Table 2. Health Quality and Utilization Outcomes of Nursing Home Residents with Advanced Dementia and Their Health Care Proxies, by Health Insurance Status.

	Fee for Service		Managed Care		Managed Care estimatea
Outcome	n	Avg (SD) or %	n	Avg (SD) or %	Unadjusted (CI)	Adjusted b (CI)
Do-not-hospitalize ordersd	852	51%	703	64%	1.7 (1.1 , 2.6)c	1.8 (1.2 , 2.9)c
Hospital transfers for acute illnesse	331	16%	229	4%	0.2 (0.1 , 0.5)c	0.2 (0.1 , 0.5)c
Pneumonia	126	18%	79	6%	0.2 (0.0 , 0.6)c	0.1 (0.0 , 0.4)c
Febrile event	182	8%	133	2%	0.2 (0.1 , 1.1)c	0.3 (0.1 , 1.3)c
Other acute event	23	61%	17	12%	0.1 (0.0 , 0.4)c	0.0 (0.0 , 0.2)c
Primary care visits in the nursing home/90 daysf	158	4.2 (5.0)	133	4.8 (2.6)	1.3 (1.1 , 1.5)c	1.4 (1.2 , 1.6)c
Physician visits	158	3.4 (4.7)	133	1.8 (1.5)	0.6 (0.5 , 0.7)c	0.7 (0.5, 0.8)c
Nurse practitioner visits	158	0.8 (2.6)	133	3.0(2.1)	3.8 (2.9 , 4.9)c	4.2 (3.2 , 5.4)c
Hospice treatmentf	158	18%	133	23%	1.4 (0.8 , 2.4)	1.4 (0.8 , 2.7)
Family satisfaction with care (SWC-EOLD)d,g	638	31.6 (4.6)	538	32.3 (4.5)	0.9 (0.0 , 1.8)	0.9 (0.0 , 1.8)
Comfort in prior 90 days (SM-EOLD)d,h	762	37.5 (7.6)	634	37.8 (7.5)	0.2 (−1.2 , 1.7)	−0.5 (−1.9 , 0.9)
Comfort during last week of life (CAD-EOLD)e,i	81	34.9 (4.6)	66	34.0 (4.2)	−0.9 (−2.3 , 0.5)	−0.9 (−2.3 , 0.4)
Pain treatmente	147	10%	114	17%	1.8 (0.8 , 4.2)	1.7 (0.7 , 4.1)
Dyspnea treatmente	124	61%	94	55%	0.9 (0.5 , 1.6)	0.8 (0.4 , 1.6)
Treatment for pneumoniae	127	100%	79	100%
No antimicrobial agent	10	8%	8	10%	-	-
Oral antimicrobial agent	71	56%	44	56%	0.8 (0.3 , 2.1)	1.5 (0.4 , 4.9)
IM antimicrobial agent	16	13%	17	22%	1.3 (0.2 , 2.4)	2.9 (0.7 , 11.7)
IV antimicrobial agent or hospitalization	30	24%	10	13%	0.4 (0.1 , 1.3)	0.6 (0.1 , 2.2)

Abbreviations: CI, confidence interval; IM, Intramuscular; IV, Intravenous

^aThe effect estimate is an odds ratio for all outcomes except for EOLD measures and MD & NP visits. EOLD effects are differences, effects of MD & NP visits are shown as rate ratios.

^bThe association of managed care status with each outcome after adjusting for all baseline characteristics described in Table 1.

^cp-value < 0.05

^dAnalysis conducted at the 90-day assessment level.

^eAnalysis conducted at the episode level.

^fAnalysis conducted at the resident level.

^gSWC-EOLD ranges from 10 to 40, with higher scores indicating greater family satisfaction with care.

^hSM-EOLD ranges from 0 to 45; higher scores indicate greater comfort.

ⁱCAD-EOLD ranges from 14-42; higher scores indicate greater comfort in the last week of life.