Table 1.
Demographic and Clinical Characteristics of Long-Stay Nursing Home Residents with UTI or Pneumonia, by Prescriber Group, 2016–2018. (N= 264,735 residents)
| Resident Characteristic* | NH specialist physician n=66,880 | Non-NH specialist physician n=175,548 | NH specialist advanced practitioner n=8,258 | Non-NH specialist advanced practitioner n=14,049 |
|---|---|---|---|---|
| Age, years, mean (SD) | 82.9 (8.6) | 84.0 (8.4) | 83.6 (8.7) | 84.3 (8.5) |
| Female sex | 49,938 (74. 7%) | 135,043 (76.9%) | 6,073 (73.5%) | 10,865 (77.3%) |
| Race/ethnicity | ||||
| White, non-Hispanic | 54,809 (82.0%) | 151,904 (86.5%) | 7,299 (88.4%) | 12,663 (90.1%) |
| Black, non-Hispanic | 7,825 (11.7%) | 12,567 (7.2%) | 602 (7.3%) | 826 (5.9%) |
| Hispanic | 2,956 (4.4%) | 7,366 (4.2%) | 241 (2.9%) | 315 (2.2%) |
| Other | 1,290 (1.9%) | 3,711 (2.1%) | 116 (1.4%) | 245 (1.7%) |
| ADL dependence† | ||||
| Independent to limited assistance required | 1,932 (2.9%) | 6,151 (3.5%) | 225 (2.7%) | 683 (4.9%) |
| Extensive assistance required | 56,095 (83.9%) | 148,727 (84.7%) | 7,119 (86.2%) | 12,168 (86.6%) |
| Extensive dependency | 8,853 (13.2%) | 20,670 (11. 8%) | 914 (11. 1%) | 1,198 (8.5%) |
| Health instability‡ | ||||
| None | 29,360 (43.9%) | 79,310 (45.2%) | 3,634 (44.0%) | 6,528 (46.5%) |
| Minimal | 22,181 (33.2%) | 58,266 (33.2%) | 2,742 (33.2%) | 4,645 (33.1%) |
| Low | 11,479 (17.2%) | 29,573 (16.9%) | 1,424 (17.2%) | 2,352 (16.7%) |
| Moderate to very high | 3,860 (5. 8%) | 8,399 (4. 8%) | 458 (5. 6%) | 524 (3.7%) |
| Cognitive impairment§ | ||||
| Cognitively intact | 20,037 (30.0%) | 53,320 (30.4%) | 2,588 (31.3%) | 4,485 (31.9%) |
| Mildly impaired | 15,559 (23.3%) | 41,969 (23.9%) | 1,911 (23.1%) | 3,361 (23.9%) |
| Moderately impaired | 23,794 (35.6%) | 62,593 (35.7%) | 2,839 (34.4%) | 4,897 (34.9%) |
| Severely impaired | 7,490 (11.2%) | 17,666 (10. 1%) | 920 (11.1%) | 1,306 (9.3%) |
| MDS comorbidities | ||||
| Diabetes | 25,755 (38.5%) | 66,255 (37.7%) | 3,032 (36.7%) | 5,073 (36.1%) |
| Anemia | 24,549 (36.7%) | 62,119 (35.4%) | 2,887 (35.0%) | 4,631 (33.0%) |
| Alzheimer’s disease or related dementia | 40,841 (61.1%) | 103,753 (59.1%) | 4,936 (59.8%) | 8,176 (58.2%) |
| Asthma/COPD | 18,699 (28.0%) | 48,747 (27.8%) | 2,341 (28.4%) | 3,954 (28.1%) |
| Atrial fibrillation | 8,262 (12.4%) | 22,491 (12.8%) | 1,198 (14.5%) | 1,921 (13.7%) |
| Coronary artery disease | 8,276 (12.4%) | 22,458 (12.8%) | 1,103 (13.4%) | 1,717 (12.2%) |
| Heart failure | 18,237 (27.3%) | 48,157 (27.4%) | 2,313 (28.0%) | 3,991 (28.4%) |
| Hypertension | 54,595 (81.6%) | 143,979 (82.0%) | 6,596 (79.9%) | 11,194 (79.7%) |
| Neurogenic bladder | 4,623 (6.9%) | 12,104 (6.9%) | 698 (8.5%) | 1,029 (7.3%) |
| Renal insufficiency/ESRD | 5,518 (8.3%) | 14,526 (8.3%) | 757 (9.2%) | 1,268 (9.0%) |
| Devices and special treatments|| | ||||
| Indwelling catheter | 9,222 (13.8%) | 22,589 (12.9%) | 1,235 (15.0%) | 1,864 (13.3%) |
| Oxygen therapy | 14,555 (21.8%) | 36,309 (20.69%) | 1,908 (23.1%) | 3,006 (21.4%) |
| Intravenous medications | 8,111 (12.1%) | 18,315 (10.4%) | 825 (10.0%) | 991 (7.1%) |
| Hospital use in past 90 days | 8,286 (12.4%) | 21,404 (12.2%) | 915 (11.1%) | 1,579 (11.2%) |
Abbreviations: UTI; Urinary Tract Infection; NH, Nursing Home; SD, standard deviation; ADL, Activities of Daily Living; ESRD, End-Stage Renal Disease; COPD, Chronic Obstructive Pulmonary Disease/Chronic Lung Disease; BiPAP/CPAP, Bilevel Positive Airway Pressure/Continuous Positive Airway Pressure; ICU, Intensive Care Unit; MDS, Minimum Data Set.
Note: Nursing home specialists were defined as prescribers for whom ≥ 90% of all dispensings (not only antibiotics) attributed to their National Provider Identifier were for nursing home residents. Nursing home specialization was reassessed yearly. Our analyses were conducted at the person-dispensing level to understand unique prescribing decisions by prescriber group. Nursing home residents could be represented multiple times if they received multiple dispensings during the study period or had infections in multiple years.
Characteristics are reported as number (%) unless otherwise noted.
Dependence in ADLs was measured using the MDS Morris 28-point ADL scale, categorized as 0 to 14 (independent to limited assistance required), 15 to 19 (extensive assistance required), and 20 or higher (extensive dependency). Dependence in ADLs is a measure of physical function.
Health instability was measured using the MDS 6-point Changes in Health, End-stage disease and Symptoms and Signs score, categorized as 0 (no instability), 1 (minimal health instability), 2 (low health instability), and 3 or higher (moderate to very high health instability).
Cognitive impairment was measured using the MDS 4-point Cognitive Function Scale, which ranged from 1 (intact) to 4 (severe impairment).
Devices and special treatments were only measured on the MDS assessment that included a diagnosis of UTI or pneumonia.