Table 7.
Univariable Model Estimating Odds of Continuing an Antipsychotic into a Skilled Nursing Facility After Hospital Discharge, Among Participants with Inpatient Antipsychotic Initiation
| Characteristic | Odds ratio | 95% confidence interval | P value | |
|---|---|---|---|---|
| Age, per 5 years | 1.02 | 0.96 | 1.08 | 0.50 |
| Female | 1.29 | 0.70 | 2.40 | 0.42 |
| Race/ethnicity | ||||
| Non-Hispanic White | Reference | |||
| Non-Hispanic Black | 1.17 | 0.88 | 1.57 | 0.28 |
| Hispanic | 0.38 | 0.16 | 0.90 | 0.03 |
| Other | 1.83 | 0.93 | 3.60 | 0.08 |
| Heart failure type | ||||
| EF 0–40%, reduced | Reference | |||
| EF 40–50%, borderline | 0.77 | 0.51 | 1.17 | 0.23 |
| EF > 50%, preserved | 1.03 | 0.75 | 1.42 | 0.84 |
| EF missing | 1.04 | 0.78 | 1.38 | 0.81 |
| Conditions | ||||
| Comorbidity index* | ||||
| Comorbidity index ≥ 6 | Reference | |||
| Comorbidity index 3–5 | 1.27 | 0.96 | 1.68 | 0.10 |
| Comorbidity index 0–2 | 1.39 | 1.04 | 1.86 | 0.03 |
| Dementia | 2.21 | 1.77 | 2.76 | < 0.001 |
| Delirium | 1.67 | 1.15 | 2.42 | 0.007 |
| Chronic lung disease | 0.72 | 0.57 | 0.91 | 0.006 |
| Diabetes | 0.79 | 0.64 | 0.99 | 0.04 |
| Hypothyroidism | 1.12 | 0.80 | 1.57 | 0.50 |
| Chronic kidney disease | 0.73 | 0.46 | 1.18 | 0.20 |
| Tumor history | 0.85 | 0.62 | 1.16 | 0.30 |
| Obesity | 0.62 | 0.44 | 0.87 | 0.006 |
| Weight loss | 1.03 | 0.70 | 1.51 | 0.90 |
| Anemia | 0.78 | 0.61 | 1.00 | 0.05 |
| Alcohol use disorder | 0.73 | 0.46 | 1.15 | 0.17 |
| Substance use disorder | 1.71 | 0.92 | 3.18 | 0.09 |
| Psychosis | 1.69 | 1.26 | 2.27 | < 0.001 |
| Depression | 0.89 | 0.67 | 1.18 | 0.42 |
| Healthcare utilization in previous year, per $5000† | 0.97 | 0.95 | 0.99 | 0.009 |
| Index hospitalization LOS | ||||
| ≥ 15 days | Reference | . | ||
| 8–14 days | 1.04 | 0.81 | 1.35 | 0.74 |
| 1–7 days | 1.19 | 0.91 | 1.56 | 0.21 |
| Type of admission | ||||
| Medicine | Reference | |||
| Surgery | 0.79 | 0.55 | 1.12 | 0.18 |
| Psychiatry | 3.57 | 1.77 | 7.22 | < 0.001 |
| ICU stay during index hospitalization | 0.68 | 0.52 | 0.89 | 0.005 |
| Mechanical ventilation during index hospitalization | 0.59 | 0.42 | 0.84 | 0.003 |
| Cognitive function‡ | ||||
| Intact | Reference | |||
| Mild impairment | 0.96 | 0.72 | 1.29 | 0.79 |
| Moderate impairment | 1.78 | 1.36 | 2.34 | < 0.001 |
| Severe impairment | 1.91 | 1.21 | 3.02 | 0.006 |
| ADL dependency score§ | ||||
| ≥ 20 | Reference | |||
| 15–19 | 0.85 | 0.66 | 1.10 | 0.21 |
| 0–14 | 0.81 | 0.61 | 1.09 | 0.17 |
| Day of index hospital admission antipsychotic started | ||||
| Day > 7 of hospital admission | Reference | |||
| Day 5–7 of hospital admission | 1.03 | 0.72 | 1.47 | 0.87 |
| Day 0–4 of hospital admission | 1.54 | 1.16 | 2.04 | 0.003 |
| Proportion of days antipsychotics administered, per 10% increase | 1.09 | 1.08 | 1.10 | < 0.001 |
| Type of antipsychotic during index hospitalization | ||||
| Both typical and atypical | Reference | |||
| Typical only | 0.16 | 0.11 | 0.21 | < 0.001 |
| Atypical only | 0.65 | 0.50 | 0.83 | < 0.001 |
| Antipsychotic route of administration during index hospitalization | ||||
| Both oral and parenteral | Reference | |||
| Oral only | 0.73 | 0.58 | 0.93 | 0.01 |
| Parenteral only | 0.06 | 0.04 | 0.11 | < 0.001 |
| Potentially excessive antipsychotic dosing during admission | 0.34 | 0.25 | 0.47 | < 0.001 |
Model adjusted for random effects of hospitals and skilled nursing facilities
EF ejection fraction, LOS length of stay, ICU intensive care unit, ADL activities of daily living
*Sum of the number of conditions listed in the set of comorbidity measures developed by Elixhauser et al.
†Sum of inpatient, outpatient (including emergency department), and pharmacy costs in the year prior to index hospitalization. Presents costs in terms of US dollars (not inflation adjusted)
‡Derived from the Minimum Data Set Cognitive Function Scale, where higher scores indicate greater impairment in cognition
§Derived from the Minimum Data Set 28-point scale of independence in activities of daily living, where higher scores indicate greater dependency in activities of daily living