Table 2.
Clinical Characteristics by Clusters. Consequently, Cluster 1 is characterized by the combination of risk factors associated with “impaired physical comfort with pain,” Cluster 2 by the combination of risk factors associated with “high comorbidity burden,” and Cluster 3 by the combination of risk factors associated with “impaired cognitive/psychological and skin integrity.” We conducted analysis of variance (ANOVA) tests to examine the differences in clinical characteristics between each cluster (all p-values < 0.05).
| Cluster 1 (N = 37,678) | Cluster 2 (N = 30,999) | Cluster 3 (N = 10,402) | |
|---|---|---|---|
| Hospitalization or ED visits [n, (%)] | 3,032 (8%) | 4,521 (14.6%) | 1,629 (15.7%) |
| Length of episode [mean: days, (SD)] | 28.3 (14.3) | 35.1 (14.6) | 33.8 (15.2) |
| Structured data (OASIS Item): Socio-demographic factor | |||
| Age [mean: years, (SD)] | 73.9 (11.2) | 82.9 (9.91) | 85.1 (10.8) *** |
| Gender: Female [n, (%)] | 21,706 (57.6%) | 21,869 (70.5%) ** | 7,013 (67.4%) |
| Race/Ethnicity: Black [n, (%)] | 6,455 (17.1%) | 5,595 (18.0%) ** | 1,647 (15.8%) |
| Race/Ethnicity: Hispanic [n, (%)] | 4,519 (12.0%) | 4,251 (13.7%) | 1,735 (16.7%) *** |
| Race/Ethnicity: White [n, (%)] | 24,777 (65.8%) * | 19,185 (61.9%) | 6,220 (59.8%) |
| Living Condition: Living alone [n, (%)] | 14,467 (38.4%) | 13,606 (43.9%) ** | 2,505 (24.1%) |
| Structured data (OASIS Item): Medical conditions - Active diagnoses [n, (%)] | |||
| Acute myocardial infarction | 6,049 (16.1%) | 7,018 (22.6%) ** | 1,508 (14.5%) |
| Arthritis | 12,102 (32.1%) * | 5,660 (18.3%) | 1,479 (14.2%) |
| Cardiac dysrhythmias | 4,293 (11.4%) | 6,550 (21.1%) ** | 1,378 (13.2%) |
| Diabetes | 9,463 (25.1%) | 10,511 (33.9%) ** | 2,772 (26.6%) |
| Dementia | 1,070 (2.8%) | 3,448 (11.1%) | 5,712 (54.9%) *** |
| Heart failure | 2,642 (7.01%) | 7,271 (23.5%) ** | 1,304 (12.5%) |
| Pulmonary disease | 4,795 (12.7%) | 6,342 (20.5%) ** | 938 (9.02%) |
| Skin ulcer | 1,688 (4.48%) | 3,886 (12.5%) | 2,844 (27.3%) *** |
| Structured data (OASIS Item): Prior medical conditions in the past 14 days [n, (%)] | |||
| Urinary incontinent | 4,818 (12.8%) | 23,523 (75.9%) | 8,898 (85.5%) *** |
| Urinary tract infection | 1,329 (3.5%) | 11,821 (38.1%) | 5,135 (49.4%) *** |
| Impaired decision-making | 654 (1.74%) | 1,914 (6.17%) | 4,582 (44.0%) *** |
| Structured data (OASIS Item): Risk factors that may affect current health status [n, (%)] | |||
| Obesity | 4,687 (12.4%) | 4,948 (16%) ** | 790 (7.6%) |
| Structured data (OASIS Item): Risk for Hospitalization [n, (%)] | |||
| History of falls in the past 12 months | 5,013 (13.3%) | 9,252 (29.8%) ** | 2,726 (26.2%) |
| Multiple hospitalizations in the past 6 months | 7,013 (18.6%) | 9,686 (31.2%) ** | 2,613 (25.1%) |
| Currently taking 5 or more medications | 28,684 (76.1%) | 26,020 (83.9%) ** | 8,102 (77.9%) |
| Decline in mental, emotional, or behavioral status in the past 3 months | 1,837 (4.9%) | 4,994 (16.1%) | 4,705 (45.2%) *** |
| Structured data (OASIS Item): Sensory Status [n, (%)] | |||
| Vision impaired | 3,415 (9.1%) | 8,307 (26.8%) | 3,725 (35.8%) *** |
| Hearing impaired | 2,523 (6.7%) | 11,318 (36.5%) | 4,771 (45.9%) *** |
| Difficulty in understanding verbal content | 2,832 (7.5%) | 12,647 (40.8%) | 7,308 (70.3%) *** |
| Difficulty in verbal expression | 3,451 (9.2%) | 11,360 (36.7%) | 9,337 (89.8%) *** |
| Having Pain | 30,274 (80.4%) * | 23,976 (77.3%) | 6,454 (62%) |
| Structured data (OASIS Item): Integumentary Status [n, (%)] | |||
| Having a risk of developing pressure ulcers | 5,263 (14.0%) | 17,933 (57.9%) | 8,123 (78.1%) *** |
| Having surgical wounds | 18,573 (49.3%) * | 2,718 (8.8%) | 555 (5.3%) |
| Having skin lesion or open wound | 6,565 (17.4%) | 6,511 (21%) | 2,355 (22.6%) *** |
| Structured data (OASIS Item): Neuro, Emotional, and Behavioral Status [n, (%)] | |||
| Cognitive functioning (i.e., required prompting, assistance or totally dependent) | 303 (0.8%) | 474 (1.5%) | 9,083 (87.3%) *** |
| Confusion | 9,122 (24.2%) | 19,224 (62.1%) | 9,896 (95.1%) *** |
| Anxiety | 9,243 (24.5%) | 11,207 (36.2%) | 4,131 (39.7%) *** |
| Structured data (OASIS Item): Overall Status [n, (%)] | |||
| Stable | 3,586 (9.5%) | 1,304 (4.2%) | 501 (4.8%) |
| Likely to be stable | 31,631 (84%) | 23,731 (76.6%) | 6,624 (63.7%) |
| Fragile | 2,414 (6.4%) | 5,789 (18.7%) | 3,056 (29.4%) *** |
| Serious | 47 (0.1%) | 175 (0.6%) | 221 (2.1%) *** |
| Structured data (OASIS Item): ADLs / IADLs | |||
| ADL Needed [mean (SD)]† | 7.4 (1.8) | 8.5 (0.9) | 8.9 (0.6) *** |
| ADL Severity [mean (SD)]‡ | 12 (4.0) | 16.4 (5.5) | 24.6 (7.6) *** |
| Unstructured Clinical Notes: Using the Omaha System as a risk factor (Identified through NLP approaches) [n, (%)] | |||
| Circulation | 11,750 (31.2%) | 12,423 (40.1%) ** | 2,777 (26.7%) |
| Cognition | 1,863 (4.94%) | 5,303 (17.1%) | 5,316 (51.1%) *** |
| Infectious condition | 9,566 (25.4%) * | 6,545 (21.1%) | 2,381 (22.9%) |
| Neuro musculoskeletal function | 16,721 (44.4%) | 15,710 (50.7%) ** | 3,824 (36.7%) |
| Mental health | 9,065 (24.1%) | 11,035 (35.6%) | 3,973 (38.2%) *** |
| Pain | 19,373 (51.4%) * | 14,500 (46.8%) | 3,136 (30.1%) |
| Respiration | 5,448 (14.5%) | 9,248 (29.8%) ** | 1,749 (16.8%) |
| Skin | 6,274 (16.7%) | 5,806 (18.7%) | 3,259 (31.3%) *** |
| Social contact | 6,293 (16.7%) | 7,192 (23.2%) ** | 9,16 (8.81%) |
Note:
denotes the representative risk factors for grouping in Cluster 1;
denotes the representative risk factors for grouping in Cluster 2;
denotes the representative risk factors for grouping in Cluster 3;
SD = standard deviation; OASIS = Outcome and Assessment Information Set; ADLs / IADLs; Activities of Daily Livings/Instrumental Activities of Daily Livings; NLP = natural language processing.
“ADL Needed” which was defined as the summed binary ADL/IADL items (ranging from 0 to 9) derived from ADL items such as grooming, dressing upper and lower, bathing, toileting, transferring, ambulating, and eating, as well as IADL items such as meal preparation. Binary indicator 0 was given if response 0 was given (no issue); otherwise, 1 was given (moderate or significant issue).
“ADLs Severity” was calculated by totaling the response categories of the dependency level in ADL/IADL items (total ranged from 0 to 38).