A “Hospital-Day-1” Model to Predict the Risk of Discharge to a Skilled Nursing Facility.

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A "Hospital-Day-1" Model to Predict the Risk of Discharge to a Skilled Nursing Facility.

J Am Med Dir Assoc. 2019 Jun;20(6):689-695.e5

Authors: Oseran AS, Lage DE, Jernigan MC, Metlay JP, Shah SJ

OBJECTIVE: To derive and validate a model to predict a patient's probability of skilled nursing facility (SNF) discharge using data available from day 1 of hospitalization.
DESIGN: Using a retrospective cohort of 11,380 hospitalized patients, we obtained administrative and electronic medical data to identify predictors of SNF discharge.
SETTING AND PARTICIPANTS: Single, urban academic medical center. Patients older than 50 years admitted to the medical service from July 2014 to August 2015.
METHODS: Primary outcome defined as SNF discharge. We split the cohort into derivation and validation sets (80/20). We created 1000 bootstrapped samples of the derivation set and used backward selection logistic regression on each bootstrapped sample. The final model included variables selected in ≥60% of the samples. To create a point-based index, a point value was assigned to each predictor variable relative to the logistic regression coefficient. The model's discrimination, calibration, positive predictive value, and negative predictive value tested in the validation set.
RESULTS: The overall frequency of SNF discharge was 12%. The final model included 11 variables. Significant demographic variables included age, marital status, insurance type, living alone, residence, and distance from hospital. The final model included 2 significant functional variables (mobility, bathing) and 3 significant clinical variables (admission mode, admission diagnosis, admission day of week). Impairment in mobility [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.4-2.2] and impairment in bathing (OR 1.9, 95% CI 1.6-2.4) were both significant predictors of SNF discharge. The final model discriminated well in the validation cohort (c-statistic = 0.82) and was well calibrated.
CONCLUSIONS/IMPLICATIONS: It is possible to predict the day of admission with good accuracy and clinical usability a patient's risk of SNF discharge. The ability to identify early in the hospitalization patients likely to use post-acute services has implications for clinicians, administrators, and policy makers working to improve discharge planning and care transitions.

PMID: 31133235 [PubMed - in process]

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