Cognitive Status of Older Adults on Admission to a Skilled Nursing Facility According to a Hospital Discharge Diagnosis of Dementia

Brian Downer, Kali S. Thomas, Vincent Mor, James Goodwin, Kenneth Ottenbacher

Research output: Contribution to journalArticle

Abstract

Objective: Describe the cognitive status on admission to a skilled nursing facility (SNF) according to a hospital discharge diagnosis of dementia in a national sample of Medicare beneficiaries. Design: Retrospective cohort design. Setting: SNFs in the United States. Participants: Medicare-fee-for-service beneficiaries newly admitted to an SNF within 3 days of discharge from an acute hospital during 2013-2014 (n = 1,885,015). Measurements: Beneficiaries with a discharge diagnosis of dementia were identified using ICD-9 CM codes from the Medicare Provider Analysis and Review (MedPAR) Part A file. Cognitive status at SNF admission was classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired according to the Cognitive Function Scale using items in the Minimum Data Set 3.0. Results: For beneficiaries with a discharge diagnosis of dementia (n = 252,970), 17.9% were classified as cognitively intact, 25.8% were mildly impaired, and 56.3% were moderately or severely impaired on SNF admission. Approximately 65% of beneficiaries without a hospital diagnosis of dementia were cognitively intact on admission to an SNF, whereas 13.1% were classified as moderately or severely impaired. Conclusion: Medicare beneficiaries with a hospital diagnosis of dementia are often classified as cognitively intact or mildly impaired on admission to an SNF. These findings provide evidence that a hospital diagnosis of dementia might not always reflect cognitive status on admission to an SNF.

Original languageEnglish (US)
JournalJournal of the American Medical Directors Association
DOIs
StateAccepted/In press - 2017

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Skilled Nursing Facilities
Dementia
Medicare
Fee-for-Service Plans
International Classification of Diseases
Cognition

Keywords

  • Cognition
  • Dementia
  • Skilled nursing facilities

ASJC Scopus subject areas

  • Nursing(all)
  • Medicine(all)
  • Health Policy

Cite this

@article{638cb735a0f24fad8465078cd1f22eb9,
title = "Cognitive Status of Older Adults on Admission to a Skilled Nursing Facility According to a Hospital Discharge Diagnosis of Dementia",
abstract = "Objective: Describe the cognitive status on admission to a skilled nursing facility (SNF) according to a hospital discharge diagnosis of dementia in a national sample of Medicare beneficiaries. Design: Retrospective cohort design. Setting: SNFs in the United States. Participants: Medicare-fee-for-service beneficiaries newly admitted to an SNF within 3 days of discharge from an acute hospital during 2013-2014 (n = 1,885,015). Measurements: Beneficiaries with a discharge diagnosis of dementia were identified using ICD-9 CM codes from the Medicare Provider Analysis and Review (MedPAR) Part A file. Cognitive status at SNF admission was classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired according to the Cognitive Function Scale using items in the Minimum Data Set 3.0. Results: For beneficiaries with a discharge diagnosis of dementia (n = 252,970), 17.9{\%} were classified as cognitively intact, 25.8{\%} were mildly impaired, and 56.3{\%} were moderately or severely impaired on SNF admission. Approximately 65{\%} of beneficiaries without a hospital diagnosis of dementia were cognitively intact on admission to an SNF, whereas 13.1{\%} were classified as moderately or severely impaired. Conclusion: Medicare beneficiaries with a hospital diagnosis of dementia are often classified as cognitively intact or mildly impaired on admission to an SNF. These findings provide evidence that a hospital diagnosis of dementia might not always reflect cognitive status on admission to an SNF.",
keywords = "Cognition, Dementia, Skilled nursing facilities",
author = "Brian Downer and Thomas, {Kali S.} and Vincent Mor and James Goodwin and Kenneth Ottenbacher",
year = "2017",
doi = "10.1016/j.jamda.2017.04.021",
language = "English (US)",
journal = "Journal of the American Medical Directors Association",
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AU - Thomas, Kali S.

AU - Mor, Vincent

AU - Goodwin, James

AU - Ottenbacher, Kenneth

PY - 2017

Y1 - 2017

N2 - Objective: Describe the cognitive status on admission to a skilled nursing facility (SNF) according to a hospital discharge diagnosis of dementia in a national sample of Medicare beneficiaries. Design: Retrospective cohort design. Setting: SNFs in the United States. Participants: Medicare-fee-for-service beneficiaries newly admitted to an SNF within 3 days of discharge from an acute hospital during 2013-2014 (n = 1,885,015). Measurements: Beneficiaries with a discharge diagnosis of dementia were identified using ICD-9 CM codes from the Medicare Provider Analysis and Review (MedPAR) Part A file. Cognitive status at SNF admission was classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired according to the Cognitive Function Scale using items in the Minimum Data Set 3.0. Results: For beneficiaries with a discharge diagnosis of dementia (n = 252,970), 17.9% were classified as cognitively intact, 25.8% were mildly impaired, and 56.3% were moderately or severely impaired on SNF admission. Approximately 65% of beneficiaries without a hospital diagnosis of dementia were cognitively intact on admission to an SNF, whereas 13.1% were classified as moderately or severely impaired. Conclusion: Medicare beneficiaries with a hospital diagnosis of dementia are often classified as cognitively intact or mildly impaired on admission to an SNF. These findings provide evidence that a hospital diagnosis of dementia might not always reflect cognitive status on admission to an SNF.

AB - Objective: Describe the cognitive status on admission to a skilled nursing facility (SNF) according to a hospital discharge diagnosis of dementia in a national sample of Medicare beneficiaries. Design: Retrospective cohort design. Setting: SNFs in the United States. Participants: Medicare-fee-for-service beneficiaries newly admitted to an SNF within 3 days of discharge from an acute hospital during 2013-2014 (n = 1,885,015). Measurements: Beneficiaries with a discharge diagnosis of dementia were identified using ICD-9 CM codes from the Medicare Provider Analysis and Review (MedPAR) Part A file. Cognitive status at SNF admission was classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired according to the Cognitive Function Scale using items in the Minimum Data Set 3.0. Results: For beneficiaries with a discharge diagnosis of dementia (n = 252,970), 17.9% were classified as cognitively intact, 25.8% were mildly impaired, and 56.3% were moderately or severely impaired on SNF admission. Approximately 65% of beneficiaries without a hospital diagnosis of dementia were cognitively intact on admission to an SNF, whereas 13.1% were classified as moderately or severely impaired. Conclusion: Medicare beneficiaries with a hospital diagnosis of dementia are often classified as cognitively intact or mildly impaired on admission to an SNF. These findings provide evidence that a hospital diagnosis of dementia might not always reflect cognitive status on admission to an SNF.

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