Abstract
Objective
Monitoring body weight and signs and symptoms related to heart failure (HF) can alert
clinicians to a patient's worsening condition but the degree to which these practices
are performed in skilled nursing facilities (SNFs) is unknown. This study analyzed
the frequency of these monitoring practices in SNFs and explored associated factors
at both the patient and SNF level.
Design
An observational study of data from the usual care arm of the SNF Connect Trial, a
randomized cluster trial of a HF disease management intervention. The data extracted
from charts were combined with publicly available facility data. A linear regression
model was estimated to evaluate the frequency of HF disease management conditional
on patient and facility covariates.
Setting
Data from 28 SNFs in Colorado.
Participants
Patients discharged from hospital to SNFs with a primary or secondary diagnosis of
HF.
Measurements
Patient-level covariates included demographics, New York Heart Association class,
type of HF, and Charlson comorbidity index. Facility-level covariates were from Nursing
Home Compare.
Results
The sample (n = 320) was majority female (66%), white (93%), with mean age 80 ± 10 years
and a Charlson comorbidity index of 3.2 ± 1.5. Seventy percent had HF with preserved
ejection fraction, mean ejection fraction of 50 ± 16% and 40% with a New York Heart
Association class III-IV. On average, patients were weighed 40% of their days in the
SNF and had documentation of at least 1 HF-related sign or symptom 70% of their days
in the SNF. Patient-level factors were not associated with frequency of documenting
weight and assessments of HF-related signs/symptoms. Health Inspection Star Rating
was positively associated with weight monitoring (P < .05) but not associated with symptom assessment.
Conclusions and Implications
Patient-level factors are not meaningfully associated with the documentation of weight
tracking or sign/symptom assessment. Monitoring weight was instead associated with
the Health Inspection Star Rating.
Keywords
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Article info
Publication history
Published online: October 16, 2020
Footnotes
This project is made possible through grant NIH 5R01HL113387-02.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
