Postacute care outcomes in home health or skilled nursing facilities in patients with a diagnosis of dementia

Burke, Robert E.; Xu, Yao; Ritter, Ashley Z.; Werner, Rachel M.

doi:10.1111/1475-6773.13855

Cited by 16 publications

(17 citation statements)

References 39 publications

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“…Furthermore, our model does not account for a growing emphasis on PAC which can be delivered in a home-based setting. (25,26) Finally, our model is parsimonious and does not include alternative variables that could predict discharge destination (e.g., social determinants of health).…”

Section: Discussionmentioning

confidence: 99%

“…Given the imbalanced ratio of discharges to PAC relative to discharges to home, a random undersampling approach was applied to the derivation cohort for developing the best t model without introducing bias into the covariates' parameter estimates. 25,26 The parameter estimates, odds ratios, and their con dence intervals of covariates are unaffected by the strati ed sampling methods, while the intercept parameter estimate is the only part in the model that is affected by the resampling.…”

Section: Discussionmentioning

confidence: 99%

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Using Phenotypic Data from the Electronic Health Record (EHR) to Predict Discharge Destination: A Predictive Model based on A Single-Center Retrospective Cohort

Bhatia

Wanderer

et al. 2022

Preprint

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Background: Timely discharge to post-acute care (PAC) settings, such as skilled nursing facilities, requires early identification of eligible patients. We sought to develop and internally validate a model which predicts a patient’s likelihood of requiring PAC based on information obtained in the first 24 hours of hospitalization. Methods: This was a retrospective observational cohort study. We collected clinical data and commonly used nursing assessments from the electronic health record (EHR) for all adult inpatient admissions at our academic tertiary care center from September 1, 2017 to August 1, 2018 We performed a multivariable logistic regression to derive the model from the derivation cohort of the available records. A secondary analysis was then conducted to evaluate the capability of the model to predict discharge destination on an internal validation cohort. Results: Age (adjusted odds ratio (AOR), 1.04 [per year]; 95% Confidence Interval (CI), 1.03 to 1.04), admission to the intensive care unit (AOR, 1.51; 95% CI, 1.27 to 1.79), admission from the emergency department (AOR, 1.53; 95% CI, 1.31 to 1.78), taking more home medications (AOR, 1.06 [per medication count increase]; 95% CI 1.05 to 1.07), and higher Morse fall risk scores at admission (AOR, 1.03 [per unit increase]; 95% CI 1.02 to 1.03) were independently associated with higher likelihood of being discharged to PAC facility. The c-statistic of the model derived from the primary analysis was 0.875, and the model predicted the correct discharge destination in 81.2% of the validation cases. Conclusions: A model that utilizes clinical factors and risk assessments has excellent model performance in predicting discharge to a PAC facility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Using Phenotypic Data from the Electronic Health Record (EHR) to Predict Discharge Destination: A Predictive Model based on A Single-Center Retrospective Cohort

Bhatia

Wanderer

et al. 2022

Preprint

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“…Following prior studies, PAC transitions were identified for each index hospitalization using hospital discharge status code from MedPAR. 2,12 Our focus was on transitions to SNF (including inpatient rehabilitation facilities) and home with and without HHC.…”

Section: Post-acute Care Transitionmentioning

confidence: 99%

“…Care transitions among older adults with ADRD are of particular interest because some care settings, such as SNF, are higher-cost, but may not necessarily produce better outcomes. In fact, Burke et al, 12 have suggested similar 30-day readmission and mortality outcomes for dementia patients who transitioned to HHC or SNF. Persons with dementia may be particularly at risk of experiencing preventable or unnecessary care transitions, 13 which may be further exacerbated among racial and ethnic minorities.…”

Section: Introductionmentioning

confidence: 96%

Post‐acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status

Temkin‐Greener

Yan

Cai

2022

Health Services Research

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Objective To evaluate how post‐acute care (PAC) transitions affect minority older adults with Alzheimer's disease or related dementia (ADRD), and the extent to which dual Medicare‐Medicaid eligibility may attenuate or exacerbate disparities in PAC outcomes. We examined: (1) PAC referrals by race/ethnicity and dual status; (2) individual, hospital, and market‐level factors associated with PAC; (3) the association between PAC and outcomes. Data Sources/Study Setting We used the following secondary data: Master Beneficiary Summary File (MBSF), Medicare Provider Analysis and Review (MedPAR), Minimum Data Set (MDS), Area Health Resource File (AHRF), hospital Provider of Services (POS) file, and the area deprivation index (ADI). Study Design This observational study consisted of 619,262 community‐residing Medicare fee‐for‐service (FFS) beneficiaries with ADRD who had a hospital stay in 2017. Data Collection/Extraction Methods PAC discharge was to skilled nursing facilities (SNF), home health care (HHC) agencies or home without services. Outcomes were 30‐day readmission and death. Multinomial logistic regressions with hospital random effects (RE), stratified by dual eligibility, were fit. Principal Findings Dual‐related differences were significantly larger than race/ethnicity differences in PAC transitions. For example, the difference in the probability of SNF transitions between White and Black patients was 3.2% and 6.8%‐points for non‐duals and duals, respectively. The difference between non‐dual/dual White patients was 21.6% points, and among Black patients 18.0%‐points. The adjusted risk of 30‐day readmission was 5.6 percentage point higher among non‐duals discharged to SNF, compared to home, but such risk among duals was not statistically significantly different. The adjusted probabilities of 30‐day mortality were larger for duals and non‐duals who transitioned to SNF, compared to those discharged home. Conclusions PAC referrals and the resulting outcomes for Medicare beneficiaries with ADRD are associated with multi‐level variables that need to be incorporated in discharge decision making.

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“…In 2020, about 3.1 million homebound Medicare beneficiaries received HHC, which provides skilled nursing, therapy, social work, and aide services. 1 Although the HHC setting is focused on rehabilitative goals of care, 1,2 the acuity of HHC patients has increased markedly in recent years. 1 Indeed, growing evidence shows that HHC patients experience burdensome transitions, even at the end-of-life (EoL).…”

Section: Introductionmentioning

confidence: 99%

“The Crossover to Hospice”: Perspectives of Home Healthcare Nurses and Social Workers

Osakwe

Oni-Eseleh

Rosati

et al. 2022

Am J Hosp Palliat Care

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Background: Although home healthcare(HHC) clinicians increasingly provide care to a homebound population with advanced illness and high symptom burden, we know little about how HHC clinicians navigate discussions about hospice with patients and families in this setting. Objective We sought to explore perspectives on transition from HHC to hospice among HHC nurses and social workers. Design PQualitative study using semi-structured interviews and thematic analysis. Results: Fifteen nurses and 3 Social workers participated in the study. Four main themes emerged from the interviews: (1) Regulatory Forces of Hospice and HHC; (2) Structure of HHC; (3) Individual beliefs—Hospice means giving up; and (4) Dynamics of Communication in HHC to Facilitate Transitions to Hospice. Conclusion Introducing the option of hospice to patients and families nearing end-of-life in the HHC setting is complex and challenging. Facilitators of hospice discussions in the HHC setting include interdisciplinary team-based clinical review, clinical decision support tools to identify patients who are hospice-eligible, and staff training. These factors provide targets for future interventions.

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Postacute care outcomes in home health or skilled nursing facilities in patients with a diagnosis of dementia

Abstract: Objective: To compare the outcomes of postacute care between home health (HH) and skilled nursing facilities (SNFs) following hospitalization among Medicare beneficiaries with a diagnosis of dementia.

Cited by 16 publications

References 39 publications

Using Phenotypic Data from the Electronic Health Record (EHR) to Predict Discharge Destination: A Predictive Model based on A Single-Center Retrospective Cohort

Using Phenotypic Data from the Electronic Health Record (EHR) to Predict Discharge Destination: A Predictive Model based on A Single-Center Retrospective Cohort

Post‐acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status

“The Crossover to Hospice”: Perspectives of Home Healthcare Nurses and Social Workers

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