{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:53:44Z","timestamp":1790121224764,"version":"4.0.1"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,2,13]],"date-time":"2018-02-13T00:00:00Z","timestamp":1518480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005227","name":"Centers for Medicare and Medicaid Services","doi-asserted-by":"publisher","award":["1E1CMS331082\u201304\u201300"],"award-info":[{"award-number":["1E1CMS331082\u201304\u201300"]}],"id":[{"id":"10.13039\/100005227","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the relationship between nursing facility resident risk conditions and signs and symptoms at time of acute transfer and diagnosis of conditions associated with potentially avoidable acute transfers (pneumonia, urinary tract infection, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) or asthma, dehydration, pressure sores).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>As part of a demonstration project to reduce potentially avoidable hospital transfers, Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project clinical staff collected data on residents who transferred to the emergency department (ED) or hospital. Cross\u2010tabulations were used to identify associations between risk conditions or symptoms and hospital diagnoses or death. Mixed\u2010effects logistic regression models were used to describe the significance of risk conditions, signs, or symptoms as predictors of potentially avoidable hospital diagnoses or death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Indiana nursing facilities (N=19).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Long\u2010stay nursing facility residents (N=1,174), who experienced 1,931 acute transfers from November 2014 to July 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Participant symptoms, transfers, risk factors, and hospital diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We found that 44% of acute transfers were associated with 1 of 6 potentially avoidable diagnoses. Symptoms before transfer did not discriminate well among hospital diagnoses. Symptoms mapped into multiple diagnoses and most hospital diagnoses had multiple associated symptoms. For example, more than two\u2010thirds of acute transfers of residents with a history of CHF and COPD were for reasons other than exacerbations of those two conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although it is widely recognized that many transfers of nursing facility residents are potentially avoidable, determining \u201cavoidability\u201d at time of transfer is complex. Symptoms and risk conditions were only weakly predictive of hospital diagnoses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.15286","type":"journal-article","created":{"date-parts":[[2018,2,13]],"date-time":"2018-02-13T11:32:18Z","timestamp":1518521538000},"page":"895-901","source":"Crossref","is-referenced-by-count":39,"title":["The Complexity of Determining Whether a Nursing Home Transfer Is Avoidable at Time of Transfer"],"prefix":"10.1111","volume":"66","author":[{"given":"Kathleen T.","family":"Unroe","sequence":"first","affiliation":[{"name":"School of Medicine Department of Medicine, Indiana University Indianapolis Indiana"},{"name":"Regenstrief Institute Indiana University Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-4735","authenticated-orcid":false,"given":"Jennifer L.","family":"Carnahan","sequence":"additional","affiliation":[{"name":"School of Medicine Department of Medicine, Indiana University Indianapolis Indiana"},{"name":"Regenstrief Institute Indiana University Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Hickman","sequence":"additional","affiliation":[{"name":"School of Nursing Indiana University Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg A.","family":"Sachs","sequence":"additional","affiliation":[{"name":"School of Medicine Department of Medicine, Indiana University Indianapolis Indiana"},{"name":"Regenstrief Institute Indiana University Indianapolis Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Hass","sequence":"additional","affiliation":[{"name":"School of Nursing Purdue University West Lafayette Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Arling","sequence":"additional","affiliation":[{"name":"School of Nursing Purdue University West Lafayette Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2007.025957"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2009.0629"},{"key":"e_1_2_7_4_1","article-title":"Cost and predictors of hospitalizations for ambulatory care\u2010sensitive conditions among Medicaid enrollees in comprehensive managed care plans","volume":"3","author":"Mkanta WN","year":"2016","journal-title":"Health Serv Res Manag Epidemiol"},{"key":"e_1_2_7_5_1","volume-title":"Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring (OEI\u201006\u201311\u201300040)","author":"Office of Inspector General","year":"2013"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.1179"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12002"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.02768.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182984bff"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2012.03920.x"},{"key":"e_1_2_7_11_1","article-title":"Medicare\u2010Medicaid eligible beneficiaries and potentially avoidable hospitalizations. 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