Analysis of Functional Recovery in Older Adults Discharged to Skilled Nursing Facilities and Then Home

Shi, Sandra; Olivieri‐Mui, Brianne; Oh, Gahee; McCarthy, Ellen P.; Kim, Dae Hyun

doi:10.1001/jamanetworkopen.2022.25452

Cited by 12 publications

(8 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 [2][3][4] 3 [2][3][4] 0.952 28-day Hospital-free days ‡ 24 [22][23][24][25][26] 25 [23][24][25][26] 24 [23][24][25][26] 24 [21][22][23][24][25][26] 23 [21][22][23][24][25] 23 [20][21][22][23][24][25] 24 [20][21][22][23][24][25] <0.001…”

Section: Discussionmentioning

confidence: 99%

“…28-day ICU-free days § 25 [24][25][26] 24 [25][26] 25 [23][24][25][26] 25 [23][24][25][26] 25 [24][25][26] 25 [23][24][25][26] 25 [24][25][26] 0.952 28-day Ventilator-free days ¶ 24 [21][22][23][24][25][26] 23 [20][21][22][23][24][25] 21 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] 22 [11]…”

Section: Discussionmentioning

confidence: 99%

“…We reported an increased risk of unfavorable discharge with increasing frailty scores. It has been shown previously that frail patients are at high risk of unfavorable discharge and that discharge to SNF/rehab is associated with worse outcomes 21–23 . Although these facilities are designed to accelerate the return to baseline functionality in older adult patients, they are not without complications 24–26 .…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown previously that frail patients are at high risk of unfavorable discharge and that discharge to SNF/rehab is associated with worse outcomes. [21][22][23] Although these facilities are designed to accelerate the return to baseline functionality in older adult patients, they are not without complications. [24][25][26] Social isolation, unfamiliarity with the new environment, increasing dependency, and decreasing motivation are some of the many factors that can affect the overall outcomes of patients discharged to these facilities.…”

Section: <0001mentioning

confidence: 99%

See 3 more Smart Citations

It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients

Alizai,

Colosimo,

Hosseinpour

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

Background Frailty is associated with poor outcomes in trauma patients. However, the spectrum of physiologic deficits, once a patient is identified as frail, is unknown. The aim of this study was to assess the dynamic association between increasing frailty and outcomes among frail geriatric trauma patients. Methods This is a secondary analysis of the American Association of Surgery for Trauma Frailty Multi-institutional Trial. Patients ≥65 years presenting to one of the 17 trauma centers over 3 years (2019-2022) were included. Frailty was assessed within 24 hours of presentation using the trauma-specific frailty index (TSFI) questionnaire. Patients were stratified by TSFI score into six groups: non-frail (<0.12), Grade I (0.12-0.19), Grade II (0.20-0.29), Grade III (0.30-0.39), Grade IV (0.40-0.49), and Grade V (0.50-1). Our Outcomes included in-hospital and 3-month post-discharge mortality, major complications, readmissions, and fall recurrence. Multivariable regression analyses were performed. Results 1,321 patients were identified. The mean (SD) age was 77 (8.6) years and 49% were males. Median [IQR] ISS was 9[5-13] and 69% presented after a low-level fall. Overall, 14% developed major complications and 5% died during the index admission. Among survivors, 1,116 patients had a complete follow-up, 16% were readmitted within 3 months, 6% had a fall recurrence, 7% had a complication, and 2% died within 3 months post-discharge. On multivariable regression, every 0.1 increase in the TSFI score was independently associated with higher odds of index-admission mortality and major complications, and 3 months post-discharge mortality, readmissions, major complications, and fall recurrence. Conclusions The frailty syndrome goes beyond a binary stratification of patients into Non-Frail and Frail and should be considered as a spectrum of increasing vulnerability to poor outcomes. Frailty scoring can be used in developing guidelines, patient management, prognostication, and care discussions with patients and their families. Level of Evidence Level III, Prognostic and Epidemiological

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: <0001mentioning

confidence: 99%

See 2 more Smart Citations

It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients

Alizai,

Colosimo,

Hosseinpour

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Differences between unadjusted and adjusted functional outcomes reinforce the importance of accounting for a healthier MA population, including incorporating function and a comprehensive set of personal and community factors that are associated with outcomes. 11 , 53 , 54 , 55 …”

Section: Discussionmentioning

confidence: 99%

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Prusynski,

D’Alonzo,

Johnson

et al. 2024

JAMA Health Forum

View full text Add to dashboard Cite

ImportancePrivate Medicare Advantage (MA) plans recently surpassed traditional Medicare (TM) in enrollment. However, MA plans are facing scrutiny for burdensome prior authorization and potential rationing of care, including home health. MA beneficiaries are less likely to receive home health, but recent evidence on differences in service intensity and outcomes among home health patients is lacking.ObjectiveTo examine differences in home health service intensity and patient outcomes between MA and TM.Design, Setting, and ParticipantsThis cross-sectional study was conducted from January 2019 to December 2022 in 102 home health locations in 19 states and included 178 195 TM and 107 102 MA patients 65 years or older with 2 or fewer 60-day home health episodes. It included a secondary analysis of standardized assessment and visit data. Inverse probability of treatment weighting regression compared service intensity and patient outcomes between MA and TM episodes, accounting for differences in demographic characteristics, medical complexity, functional and cognitive impairments, social environment, caregiver support, and local community factors. Models included office location, year, and reimbursement policy fixed effects. Data were analyzed between September 2023 and July 2024ExposureTM vs MA plan.Main Outcomes and MeasuresHome health length of stay and number of visits from nursing, physical, occupational, and speech therapy, social work, and home health aides. Patient outcomes included improvement in self-care and mobility function, discharge to the community, and transfer to an inpatient facility during home health.ResultsOf 285 297 total patients, 180 283 (63.2%) were female; 586 (0.2%) were American Indian/Alaska Native, 8957 (3.1%) Asian, 28 694 (10.1%) Black, 7406 (2.6%) Hispanic, 1959 (0.7%) Native Hawaiian/Pacific Islander, 237 017 (83.1%) non-Hispanic White, and 678 (0.2%) multiracial individuals. MA patients had shorter home health length of stay by 1.62 days (95% CI, −1.82 to 1.42) and received fewer visits from all disciplines except social work. There were no differences in inpatient transfers. MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively (mobility odds ratio [OR], 0.97; 95% CI, 0.94-0.99; self-care OR, 0.96; 95% CI, 0.92-0.99). MA patients were 5% more likely to discharge to the community compared with TM (OR, 1.05; 95% CI, 1.01-1.08).Conclusions and RelevanceThe results of this cross-sectional study suggest that MA patients receive shorter and less intensive home health care vs TM patients with similar needs. Differences may be due to the administrative burden and cost-limiting incentives of MA plans. MA patients experienced slightly worse functional outcomes but were more likely to discharge to the community, which may have negative implications for MA patients, including reduced functional independence or increased caregiver burden.

show abstract

Decision support framework for home health caregiver allocation using optimally tuned spectral clustering and genetic algorithm

Sharifnia,

Bagheri,

Sawhney

et al. 2024

Healthcare Analytics

View full text Add to dashboard Cite

Analysis of Functional Recovery in Older Adults Discharged to Skilled Nursing Facilities and Then Home

Abstract: This cohort study investigates functional recovery by frailty status among older adults discharged from hospitalization to skilled nursing facilities and then home.

Cited by 12 publications

References 49 publications

It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients

It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Decision support framework for home health caregiver allocation using optimally tuned spectral clustering and genetic algorithm

Contact Info

Product

Resources

About