External Validation of the Skilled Nursing Facility Prognosis Score for Predicting Mortality, Hospital Readmission, and Community Discharge in Veterans.

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  • Additional Information
    • Source:
      Publisher: Blackwell Science Country of Publication: United States NLM ID: 7503062 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-5415 (Electronic) Linking ISSN: 00028614 NLM ISO Abbreviation: J Am Geriatr Soc Subsets: MEDLINE
    • Publication Information:
      Publication: Malden, MA : Blackwell Science
      Original Publication: New York [etc.]
    • Subject Terms:
      Predictive Value of Tests* ; Skilled Nursing Facilities* ; Subacute Care*; Mortality/*trends ; Patient Discharge/*statistics & numerical data ; Patient Readmission/*statistics & numerical data; Aged ; Aged, 80 and over ; Comorbidity ; Female ; Heart Failure ; Hospitalization ; Humans ; Male ; Medicaid ; Medicare/statistics & numerical data ; Retrospective Studies ; United States ; Veterans/statistics & numerical data
    • Abstract:
      Background/objectives: Prognostic tools are needed to identify patients at high risk for adverse outcomes receiving post-acute care in skilled nursing facilities (SNFs) and provide high-value care. The SNF Prognosis Score was developed in a Medicare sample to predict a composite of long-term SNF stay, hospital readmission, or death during the SNF stay. Our goal was to evaluate the score's performance in an external validation cohort.
      Design: Retrospective observational analysis.
      Setting: We used a Veterans Administration (VA) Residential History File that concatenates VA, Medicare, and Medicaid claims to identify care trajectories across settings and payers for individual veterans.
      Participants: Previously community-dwelling veterans receiving post-acute care in a SNF after hospitalization from January 1, 2012, to December 31, 2014. Both VA and non-VA hospitals and SNFs were included.
      Measurements: We calculated the five-item SNF Prognosis Score for all eligible veterans in our sample and determined its discrimination (using a receiver operating characteristic curve) and calibration (plotting observed and expected events).
      Results: The 386,483 veterans in our sample had worse physical function, more comorbidities, and were more likely to be treated for heart failure, but they had shorter index hospital lengths of stay and fewer catheters than the original Medicare cohort. The SNF Prognosis Score had similar discrimination (C-statistic = .70; .75 in the derivation cohort) and calibration at low to moderate levels of risk; at high levels, calibration was poorer with the score overestimating risks of adverse events.
      Conclusion: The SNF Prognosis Score has reasonable discrimination and calibration, and it is simple to calculate using an admission SNF assessment and a nomogram. Future work embedding the score into practice is needed to determine real-world feasibility, acceptability, and effectiveness.
      (© 2020 The American Geriatrics Society.)
    • Comments:
      Comment in: J Am Geriatr Soc. 2020 Sep;68(9):1931-1932. (PMID: 32609882)
      Comment in: J Am Geriatr Soc. 2020 Sep;68(9):1933-1935. (PMID: 32853396)
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    • Grant Information:
      IK2 HX001796 United States HX HSRD VA; T32HS026116-02 United States HS AHRQ HHS; 1IK2 HX001796 United States HX HSRD VA
    • Contributed Indexing:
      Keywords: advance care planning; post-acute care; prognostic score; skilled nursing facility
    • Publication Date:
      Date Created: 20200702 Date Completed: 20210311 Latest Revision: 20210311
    • Publication Date:
      20240513
    • Accession Number:
      10.1111/jgs.16650
    • Accession Number:
      32609892