The Association of Nursing Home Characteristics and Quality with Adverse Events After a Hospitalization
Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved..
BACKGROUND/OBJECTIVES: We previously found high rates of adverse events (AEs) for long-stay nursing home residents who return to the facility after a hospitalization. Further evidence about the association of AEs with aspects of the facilities and their quality may support quality improvement efforts directed at reducing risk.
DESIGN: Prospective cohort analysis.
SETTING AND PARTICIPANTS: 32 nursing homes in the New England states. A total of 555 long-stay residents contributed 762 returns from hospitalizations.
METHODS: We measured the association between AEs developing in the 45 days following discharge back to long-term care and characteristics of the nursing homes including bed size, ownership, 5-star quality ratings, registered nurse and nursing assistant hours, and the individual Centers for Medicare & Medicaid Services (CMS) quality indicators. We constructed Cox proportional hazards models controlling for individual resident characteristics that were previously found associated with AEs.
RESULTS: We found no association of AEs with most nursing home characteristics, including 5-star quality ratings and the composite quality score. Associations with individual quality indicators were inconsistent and frequently not monotonic. Several individual quality indicators were associated with AEs; the highest tertile of percentage of residents with depression (4%-25%) had a hazard ratio (HR) of 1.65 [95% confidence interval (CI) 1.16, 2.35] and the highest tertile of the percentage taking antipsychotic medications (18%-35%) had an HR of 1.58 (CI 1.13, 2.21). The percentage of residents needing increased assistance with activities of daily living was statistically significant but not monotonic; the middle tertile (13% to <20%) had an HR of 1.69 (CI 1.16, 2.47).
CONCLUSIONS AND IMPLICATIONS: AEs occurring during transitions between nursing homes and hospitals are not explained by the characteristics of the facilities or summary quality scores. Development of risk reduction approaches requires assessment of processes and quality beyond the current quality measures.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
|---|---|
| Enthalten in: |
Journal of the American Medical Directors Association - 22(2021), 10 vom: 27. Okt., Seite 2196-2200 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Field, Terry S [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Adverse events |
|---|
| Anmerkungen: |
Date Completed 20.10.2021 Date Revised 20.10.2021 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jamda.2021.02.027 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM323410367 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM323410367 | ||
| 003 | DE-627 | ||
| 005 | 20231225184122.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jamda.2021.02.027 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1077.xml |
| 035 | |a (DE-627)NLM323410367 | ||
| 035 | |a (NLM)33785310 | ||
| 035 | |a (PII)S1525-8610(21)00247-4 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Field, Terry S |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The Association of Nursing Home Characteristics and Quality with Adverse Events After a Hospitalization |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 20.10.2021 | ||
| 500 | |a Date Revised 20.10.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND/OBJECTIVES: We previously found high rates of adverse events (AEs) for long-stay nursing home residents who return to the facility after a hospitalization. Further evidence about the association of AEs with aspects of the facilities and their quality may support quality improvement efforts directed at reducing risk | ||
| 520 | |a DESIGN: Prospective cohort analysis | ||
| 520 | |a SETTING AND PARTICIPANTS: 32 nursing homes in the New England states. A total of 555 long-stay residents contributed 762 returns from hospitalizations | ||
| 520 | |a METHODS: We measured the association between AEs developing in the 45 days following discharge back to long-term care and characteristics of the nursing homes including bed size, ownership, 5-star quality ratings, registered nurse and nursing assistant hours, and the individual Centers for Medicare & Medicaid Services (CMS) quality indicators. We constructed Cox proportional hazards models controlling for individual resident characteristics that were previously found associated with AEs | ||
| 520 | |a RESULTS: We found no association of AEs with most nursing home characteristics, including 5-star quality ratings and the composite quality score. Associations with individual quality indicators were inconsistent and frequently not monotonic. Several individual quality indicators were associated with AEs; the highest tertile of percentage of residents with depression (4%-25%) had a hazard ratio (HR) of 1.65 [95% confidence interval (CI) 1.16, 2.35] and the highest tertile of the percentage taking antipsychotic medications (18%-35%) had an HR of 1.58 (CI 1.13, 2.21). The percentage of residents needing increased assistance with activities of daily living was statistically significant but not monotonic; the middle tertile (13% to <20%) had an HR of 1.69 (CI 1.16, 2.47) | ||
| 520 | |a CONCLUSIONS AND IMPLICATIONS: AEs occurring during transitions between nursing homes and hospitals are not explained by the characteristics of the facilities or summary quality scores. Development of risk reduction approaches requires assessment of processes and quality beyond the current quality measures | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, U.S. Gov't, P.H.S. | |
| 650 | 4 | |a Nursing homes | |
| 650 | 4 | |a adverse events | |
| 650 | 4 | |a hospitalization | |
| 650 | 4 | |a quality indicators | |
| 650 | 4 | |a transition of care | |
| 700 | 1 | |a Fouayzi, Hassan |e verfasserin |4 aut | |
| 700 | 1 | |a Crawford, Sybil |e verfasserin |4 aut | |
| 700 | 1 | |a Kapoor, Alok |e verfasserin |4 aut | |
| 700 | 1 | |a Saphirak, Cassandra |e verfasserin |4 aut | |
| 700 | 1 | |a Handler, Steven M |e verfasserin |4 aut | |
| 700 | 1 | |a Fisher, Kimberly |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, Florence |e verfasserin |4 aut | |
| 700 | 1 | |a Spenard, Ann |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Ning |e verfasserin |4 aut | |
| 700 | 1 | |a Gurwitz, Jerry H |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of the American Medical Directors Association |d 2000 |g 22(2021), 10 vom: 27. Okt., Seite 2196-2200 |w (DE-627)NLM125714041 |x 1538-9375 |7 nnns |
| 773 | 1 | 8 | |g volume:22 |g year:2021 |g number:10 |g day:27 |g month:10 |g pages:2196-2200 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jamda.2021.02.027 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 22 |j 2021 |e 10 |b 27 |c 10 |h 2196-2200 | ||