Predicting Discharge Outcomes of VA Nursing Home Residents
Open accessAbstract
This article's purpose was to identify predictors of discharge outcomes of VA nursing home stays. Using data tapes, diagnostic and assessment data were assembled on elderly individuals admitted to VA nursing homes nationwide during Fiscal Year 1987. Six-month outcomes for 3 groups were considered: all residents (n = 5,895), and those remaining in care after 6 (n = 2,815) and 12 months (n = 1,812), respectively. Logistic regression was used to evaluate predictors of death and community discharge. Limited activities of daily living (ADL) dependency, younger age, and receipt of rehabilitation services most consistently predicted community discharge. ADL dependency, older age, oxygen use, terminally ill prognosis, malignancy, and congestive heart failure most consistently predicted mortality. For both dependent variables, predictive ability declined as stay length increased. Predicting death and community discharge become increasingly problematic as stay lengthens. Comparing observed versus expected discharge outcomes has limited usefulness as a quality-improvement tool.
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Typically, patients are referred from the hospital to postacute care settings because of greater disease complexity, deconditioning, or cognitive declines that have left them particularly debilitated.
“Typically, patients are referred from the hospital to postacute care settings because of greater disease complexity, deconditioning, or cognitive declines that have left them particularly debilitated.228–230”
Impaired physical function is among the most important predictors of reinstitutionalization after SNF discharge.
“In fact, impaired physical function is among the most important predictors of reinstitutionalization after SNF discharge.229,230”
The low percentage of community discharge from SNFs correlates particularly with functional status.
“Although many factors play a role in the need for long-term institutionalization (ie, psychosocial, environmental), the low percentage of community discharge correlates particularly with functional status.229”
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- Authors
- Mehr, D. R., Williams, B. C., & Fries, B.
- Affiliations
- University of Missouri (US)
- University of Michigan (US)
- University of Michigan and Ann Arbor VA Medical Center
- ORCID
- Mehr, David R.
- Venue
- Journal of Aging and Health
- Publisher
- SAGE Publications
- Published
- 1997-05
- Volume
- 9
- Issue
- 2
- Pages
- 244-265
- ISSN
- 0898-2643 (ISSN-L)
- 1552-6887
- OpenAlex
- W1986145623
- Cited by
- 21
- References
- 28
- Citations by year
- 2025: 2 · 2023: 2 · 2022: 1 · 2019: 1 · 2017: 2 · 2016: 1 · 2015: 2 · 2013: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of Aging and Health (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- U.S. Public Health Service (11R 90-096)
- National Institute on Aging (AG-08808)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- nursing home discharge, veterans, nursing home residents, mortality prediction, community discharge, activities of daily living dependence, rehabilitation services, oxygen consumption, congestive heart failure, cancer, length of hospital stay, quality improvement
- MeSH terms
- Activities of Daily Living, Age Factors, Aged, Homes for the Aged, Humans, Length of Stay, Mortality, Nursing Homes, Patient Discharge, Time Factors, United States, Veterans, Logistic Models, Outcome Assessment, Health Care
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