Abstract
Objective
The quality of care provided by the US Department of Veterans Affairs (VA) is increasingly
being compared to community providers. The objective of this study was to compare
the VA Community Living Centers (CLCs) to nursing homes in the community (NHs) in
terms of characteristics of their post-acute populations and performance on 3 claims-based
(“short-stay”) quality measures.
Design
Observational, cross-sectional.
Setting and Participants
CLC and NH residents admitted from hospitals during July 2015–June 2016.
Methods
CLC residents were compared with 3 NH populations: males, Veterans, and all NH residents.
CLC and NH performance was compared on risk-adjusted claims-based measures: unplanned
rehospitalizations and emergency department visits within 30 days of CLC or NH admission
and successful discharge to the community within 100 days of NH admission.
Results
Veterans admitted from hospitals to CLCs (n = 23,839 Veterans/135 CLCs) were less
physically impaired, less likely to have anxiety, congestive heart failure, hypertension,
and dementia than Veterans (n = 241,177/14,818 NHs), males (n = 661,872/15,280 NHs),
and all residents (n = 1,674,578/15,395 NHs) admitted to NHs from hospitals. Emergency
department and successful discharge risk-adjusted rates of CLCs were statistically
significantly better than those of NHs [mean (standard deviation): 8.3% (4.6%) and
67.7% (11.5%) in CLCs vs 11.9% (5.3%) and 57.0% (10.5%) in NHs, respectively]. CLCs
had slightly worse rehospitalization rates [22.5% (6.2%) in CLCs vs 21.1% (5.9%) in
NHs], but lower combined emergency department and rehospitalization rates [30.8% (0.8%)
in CLCs vs 33.0% (0.7%) in NHs].
Conclusions and Implications
CLCs and NHs serve different post-acute care populations. Using the same risk-adjusted
NH quality metrics, CLCs provided better post-acute care than community NHs.
Keywords
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Article info
Publication history
Published online: November 02, 2021
Footnotes
The work on this project was conducted for quality improvement purposes for the VA Central Offices Geriatrics & Extended Care (GEC) and Improvement & Analytics. GEC partially supported Orna Intrator, Rajesh Makineni, and Winifred Scott. Dr O'Hanlon was supported by the Office of Academic Affiliations in the Department of Veterans Affairs (VA) through the Advanced Fellowship Program in Health Services Research. The views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The work presented in this article was performed under Operational Authority for quality improvement.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
