PMID- 33785310 OWN - NLM STAT- MEDLINE DCOM- 20211020 LR - 20211020 IS - 1538-9375 (Electronic) IS - 1525-8610 (Linking) VI - 22 IP - 10 DP - 2021 Oct TI - The Association of Nursing Home Characteristics and Quality with Adverse Events After a Hospitalization. PG - 2196-2200 LID - S1525-8610(21)00247-4 [pii] LID - 10.1016/j.jamda.2021.02.027 [doi] AB - BACKGROUND/OBJECTIVES: We previously found high rates of adverse events (AEs) for long-stay nursing home residents who return to the facility after a hospitalization. Further evidence about the association of AEs with aspects of the facilities and their quality may support quality improvement efforts directed at reducing risk. DESIGN: Prospective cohort analysis. SETTING AND PARTICIPANTS: 32 nursing homes in the New England states. A total of 555 long-stay residents contributed 762 returns from hospitalizations. METHODS: We measured the association between AEs developing in the 45 days following discharge back to long-term care and characteristics of the nursing homes including bed size, ownership, 5-star quality ratings, registered nurse and nursing assistant hours, and the individual Centers for Medicare & Medicaid Services (CMS) quality indicators. We constructed Cox proportional hazards models controlling for individual resident characteristics that were previously found associated with AEs. RESULTS: We found no association of AEs with most nursing home characteristics, including 5-star quality ratings and the composite quality score. Associations with individual quality indicators were inconsistent and frequently not monotonic. Several individual quality indicators were associated with AEs; the highest tertile of percentage of residents with depression (4%-25%) had a hazard ratio (HR) of 1.65 [95% confidence interval (CI) 1.16, 2.35] and the highest tertile of the percentage taking antipsychotic medications (18%-35%) had an HR of 1.58 (CI 1.13, 2.21). The percentage of residents needing increased assistance with activities of daily living was statistically significant but not monotonic; the middle tertile (13% to <20%) had an HR of 1.69 (CI 1.16, 2.47). CONCLUSIONS AND IMPLICATIONS: AEs occurring during transitions between nursing homes and hospitals are not explained by the characteristics of the facilities or summary quality scores. Development of risk reduction approaches requires assessment of processes and quality beyond the current quality measures. CI - Copyright (c) 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved. FAU - Field, Terry S AU - Field TS AD - University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, Worcester, MA, USA. Electronic address: terry.field@umassmed.edu. FAU - Fouayzi, Hassan AU - Fouayzi H AD - University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, Worcester, MA, USA. FAU - Crawford, Sybil AU - Crawford S AD - University of Massachusetts Medical School, Worcester, MA, USA. FAU - Kapoor, Alok AU - Kapoor A AD - University of Massachusetts Medical School, Worcester, MA, USA. FAU - Saphirak, Cassandra AU - Saphirak C AD - Meyers Primary Care Institute, Worcester, MA, USA. FAU - Handler, Steven M AU - Handler SM AD - University of Pittsburgh, Pittsburgh, PA, USA. FAU - Fisher, Kimberly AU - Fisher K AD - University of Massachusetts Medical School, Worcester, MA, USA. FAU - Johnson, Florence AU - Johnson F AD - Qualidigm, Wethersfield, CT, USA. FAU - Spenard, Ann AU - Spenard A AD - Qualidigm, Wethersfield, CT, USA. FAU - Zhang, Ning AU - Zhang N AD - University of Massachusetts, Amherst, MA, USA. FAU - Gurwitz, Jerry H AU - Gurwitz JH AD - University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, Worcester, MA, USA. LA - eng GR - R01 HS024422/HS/AHRQ HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. DEP - 20210327 PL - United States TA - J Am Med Dir Assoc JT - Journal of the American Medical Directors Association JID - 100893243 SB - IM MH - *Activities of Daily Living MH - Aged MH - Hospitalization MH - Humans MH - *Medicare MH - Nursing Homes MH - Prospective Studies MH - United States OTO - NOTNLM OT - Nursing homes OT - adverse events OT - hospitalization OT - quality indicators OT - transition of care EDAT- 2021/04/01 06:00 MHDA- 2021/10/21 06:00 CRDT- 2021/03/31 05:52 PHST- 2020/12/01 00:00 [received] PHST- 2021/02/08 00:00 [revised] PHST- 2021/02/15 00:00 [accepted] PHST- 2021/04/01 06:00 [pubmed] PHST- 2021/10/21 06:00 [medline] PHST- 2021/03/31 05:52 [entrez] AID - S1525-8610(21)00247-4 [pii] AID - 10.1016/j.jamda.2021.02.027 [doi] PST - ppublish SO - J Am Med Dir Assoc. 2021 Oct;22(10):2196-2200. doi: 10.1016/j.jamda.2021.02.027. Epub 2021 Mar 27.