Table 3.
Model of Discharge Location Following Hospitalization, Compared with Returning to Baseline Nursing Home
| Other Nursing Home |
Institution Other Than Nursing Home |
|||||
|---|---|---|---|---|---|---|
| Characteristics/Factors | AOR | LCI | UCI | AOR | LCI | UCI |
| State policies | ||||||
| Any bed-hold policy | 0.55** | 0.52 | 0.58 | 0.76 | 0.44 | 1.31 |
| Average per-diem Medicaid rate (std to [x−$103.3]/$10) | 0.85** | 0.82 | 0.87 | 0.88* | 0.78 | 0.99 |
| County market | ||||||
| Area wage index adjusted to geographic variation (std to [x−0.96]/0.12) | 0.93** | 0.90 | 0.96 | 0.95 | 0.84 | 1.08 |
| Average number of empty beds (std to [x−14 beds]/10 beds) | 1.05 | 0.96 | 1.14 | 1.26** | 1.06 | 1.50 |
| Average hospital occupancy (std to [x−52.6%]/20%) | 1.11* | 1.02 | 1.21 | 1.04 | 0.91 | 1.19 |
| Baseline nursing home | ||||||
| Total beds (std to [x−100 beds]/70 beds) | 0.87** | 0.83 | 0.92 | 1.06+ | 1.00 | 1.13 |
| For-profit | 1.22** | 1.14 | 1.30 | 1.09 | 0.93 | 1.29 |
| Chain ownership | 1.03 | 0.99 | 1.08 | 1.05 | 0.92 | 1.21 |
| Average nursing case-mix index on admission assessments (std to [x−0.96]/0.125) | 0.84** | 0.79 | 0.89 | 1.00 | 0.92 | 1.10 |
| Average nursing case-mix index on annual assessments (std to [x−0.719]/0.066) | 0.89** | 0.84 | 0.95 | 0.92+ | 0.84 | 1.01 |
| Occupancy <85% | 1.08** | 1.03 | 1.14 | 0.98 | 0.85 | 1.12 |
| Dementia unit available | 0.93+ | 0.85 | 1.01 | 1.11 | 0.95 | 1.30 |
| Rehabilitation unit available | 1.13 | 0.90 | 1.41 | 1.09 | 0.79 | 1.52 |
| >35% Residents nongovernment paid | 1.10+ | 0.98 | 1.22 | 1.05 | 0.88 | 1.25 |
| >15% Medicare paid | 1.01 | 0.93 | 1.09 | 1.08 | 0.90 | 1.29 |
| >1/2 FTE MD | 1.01 | 0.87 | 1.16 | 0.95 | 0.77 | 1.16 |
| Any NP/PA | 1.04 | 0.98 | 1.10 | 1.18* | 1.02 | 1.36 |
| Ratio RNs/(RNs+LPNs) (std to [x−0.3]/0.2) | 0.98 | 0.94 | 1.01 | 1.02 | 0.94 | 1.11 |
| Hospitalization event | ||||||
| Event length of stay (LOS) (std to [x−7.3 days]/7.3 days) | 1.41** | 1.35 | 1.46 | 1.28** | 1.20 | 1.37 |
| LOS <3 days | 0.20** | 0.17 | 0.25 | 0.99 | 1.04 | 0.94 |
| LOS 3–7 days | 0.73** | 0.69 | 0.76 | 0.61** | 0.53 | 0.70 |
| LOS >14 days | 1.33** | 1.21 | 1.45 | 1.37** | 1.12 | 1.68 |
| Primary diagnosis is ambulatory care sensitive | 1.07+ | 1.00 | 1.15 | 0.67** | 0.58 | 0.77 |
| Primary diagnosis is stroke | 1.23+ | 1.03 | 1.49 | 2.59** | 2.13 | 3.16 |
| Primary diagnosis is chronic obstructive pulmonary disease | 0.71** | 0.55 | 0.92 | 1.01 | 0.67 | 1.54 |
| Primary diagnosis is congestive heart failure | 0.70** | 0.61 | 0.80 | 0.87 | 0.63 | 1.20 |
| Hip fracture | 1.97** | 1.73 | 2.24 | 1.72** | 1.36 | 2.16 |
| Has a psychiatric diagnosis | 1.29** | 1.17 | 1.42 | 0.31** | 0.22 | 0.45 |
| Elixhauser comorbidity score | 1.00 | 0.97 | 1.04 | 1.13** | 1.07 | 1.19 |
| Any ICU during hospitalization event | 0.93+ | 0.86 | 1.00 | 1.59** | 1.41 | 1.80 |
| Resident | ||||||
| Age (std to [x−83 years]/8 years) | 1.00 | 0.94 | 1.06 | 0.93* | 0.88 | 0.99 |
| Married | 1.00 | 0.94 | 1.06 | 1.15* | 1.00 | 1.33 |
| African American | 0.86+ | 0.72 | 1.02 | 0.99 | 0.84 | 1.17 |
| Male | 1.12** | 1.06 | 1.19 | 1.07 | 0.95 | 1.21 |
| Do-not-resuscitate order | 0.86** | 0.79 | 0.92 | 0.97 | 0.86 | 1.09 |
| Moderate cognitive impairment (CPS=3, 4) | 0.93 | 0.84 | 1.03 | 0.80** | 0.71 | 0.91 |
| Severe cognitive impairment (CPS=5, 6) | 0.87* | 0.77 | 0.98 | 1.05 | 0.90 | 1.22 |
| ADL <8 | 0.72** | 0.63 | 0.81 | 0.77** | 0.64 | 0.92 |
| ADL 8–15 | 0.91** | 0.85 | 0.97 | 0.73** | 0.63 | 0.83 |
| Weight loss | 1.03 | 0.93 | 1.14 | 0.85+ | 0.70 | 1.02 |
| Flacker score (std) | 0.98 | 0.94 | 1.02 | 1.23** | 1.13 | 1.34 |
| Diagnosis of diabetes affecting functioning | 0.93+ | 0.85 | 1.01 | 0.87* | 0.77 | 0.98 |
| Diagnosis of CHF affecting functioning | 1.09* | 1.02 | 1.18 | 0.90 | 0.77 | 1.04 |
| Bipolar/schizophrenia without treatment | 0.63** | 0.47 | 0.83 | 0.87 | 0.54 | 1.41 |
| Bipolar/schizophrenia with treatment | 0.70** | 0.55 | 0.89 | 0.93 | 0.68 | 1.27 |
| More than nine medications in past 7 days | 1.01 | 0.93 | 1.09 | 1.05 | 0.94 | 1.18 |
| Obese (BMI>30) | 0.93+ | 0.86 | 1.01 | 1.07 | 0.91 | 1.26 |
| Low weight (BMI<18) | 1.11* | 1.02 | 1.21 | 0.98 | 0.82 | 1.17 |
| Variance components | var | SE | ICC (%) | var | SE | ICC (%) |
| State | 0.199 | 0.052 | 4.72 | 0.418 | 0.143 | 8.66 |
| County | 0.216 | 0.014 | 5.13 | 0.6 | 0.099 | 12.45 |
| Facility | 0.514 | 0.011 | 12.19 | 0.516 | 0.09 | 10.70 |
Std, standardized; AOR, adjusted odds ratio; LCI, lower confidence interval; UCI, upper confidence interval; ICC, intra-class correlation; FTE, full-time-equivalent (% time employed); NP/PA, nurse practitioner/physician assistant; ICU, intensive care unit; CPS, cognitive performance scale; ADL, activity of daily living scale; BMI, body mass index; Var, variance; SE, standard error.
**
p-value <.01.
*
p-value <.05.
+
p-value <.1.