Abstract
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.
Keywords
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Article info
Publication history
Published online: March 27, 2021
Footnotes
This study was supported by grant 5R01HS024422-03 from the Agency for Healthcare Research and Quality. The Agency for Healthcare Research and Quality had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
The authors declare no conflicts of interest.
Identification
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© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
