​A new white paper named 250 quality measures that researchers believe to be associated with potentially preventable hospitalizations for the nation’s frail and elderly population, including such examples as “hospital admissions for diabetes” and for “chronic cardiac conditions.”

The quality measures are part of a paper titled, “Measurement of Potentially Preventable Hospitalizations,” written by Katie Maslow and Joseph Ouslander, MD, for the Long-Term Quality Alliance (LTQA) that was released and discussed at the LTQA annual meeting on Thursday.

Maslow is scholar-in-residence at the Institute of Medicine, National Academy of Sciences, and Ouslander is professor and senior associate dean for geriatric programs at the Charles E. Schmidt College of Medicine, Florida Atlantic University.

The paper is intended to provide information and recommendations to help the LTQA select quality measures and prioritize next steps to improve identification of potentially preventable hospitalizations in order to reduce these hospitalizations.

The 2010 Accountable Care Act (ACA) mandated many new programs that require measurement of potentially preventable hospitalizations.

The white paper listed six cross-cutting issues that emerged from the analysis of quality measures. These were the overlapping and highly detailed nature of the measures; the failure of the measures to account for medical comorbidities and clinical complexity; the failure of the measures to account for differences in the available resources for care in particular facilities and other care settings; lack of research to validate the measures for use with the frail and elderly; lack of attention to how and where decisions about hospitalization are made; and the extent of current and future efforts to reduce potentially preventable hospitalizations.

Ouslander, who spoke on a panel at the LTQA meeting facilitated by David Gifford, MD, senior vice president, quality and regulatory affairs for the American Health Care Association, says there are many important points included in the white paper, among them the very definitions being used to describe the issue. He notes that the National Quality Forum has called the rehospitalizations “avoidable,” while others use the term “unnecessary,” while the LTQA uses “preventable.”

Semantics aside, he says the issue is complicated by the fact it revolves around nursing home residents and other frail and elderly Americans who have complex medical problems and a complex system of care. “There are lots of different factors that are involved in a decision” on whether to send an elderly person or resident to the hospital, and not all of them are easy to understand, Ouslander says.

The system as it is now favors sending residents to the hospital, but there needs to be more education with resident families and residents on how that transition may actually do more harm than good, he says.

The white paper notes that hospitalization itself and complications that develop during hospital stays can cause additional morbidity, loss of functional abilities, and death, and some of the hospitalizations are preventable.

“The key is to have a good relationship with the people we take care of and good advance-care plans in place,” Ouslander says.

Read more on the white paper at www.ltqa.org.