Inclusion of nursing home status in metric yields better results for dialysis stakeholders
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Researchers of a study in Kidney Medicine recommend the Dialysis Facility Report use a new nursing home metric that separates short-term from long-term care in order to provide more interpretable results for dialysis stakeholders.
According to the study, using home status in metrics are better indicators of mortality.
“The original nursing home status (any nursing home stay in previous calendar year) adjusted in the standardized mortality ratio (SMR) and the standardized hospitalization ratio (SHR) models of the Dialysis Facility Report is a strong predictor of mortality/hospitalization outcomes but does not precisely reflect recent nursing home status or consider the length of nursing home stays,” Shu Chen, MS, from the Kidney Epidemiology and Cost Center at University of Michigan, and colleagues wrote. “We developed a new nursing home metric that effectively separates short-term from long-term nursing home utilization, provides more specific information about nursing home stays in this population and improves the risk adjustment of these important outcome models.”
In a retrospective observational study, researchers examined data of 625,040 patients on maintenance dialysis with more than 90 kidney failure days in 2019 to test the new nursing home metric. Of the population observed, 70,264 were patients from short-term care and 35,322 were from long-term care.
Using the SMR/SHR model, researchers assigned patients and patient times to one of three categories based on nursing home stays in the previous 365 days from the first day of the time period at risk: long-term care ( 90 days), short-term care (1 to 89 days) or non-nursing home. Further, researchers compared the HRs from adjusted models, facility SMR/SHR performance and model C-statistics between the original and new home metric models. With nursing home status variables, patient characteristics and comorbidities as the predictors, researchers considered mortality or hospitalization as primary outcomes of the study.
Analyses revealed the HR of the SMR of original nursing home status was 2.09, which was lower than that of the short-term care (2.38) and long-term care (2.43). The HR of the SHR of original nursing home status was 1.10 compared with 1.01 of long-term care and 1.20 of short-term care.
Researchers observed a small percentage of facilities changed performance categories. The SMR C-statistic improved, although the SHR C-statistic was almost unchanged.
“While all three nursing home metrics evaluated in our research are strong predictors of mortality, when compared to the older solitary nursing home metric, both the short-term care and long-term care metrics result in incremental identification of nursing home use and are stronger predictors of mortality. The short-term care and long-term care metrics also improve identification of nursing home use when applied to the active Medicare-insured subset of patients used for hospitalization modeling,” Chen and colleagues wrote. They added, “In conclusion, adjustment for nursing home status is an important component of the overall risk-adjustment strategy when evaluating U.S. dialysis facility outcomes.”
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