PMID- 30879948
OWN - NLM
STAT- MEDLINE
DCOM- 20201111
LR  - 20201111
IS  - 1538-9375 (Electronic)
IS  - 1525-8610 (Linking)
VI  - 20
IP  - 9
DP  - 2019 Sep
TI  - Nursing Home Length of Stay in 3 Canadian Health Regions: Temporal Trends, 
      Jurisdictional Differences, and Associated Factors.
PG  - 1121-1128
LID - S1525-8610(19)30178-1 [pii]
LID - 10.1016/j.jamda.2019.01.144 [doi]
AB  - OBJECTIVES: To assess (1) temporal changes (2008-2015) in nursing home (NH) 
      length of stay (LoS) in 3 Canadian health jurisdictions (Edmonton, Calgary, 
      Winnipeg), (2) resident admission characteristics associated with LoS, and (3) 
      temporal changes of admission characteristics in each of the 3 jurisdictions. 
      DESIGN: Retrospective cohort study using data previously collected in Translating 
      Research in Elder Care (TREC), a longitudinal program of applied health services 
      research in Canadian NHs. SETTING AND PARTICIPANTS: 7817 residents admitted 
      between January 2008 and December 2015 to a stable cohort of 18 NHs that have 
      consistently participated in TREC since 2007. METHODS: LoS was defined as time 
      between a resident's first NH admission and final discharge from the NH sector. 
      Analyses included descriptive statistics, Kaplan Meier estimates (unadjusted 
      LoS), and Cox proportional hazard regressions (adjusted LoS), adjusted for 
      resident characteristics (eg, age, cognitive performance, and health 
      instability). We also controlled for NH size and ownership. RESULTS: In 
      jurisdictions with increasing care needs, unadjusted median LoS [95% confidence 
      interval (CI)] decreased over time (2008 and 2009 vs 2014 and 2015 admissions); 
      in Calgary from 1.837 (95% CI 1.618, 2.275) to 1.328 (95% CI 1.185, 1.489) years 
      and in Edmonton from 1.927 (95% CI 1.725, 2.188) to 1.073 (95% CI 0.936, 1.248) 
      years. In Winnipeg, care needs and LoS remained constant (2.163, 95% CI 1.867, 
      2.494, vs 2.459, 95% CI 2.155, 2.883, years). Resident characteristics including 
      higher physical dependency [hazard ratio (HR) 1.205, 95% CI 1.133, 1.282], higher 
      cognitive impairment (HR 1.112, 95% CI 1.042, 1.187), or higher health 
      instability (HR 1.333, 95% CI 1.224, 1.452) were associated with lower LoS. 
      Adjustment for resident characteristics reduced jurisdictional LoS differences 
      and rendered temporal LoS differences within jurisdictions statistically 
      nonsignificant. CONCLUSIONS/IMPLICATIONS: In jurisdictions where care needs at 
      admission have increased since 2008, resident LoS has decreased. Jurisdictional 
      differences in care needs and LoS indicate that health policies may affect these 
      outcomes. Variations of resident outcomes by policy environment require 
      additional scrutiny.
CI  - Copyright (c) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine. 
      All rights reserved.
FAU - Hoben, Matthias
AU  - Hoben M
AD  - Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. Electronic 
      address: mhoben@ualberta.ca.
FAU - Chamberlain, Stephanie A
AU  - Chamberlain SA
AD  - Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
FAU - Gruneir, Andrea
AU  - Gruneir A
AD  - Department of Family Medicine, Faculty of Medicine & Dentistry, University of 
      Alberta, Edmonton, Alberta, Canada.
FAU - Knopp-Sihota, Jennifer A
AU  - Knopp-Sihota JA
AD  - Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Faculty of 
      Health Disciplines, Athabasca University, Athabasca, Alberta, Canada.
FAU - Sutherland, Jason M
AU  - Sutherland JM
AD  - Centre for Health Services and Policy Research, School of Population and Public 
      Health, University of British Columbia, Vancouver Campus, Vancouver, British 
      Columbia, Canada.
FAU - Poss, Jeffrey W
AU  - Poss JW
AD  - School of Public Health and Health Systems, University of Waterloo, Waterloo, 
      Ontario, Canada.
FAU - Doupe, Malcolm B
AU  - Doupe MB
AD  - Max Rady College of Medicine, Rady Faculty of Health Sciences, University of 
      Manitoba, Winnipeg, Manitoba, Canada.
FAU - Bergstrom, Veronica
AU  - Bergstrom V
AD  - Department of Psychology, Faculty of Arts and Science, University of Toronto, 
      Toronto, Ontario, Canada.
FAU - Norton, Peter G
AU  - Norton PG
AD  - Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.
FAU - Schalm, Corinne
AU  - Schalm C
AD  - Alberta Government, Continuing Care Branch, Edmonton, Alberta, Canada.
FAU - McCarthy, Kimberley
AU  - McCarthy K
AD  - Alberta Government, Continuing Care Branch, Edmonton, Alberta, Canada.
FAU - Kashuba, Kierstin
AU  - Kashuba K
AD  - Alberta Government, Continuing Care Branch, Edmonton, Alberta, Canada.
FAU - Ackah, Fred
AU  - Ackah F
AD  - Alberta Government, Continuing Care Branch, Edmonton, Alberta, Canada.
FAU - Estabrooks, Carole A
AU  - Estabrooks CA
AD  - Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190314
PL  - United States
TA  - J Am Med Dir Assoc
JT  - Journal of the American Medical Directors Association
JID - 100893243
SB  - IM
MH  - Aged, 80 and over
MH  - Canada
MH  - Female
MH  - Health Policy
MH  - Health Services Research
MH  - Humans
MH  - Length of Stay/*trends
MH  - Male
MH  - *Nursing Homes
MH  - Proportional Hazards Models
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Length of stay
OT  - health policy
OT  - health services research
OT  - nursing homes
EDAT- 2019/03/19 06:00
MHDA- 2020/11/12 06:00
CRDT- 2019/03/19 06:00
PHST- 2018/11/28 00:00 [received]
PHST- 2019/01/17 00:00 [revised]
PHST- 2019/01/23 00:00 [accepted]
PHST- 2019/03/19 06:00 [pubmed]
PHST- 2020/11/12 06:00 [medline]
PHST- 2019/03/19 06:00 [entrez]
AID - S1525-8610(19)30178-1 [pii]
AID - 10.1016/j.jamda.2019.01.144 [doi]
PST - ppublish
SO  - J Am Med Dir Assoc. 2019 Sep;20(9):1121-1128. doi: 10.1016/j.jamda.2019.01.144. 
      Epub 2019 Mar 14.