Table 2. Hospital Transfer Outcomes Across 12 Months Among Nursing Home Residents With Advanced Illness by Cohort Yeara.
| Outcome | Cohort Yeara | |||||
|---|---|---|---|---|---|---|
| 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | |
| Advanced Dementia | ||||||
| Any transfer, adjusted % (95% CI)b | ||||||
| All causes | 56.1 (55.4-56.9) | 51.1 (50.5-51.4) | 45.9 (45.6-46.4) | 45.1 (44.7-45.5) | 44.5 (44.1-44.9) | 45.4 (44.9-45.8) |
| Potentially avoidablec | 26.5 (25.9-27.2) | 23.2 (22.8-23.6) | 20.0 (19.6-20.3) | 19.7 (19.4-20.1) | 19.5 (19.2-19.8) | 20.4 (20.1-20.7) |
| Fracturesd | 2.4 (2.2-2.6) | 2.3 (2.2-2.5) | 2.3 (2.1-2.4) | 2.3 (2.2-2.5) | 2.4 (2.2-2.5) | 2.4 (2.3-2.6) |
| Hospital transfers per person-year alive | ||||||
| All causes, mean (SD) | 5.8 (22.7) | 4.1 (16.7) | 3.3 (14.4) | 3.1 (13.6) | 3.2 (14.2) | 3.9 (17.9) |
| Adjusted RRb | 1 [Reference] | 0.71 (0.66-0.77) | 0.58 (0.54-0.62) | 0.56 (0.52-0.60) | 0.57 (0.53-0.62) | 0.72 (0.67-0.78) |
| Potentially avoidable, mean (SD)c | 2.4 (14.0) | 1.6 (10.2) | 1.2 (7.8) | 1.2 (7.6) | 1.2 (8.0) | 1.6 (11.2) |
| Adjusted RRb | 1 [Reference] | 0.67 (0.60-0.75) | 0.52 (0.47-0.58) | 0.51 (0.46-0.57) | 0.53 (0.48-0.59) | 0.73 (0.65-0.81) |
| Fractures, mean (SD)d | 0.06 (0.78) | 0.06 (0.87) | 0.05 (0.82) | 0.06 (0.72) | 0.07 (1.08) | 0.08 (1.24) |
| Adjusted RR | 1 [Reference] | 0.98 (0.77-1.24) | 0.85 (0.67-1.07) | 0.93 (0.75-1.16) | 1.03 (0.81-1.30) | 1.28 (1.00-1.61) |
| Advanced Congestive Heart Failure | ||||||
| Any transfer, adjusted % (95% CI)b | ||||||
| All causes | 77.6 (76.7-78.5) | 69.3 (68.6-70.0) | 63.6 (62.9-64.3) | 63.2 (62.5-63.9) | 64.7 (63.9-65.4) | 69.5 (68.9-70.2) |
| Potentially avoidablec | 50.0 (49.9-51.1) | 41.5 (40.7-42.2) | 36.4 (35.7-37.1) | 36.6 (35.8-37.3) | 38.1 (37.3-38.8) | 42.9 (42.2-43.6) |
| Fracturesd | 2.0 (1.8-2.3) | 1.9 (1.8-2.2) | 2.0 (1.8-2.2) | 2.1 (1.9-2.3) | 2.0 (1.8-2.2) | 2.0 (1.8-2.2) |
| Hospital transfers per person-year alive | ||||||
| All causes, mean (SD) | 16.8 (43.9) | 11.1 (33.6) | 8.0 (24.1) | 8.0 (24.3) | 9.6 (28.3) | 13.5 (38.9) |
| Adjusted RRb | 1 [Reference] | 0.69 (0.64-0.75) | 0.49 (0.45-0.53) | 0.49 (0.45-0.53) | 0.57 (0.53-0.62) | 0.74 (0.68-0.80) |
| Potentially avoidable, mean (SD)c | 8.5 (32.0) | 5.2 (23.5) | 3.5 (15.8) | 3.4 (15.1) | 4.5 (19.6) | 6.7 (26.8) |
| Adjusted RRb | 1 [Reference] | 0.64 (0.58-0.72) | 0.42 (0.38-0.47) | 0.42 (0.38-0.47) | 0.53 (0.48-0.59) | 0.72 (0.65-0.81) |
| Fractures, mean (SD)d | 0.08 (1.20) | 0.08 (1.59) | 0.08 (1.01) | 0.07 (1.01) | 0.07 (1.21) | 0.90 (2.37) |
| Adjusted RR | 1 [Reference] | 0.99 (0.65-1.51) | 0.86 (0.60-1.24) | 0.84 (0.58-1.21) | 0.82 (0.55-1.21) | 1.02 (0.63-1.63) |
| Advanced Chronic Obstructive Pulmonary Disease | ||||||
| Any transfer, adjusted % (95% CI)b | ||||||
| All causes | 76.2 (75.3-77.1) | 69.1 (68.4-69.9) | 63.3 (62.6-64.0) | 63.1 (62.3-63.8) | 63.9 (63.2-64.7) | 67.2 (66.6-67.9) |
| Potentially avoidablec | 49.2 (48.2-50.2) | 41.2 (40.4-41.9) | 35.9 (35.2-36.6) | 36.0 (35.3-36.7) | 37.2 (36.4-37.9) | 40.7 (40.0-41.4) |
| Fracturesd | 2.3 (2.0-2.6) | 2.2 (2.0-2.5) | 2.3 (2.1-2.6) | 2.4 (2.2-2.6) | 2.2 (2.0-2.5) | 2.2 (2.0-2.5) |
| Hospital transfers per person-year alive | ||||||
| All causes, mean (SD) | 15.6 (42.4) | 9.9 (30.2) | 7.3 (22.1) | 7.7 (24.8) | 8.6 (27.4) | 11.2 (35.8) |
| Adjusted RRb | 1 [Reference] | 0.60 (0.55-0.65) | 0.43 (0.39-0.46) | 0.46 (0.41-0.49) | 0.50 (0.46-0.55) | 0.66 (0.61-0.72) |
| Potentially avoidable, mean (SD)c | 7.8 (30.9) | 4.6 (21.1) | 3.1 (14.3) | 3.2 (15.5) | 3.8 (17.5) | 5.5 (24.8) |
| Adjusted RRb | 1 [Reference] | 0.55 (0.49-0.62) | 0.36 (0.32-0.41) | 0.37 (0.33-0.42) | 0.44 (0.39-0.49) | 0.64 (0.57-0.72) |
| Fractures, mean (SD)d | 0.09 (1.19) | 0.07 (0.98) | 0.08 (0.98) | 0.09 (1.08) | 0.07 (0.74) | 0.95 (2.16) |
| Adjusted RR | 1 [Reference] | 0.79 (0.55-1.11) | 0.82 (0.58-1.14) | 0.88 (0.63-1.23) | 0.69 (0.50-0.96) | .095 (0.63-1.46) |
Abbreviations: COPD, chronic obstructive pulmonary disease; MDS, Minimum Data Set; MRS3, MDS 3.0 mortality risk score; RR, relative risk.
Cohort year refers to the calendar year of the inception cohort constructed for each advanced illness using MDS assessments from 2011 to 2016. Medicare data from 2011 to 2017 were used to identify transfers occurring within 12 months of meeting the criteria for advanced illness for each cohort. Thus, person-time and transfers were assessed for up to 12 months and spanned 2 calendar years (eg, for the 2016 cohort, transfers were assessed in both 2016 and 2017).
All models were adjusted for age, sex, nonwhite race, and MRS3 and included an offset for log(person-time).
Transfers for primary diagnosis of sepsis, pneumonia, dehydration, urinary tract infections, heart failure, and COPD or asthma.
Fractures of pelvis, hip, wrist, ankle, and long bone fractures of arms (humerus, ulna, and radius) and legs (femur, tibia, and fibula).