Patterns and determinants of health services use and mortality after VA nursing home care

TitlePatterns and determinants of health services use and mortality after VA nursing home care
Publication TypeJournal Article
Year of Publication1996
AuthorsWilliams B.C, Fries B.E, Mehr D.R
JournalJournal of Aging & Health
Volume8
Issue2
Pagination280-301
Date PublishedMay
Accession Number10160562
Keywords*Health Services, *Hospitalization, *Mortality, *Patient Readmission, *Survival Analysis, Cohort Studies, Human, Male, Multivariate Analysis, Nursing Homes, Risk Assessment, Risk Factors, Support, U.S. Gov't, Non-P.H.S., Veterans
Abstract

Risk factors for institutionalization and death for up to four years for a nationwide cohort (n = 6,488) of males discharged alive from Department of Veterans Affairs (DVA) nursing homes were identified through linked records of the DVA. Two-year cumulative probabilities of nursing home readmission, hospitalization, and death among nursing home dischargees were 0.30, 0.61, and 0.24, respectively. Using multivariate survival analyses, chronic functional impairments and past nursing home use were important predictors of nursing home readmission, whereas hospitalizations for exacerbations of chronic medical conditions were predictors of hospitalization and death. Past hospitalizations predicted all three outcomes. Differences in risk factors for nursing home readmission as compared with hospitalization or death among DVA nursing home dischargees suggest that high-risk patients can be identified at nursing home discharge and that different types of interventions will be necessary to decrease nursing home readmission as compared with hospitalization or death. Future development of linked record systems across multiple settings, both within and outside the DVA, will help to further characterize persons at high risk of institutionalization or death and to design and evaluate targeted interventions to decrease this risk.

Short TitleJ Aging HealthJ Aging Health
Alternate JournalJ Aging Health