The following is a summary of “Nursing Home Status Adjustment for Standardized Mortality and Hospitalization in Dialysis Facility Reports,” published in the February 2023 issue of  Kidney Medicine by Chen et al.

New nursing home status variables were developed to replace the original nursing home status (any nursing home stay in the previous calendar year) for use in risk adjustment of Standardized Mortality/Hospitalization Ratio (SMR/SHR) models for public reporting of dialysis quality of care, such as the Annual Dialysis Facility Report. Based on nursing home stay in the past 365 days from the beginning day of the risk period, researchers assigned patients and patient times (SMR/SHR model) to one of three mutually exclusive categories: long-term care (≥90 days), short-term care (1-89 days), or non-nursing home. The Nursing Home Minimum Data Set was used to determine the nursing home status of each facility. The original and revised models were compared using measures such as hazard ratios from the adjusted models, SMR/SHR performance at the facility, and model C-statistics. 

Both short-term care (2.38) and long-term care (2.43 times the risk) were lower than the hazard ratio of original nursing home status (2.09) for SMR. In contrast, the hazard ratio of original nursing home status (1.10) for SHR fell between these two values (1.20). Short-term care was associated with lower hazard ratios than long-term care was for both outcomes. 

Just 0.7% of SMR facilities and 0.4% of SHR facilities switched performance categories. The SHR C-statistic did not alter significantly; however, the SMR C-statistic did. Using a 90-day cutoff for short-term and long-term care limits the capture of subacute rehabilitation stays in the nursing home; this makes it impossible to draw causal inferences regarding nursing home care. More interpretable data for dialysis stakeholders may arise from using a nursing home indicator that successfully distinguishes between short-term and long-term nursing home utilization.

Source: sciencedirect.com/science/article/pii/S2590059522002138