Table 4:
Effect of province on long-term care facility transitions (ref = Ontario): odds of transition from baseline health instability score in long-term care to another health instability score (if the patient remained in the same long-term care facility) or to hospital, death, another setting or home at 90-d follow-up
| Region | Adjusted odds ratio (95% CI) for transition at 90-d follow-up (T2)* | ||||||
|---|---|---|---|---|---|---|---|
| Remained in the same long-term care facility; health instability score† | Admitted to hospital | Died | Discharged to other setting‡ | Discharged home | |||
| Low (0) | Medium (1, 2) | High (≥ 3) | |||||
| Alberta (Ref. = Ontario); health instability score at baseline (T1)† | |||||||
| Low (0) | – | 1.43 (1.37–1.48) | 2.02 (1.83–2.23) | 0.38 (0.35–0.40) | 1.21 (1.09–1.36) | 2.31 (1.93–2.77) | NS |
| Medium (1, 2) | 0.96 (0.92–0.99) | – | 1.46 (1.38–1.54) | 0.39 (0.37–0.41) | 0.93 (0.87–0.98) | 1.46 (1.24–1.71) | NS |
| High (≥ 3) | 0.76 (0.66–0.87) | 0.77 (0.71–0.85) | – | 0.39 (0.34–0.43) | 0.52 (0.47–0.58) | NS | NS |
| British Columbia (Ref. = Ontario); health instability score at baseline (T1)† | |||||||
| Low (0) | – | 0.84 (0.77–0.93) | 0.84 (0.77–0.93) | 0.44 (0.42–0.46) | 1.39 (1.28–1.51) | 0.74 (0.62–0.90) | 0.50 (0.42–0.60) |
| Medium (1, 2) | NS | – | 1.15 (1.08–1.22) | 0.51 (0.48–0.53) | 1.35 (1.27–1.43) | NS | 0.55 (0.43–0.70) |
| High (≥ 3) | 0.40 (0.34–0.48) | 0.55 (0.50–0.61) | – | 0.33 (0.29–0.37) | 0.58 (0.52–0.65) | 0.51 (0.31–0.83) | 0.52 (0.27–0.99) |
Note: CI = confidence interval, NS = not significant, Ref. = reference category.
Multistate transition models adjusted for physician visits, age, gender, marital status, ADL Hierarchy scale score, Cognitive Performance Scale score, diagnosis (binary variables for Chronic Obstructive Pulmonary Disease, pneumonia, diabetes, arthritis, renal failure, Urinary tract infection, Alzheimer’s Dementia and Related Dementias, heart failure, cancer, depression), facility size, Advanced directives (i.e., do not resuscitate, do not hospitalize), day of stay, functional improvement potential.
Health instability was measured with the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale (CHESS); higher scores indicate greater instability.
Other settings for transitions from nursing homes included discharges to other nursing homes, assisted living or retirement homes.