Evidence map›Paper›PMID 38041834›Full record

ArticleJournal of the American Geriatrics Society2024

Impact of dementia special care units for short-stay nursing home patients.

Amanda C Chen, Arnold M Epstein, Karen E Joynt Maddox, David C Grabowski, E John Orav, Michael L Barnett

Open access · greenAbstract read
In one paragraph

Article in Journal of the American Geriatrics Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
2.2field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Amanda C ChenHarvard Graduate School of Arts and Sciences, Cambridge, Massachusetts, USA.ORCID 0000-0003-3933-8570
Arnold M EpsteinDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Karen E Joynt MaddoxCardiovascular Division, Department of Medicine, Washington University School of Medicine and Center for Advancing Health Services, Policy and Economics Research, Institute of Public Health at Washington University, St. Louis, Missouri, USA.ORCID 0000-0003-3779-8653
David C GrabowskiDepartment of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
E John OravDivision of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Michael L BarnettDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.ORCID 0000-0002-4884-6609
Harvard University · USBrigham and Women's Hospital · USWashington University in St. Louis · US

Funding

Improving the Quality of Care Provided Through Bundled Payments for Patients with Alzheimer's Disease or Other Forms of Dementia or FrailtyR01AG060935 · NIA · HARVARD SCHOOL OF PUBLIC HEALTH · PI EPSTEIN, ARNOLD, JOYNT MADDOX, KAREN ELLEN · 2019 to 2021
$2.7M
The Changing Landscape of Post-Acute Care and Health Outcomes for Older AdultsK23AG058806 · NIA · HARVARD SCHOOL OF PUBLIC HEALTH · PI BARNETT, MICHAEL LAWRENCE · 2018 to 2022
$1.0M
NIA NIH HHS K23 AG058806NIA NIH HHS R01 AG060935
6 · The paper itself

Abstract

backgroundImproving quality of care provided to short-stay patients with dementia in nursing homes is a policy priority. However, it is unknown whether dementia-focused care strategies are associated with improved clinical outcomes or lower utilization and costs for short-stay dementia patients.

methodsWe performed a national survey of nursing home administrators in 2020-2021, asking about the presence of three dementia-focused care services used for their short-stay patients: (1) a dementia care unit, (2) cognitive deficiency training for staff, and (3) dementia-specific occupational therapy. Using Medicare claims, we identified short-stay episodes for beneficiaries residing in surveyed skilled nursing facilities (SNFs) with and without dementia. We compared clinical, cost, and utilization outcomes for dementia patients in SNFs, which did and did not offer dementia-focused care services. As a counterfactual control, we compared these differences to those for non-dementia patients in the same facilities. Our primary quantity of interest was an interaction term between a patients' dementia status and the presence of a dementia-focused care tool.

resultsThe study population included 102,860 Medicare episodes of care from 377 SNF survey respondents in 2018-2019. In adjusted comparisons of the interaction between dementia status and the presence of each dementia-focused care tool, dementia care units were associated with a 1.5-day increase in healthy days at home in the 90 days following discharge (p = 0.01) and a 3.1% decrease in the likelihood of a subsequent SNF admission (p = 0.001). Cognitive deficiency training was also associated with a 2.0% increase in antipsychotics (p = 0.03), whereas dementia-specific occupational therapy was associated with a 1.2% increase in falls (p = 0.01) per patient episode.

conclusionsSelf-reported use of dementia care units for short-stay patients was associated with modestly better performance in some, but not all, outcome measures. This provides hypothesis-generating evidence that dementia care units could be a promising mechanism to improve care delivery in nursing homes.

Indexed as

DementiaSkilled Nursing FacilitiesAgedHospitalizationHumansMedicarePatient DischargeUnited Statesdementianursing homeshort-stay patients

Identifiers

PMID38041834
PMCPMC10947952
OpenAlexW4389263691

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.