Table A10-a.
Sensitivity analysis (+/− 45-day window)*: Association between nursing home star ratings and residents’ severity of depressive symptoms (unadjusted for study covariates)
| Mild vs. Minimal symptoms | Moderate vs. Minimal symptoms | Moderately severe/severe vs. Minimal symptoms | ||||
|---|---|---|---|---|---|---|
| OR† | 95% Cl | OR† | 95% Cl | OR† | 95% Cl | |
| Overall rating (ref: 3 stars) | ||||||
| 1 star | 0.98 | (0.90– 1.08) | 1.02 | (0.85– 1.21) | 1.17 | (0.89– 1.55) |
| 2 stars | 0.95 | (0.87– 1.02) | 0.88 | (0.75– 1.03) | 0.97 | (0.75– 1.25) |
| 4 stars | 0.98 | (0.92– 1.06) | 0.90 | (0.78– 1.04) | 1.01 | (0.80– 1.29) |
| 5 stars | 0.93 | (0.85– 1.01) | 0.71 | (0.60– 0.84) | 0.76 | (0.58– 1.01) |
| Overall P‡ | 0.3274 | 0.0006 | 0.0859 | |||
| Linear trend P§ | 0.5649 | 0.0018 | 0.0289 | |||
| Health inspection rating (ref: 3 stars) | ||||||
| 1 star | 0.94 | (0.87– 1.02) | 0.95 | (0.81– 1.11) | 0.93 | (0.72– 1.18) |
| 2 stars | 1.02 | (0.94– 1.10) | 0.88 | (0.76– 1.02) | 1.03 | (0.82– 1.30) |
| 4 stars | 0.99 | (0.92– 1.07) | 0.91 | (0.78– 1.06) | 0.87 | (0.68– 1.12) |
| 5 stars | 1.10 | (0.99– 1.21) | 0.83 | (0.67– 1.03) | 0.88 | (0.63– 1.24) |
| Overall P‡ | 0.0643 | 0.3370 | 0.6600 | |||
| Linear trend P§ | 0.0384 | 0.5517 | 0.4722 | |||
| Staffing rating (ref: 3 stars) | ||||||
| 1 star | 1.00 | (0.91– 1.09) | 1.29 | (1.08– 1.54) | 1.44 | (1.08– 1.91) |
| 2 stars | 0.95 | (0.87– 1.03) | 1.06 | (0.90– 1.24) | 1.26 | (0.96– 1.65) |
| 4 stars | 0.99 | (0.93– 1.06) | 0.94 | (0.82– 1.08) | 1.13 | (0.90– 1.42) |
| 5 stars | 1.06 | (0.95– 1.18) | 0.79 | (0.64– 0.99) | 1.11 | (0.76– 1.61) |
| Overall P‡ | 0.4613 | 0.0004 | 0.1320 | |||
| Linear trend P§ | 0.3327 | <0.0001 | 0.0758 | |||
| Quality measures rating (ref: 3 stars) | ||||||
| 1 star | 1.24 | (1.09– 1.41) | 1.13 | (0.87– 1.45) | 1.40 | (0.96– 2.05) |
| 2 stars | 1.11 | (1.01– 1.21) | 1.20 | (1.02– 1.42) | 1.16 | (0.89– 1.52) |
| 4 stars | 0.97 | (0.91– 1.04) | 0.89 | (0.78– 1.02) | 0.72 | (0.58– 0.90) |
| 5 stars | 0.81 | (0.75– 0.88) | 0.77 | (0.65– 0.90) | 0.67 | (0.53– 0.86) |
| Overall P‡ | <0.0001 | <0.0001 | <0.0001 | |||
| Linear trend P§ | <0.0001 | <0.0001 | <0.0001 | |||
Note:
Sensitivity analysis: Residents’ 90-day assessment was identified as the assessment (quarterly/annual/SCSA) closest to 90 days after admission within a +/−45-day window.
Unadjusted odds ratios: Multinomial logistic regression model estimated through generalized estimation equation, adjusting for clustering of residents in the same nursing home and clustering of nursing homes in the same state. The model did not adjust for other covariates.
P-value for Type III test of overall association between ordinal star ratings and depression diagnosis.
P-value for linear trend for star ratings by entering the ratings as a continuous variable into the model.