicated as the MedPAR admitting diagnosis code and POA. We classified all transfers, including those caused by infection, for which infection was POA in any of the 25 diagnosis codes as transfers with infection. Types of infection included respiratory, sepsis, urinary tract infection (UTI), and all (including ‘other’). Results: Table 1 shows the number of all-cause transfers and the percentage caused by infections. From 2011 to 2014, the rate of all-cause transfers declined from 0.479 to 0.396 per patient; infections were primarily responsible for ~1 in 3 transfers each year. The rate of transfers caused by sepsis increased by 37% from 2011 to 2014, and the rate for respiratory infections fell by 18%. More than half of all transfers from nursing home to hospital in each year had an infection POA. Although the percentage of transfers caused by any kind of infection increased by >7% during the period, the number of transfers per patient dropped by 17%. Conclusions: A large number of elderly nursing home residents are transferred to hospitals with infection each year. Many of these transitions may be avoidable with improved infection prevention and surveillance in nursing homes. Reduced infection rates would improve health and quality of life of nursing home residents and reduce infection-related inpatient costs.

Funding: None

Disclosures: None