Objective
To examine the association between the prevalence of delirium among patients admitted
to postacute care and the quality of nursing home care as reflected in deficiency
counts.
Design
Analysis of screening data from a randomized controlled trial (RCT) of a delirium
abatement program.
Setting and Participants
We screened 4744 of 6352 RCT-eligible persons admitted to 1 of 8 skilled nursing facilities
in the Boston area over a 3-year period. Quality of care was operationalized with
the count of deficiencies noted by state surveyors.
Measurements
Prevalence of Confusion Assessment Method (CAM) diagnoses of delirium as completed
by trained research interviewers at each facility.
Results
About 1 in 7 persons admitted to postacute care met CAM criteria for delirium, but
this varied from 1 in 15 to 1 in 4 across facilities. The correlation of deficiency
count per 100 beds and the prevalence of CAM delirium was strong (r=0.45) and significant (95% Confidence interval =0.07, 0.71).
Conclusion
Although this study is limited by small sample size, limited geographic scope, and
crude assessment of quality with deficiency counts, we have found that facilities
with more deficiencies admit more persons that satisfy CAM criteria for delirium.
It is possible that good facilities often choose to admit and/or are referred good
candidates for rehabilitation, whereas facilities with more deficiencies are not able
to be so selective. The end result may be that delirious patients are being preferentially
admitted to poorer quality facilities, increasing their likelihood of poor postacute
outcomes.
Keywords
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References
- Delirium in older persons.N Engl J Med. 2006; 354: 1157-1165
- The course of delirium in older medical inpatients: a prospective study.J Gen Intern Med. 2003; 18: 696-704
- A Data Book: Healthcare Spending and the Medicare Program.MEDPAC, Washington DC2005
- Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery.J Am Geriatr Soc. 2003; 51: 4-9
- Delirium: A symptom of how hospital care is failing older persons and a window to improve quality of hospital care.Am J Med. 1999; 106: 565-573
Centers for Medicare and Medicaid Services. Nursing Home Compare. April 23, 2008. Available at: http://www.medicare.gov/NHCompare/Static/Reated/DataCollection.asp. Accessed July 25, 2008.
- Wunderlich G. Kohler P. Institute of Medicine (US) Committee on Improving Quality in Long-Term Care. Improving the Quality of Long-Term Care. National Academy Press, Washington DC2001
- A model for management of delirious postacute care patients.J Am Geriatr Soc. 2005; 53: 1817-1825
- Association between delirium resolution and functional recovery among newly admitted post-acute facility patients.J Gerontol A Biol Sci Med Sci. 2006; 61A: 204-208
- Outcomes of elders admitted to post-acute facilities with delirium.J Am Geriatr Soc. 2005; 53: 963-969
- Characteristics associated with delirium persistence among newly admitted post-acute facility patients.J Gerontol A Biol Sci Med Sci. 2004; 59: M344-M349
- Delirium among newly admitted postacute facility patients: Prevalence, symptoms, and severity.J Gerontol A Biol Sci Med Sci. 2003; 58: M441-M445
- Clarifying confusion: The confusion assessment method. A new method for detection of delirium.Ann Intern Med. 1990; 113: 941-948
- Reliability of a structured assessment for non-clinicians to detect delirium among new admissions to post-acute care.J Am Med Dir Assoc. 2006; 7: 412-415
- Delirium in hospitalized older patients: Recognition and risk factors.J Geriatr Psychiatry Neurol. 1998; 11 (discussion 157–118): 118-125
- Trends in Nursing Home Deficiencies and Complaints.Department of Health and Human Services, Office of the Inspector General, Washington, DC2008
- Statistical Estimates and Transformed Beta Variables.John Wiley & Sons, Inc, New York1958
- Mplus Users Guide.Version 5. Muthén & Muthén, Los Angeles, CA1998–2007
- Improving detection of delirium among new admissions to post-acute facilities: A randomized controlled trial.J Am Geriatr Soc. 2005; 53: S5
- Need we do so badly in managing delirium in elderly patients?.Age Ageing. 2003; 32: 473-474
- The association between delirium resolution and functional recovery among newly admitted post-acute facility patients.J Gerontol A Biol Sci Med Sci. 2006; 61A: 204-208
- A multicomponent intervention to prevent delirium in hospitalized older patients.N Engl J Med. 1999; 340: 669-676
- Reducing delirium after hip fracture: A randomized trial.J Am Geriatr Soc. 2001; 49: 516-522
Article info
Publication history
Published online: March 08, 2010
Footnotes
The Trial to Reduce Delirium in Aged Post Acute Patients is registered at www.clinicaltrials.gov (NCT00182936) and is no longer accepting participants.
Funded in part by grants from the National Institute on Aging, R01AG17649 and P60AG008812. E.R.M. is a Paul Beeson Physician Faculty Scholar in Aging Research. The research was completed independent of influence from the funding sources. All authors had full access to all of the data in the study. R.N.J. and E.R.M. take responsibility for the integrity of the data and the accuracy of the data analysis.
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Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
