Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study
Abstract Objectives We examined which resident-level clinical factors influence the provision of a recent medical care visit in nursing homes (NHs). Design Multi-site cross-sectional. Setting and participants We extracted data on 3,556 NH residents from 18 NH facilities in Ontario, Canada, who recei...
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-022-03011-9 |
| _version_ | 1818022447448850432 |
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| author | Rebecca H. Correia Fabrice I. Mowbray Darly Dash Paul R. Katz Andrea Moser Ryan P. Strum Aaron Jones Ahmad von Schlegell Andrew P. Costa |
| author_facet | Rebecca H. Correia Fabrice I. Mowbray Darly Dash Paul R. Katz Andrea Moser Ryan P. Strum Aaron Jones Ahmad von Schlegell Andrew P. Costa |
| author_sort | Rebecca H. Correia |
| collection | DOAJ |
| description | Abstract Objectives We examined which resident-level clinical factors influence the provision of a recent medical care visit in nursing homes (NHs). Design Multi-site cross-sectional. Setting and participants We extracted data on 3,556 NH residents from 18 NH facilities in Ontario, Canada, who received at minimum, an admission and first-quarterly assessment with the Resident Assessment Instrument Minimum Data Set (MDS) 2.0 between November 1, 2009, and October 31, 2017. Methods We conducted a secondary analysis of routinely collected MDS 2.0 data. The provision of a recent medical care visit by a physician (or authorized clinician) was assessed in the 14-day period preceding a resident’s first-quarterly MDS 2.0 assessment. We utilized best-subset multivariable logistic regression to model the adjusted associations between resident-level clinical factors and a recent medical care visit. Results Two thousand eight hundred fifty nine (80.4%) NH residents had one or more medical care visits prior to their first-quarterly MDS 2.0 assessment. Six clinically relevant factors were identified to be associated with recent medical care visits in the final model: exhibiting wandering behaviours (OR = 1.34, 95% CI 1.09 – 1.63), presence of a pressure ulcer (OR = 1.37, 95% CI 1.05 – 1.78), a urinary tract infection (UTI) (OR = 1.52, 95% CI 1.06 – 2.18), end-stage disease (OR = 9.70, 95% CI 1.32 – 71.02), new medication use (OR = 1.31, 95% CI 1.09 – 1.57), and analgesic use (OR = 1.24, 95% CI 1.03 – 1.49). Conclusions and implications Our findings suggest that resident-level clinical factors drive the provision of medical care visits following NH admission. Clinical factors associated with medical care visits align with the minimum competencies expected of physicians in NH practice, including managing safety risks, infections, medications, and death. Ensuring that NH physicians have opportunities to acquire and strengthen these competencies may be transformative to meet the ongoing needs of NH residents. |
| first_indexed | 2024-12-10T03:28:34Z |
| format | Article |
| id | doaj.art-ff0270f12c264fc9a0caf2e872097714 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-10T03:28:34Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-ff0270f12c264fc9a0caf2e8720977142022-12-22T02:03:52ZengBMCBMC Geriatrics1471-23182022-04-0122111010.1186/s12877-022-03011-9Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional studyRebecca H. Correia0Fabrice I. Mowbray1Darly Dash2Paul R. Katz3Andrea Moser4Ryan P. Strum5Aaron Jones6Ahmad von Schlegell7Andrew P. Costa8Department of Health Research Methods, Evidence, and Impact, McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact, McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact, McMaster UniversityDepartment of Geriatrics, Florida State University College of MedicineDepartment of Family and Community Medicine, University of TorontoDepartment of Health Research Methods, Evidence, and Impact, McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact, McMaster UniversityTrillium Health PartnersDepartment of Health Research Methods, Evidence, and Impact, McMaster UniversityAbstract Objectives We examined which resident-level clinical factors influence the provision of a recent medical care visit in nursing homes (NHs). Design Multi-site cross-sectional. Setting and participants We extracted data on 3,556 NH residents from 18 NH facilities in Ontario, Canada, who received at minimum, an admission and first-quarterly assessment with the Resident Assessment Instrument Minimum Data Set (MDS) 2.0 between November 1, 2009, and October 31, 2017. Methods We conducted a secondary analysis of routinely collected MDS 2.0 data. The provision of a recent medical care visit by a physician (or authorized clinician) was assessed in the 14-day period preceding a resident’s first-quarterly MDS 2.0 assessment. We utilized best-subset multivariable logistic regression to model the adjusted associations between resident-level clinical factors and a recent medical care visit. Results Two thousand eight hundred fifty nine (80.4%) NH residents had one or more medical care visits prior to their first-quarterly MDS 2.0 assessment. Six clinically relevant factors were identified to be associated with recent medical care visits in the final model: exhibiting wandering behaviours (OR = 1.34, 95% CI 1.09 – 1.63), presence of a pressure ulcer (OR = 1.37, 95% CI 1.05 – 1.78), a urinary tract infection (UTI) (OR = 1.52, 95% CI 1.06 – 2.18), end-stage disease (OR = 9.70, 95% CI 1.32 – 71.02), new medication use (OR = 1.31, 95% CI 1.09 – 1.57), and analgesic use (OR = 1.24, 95% CI 1.03 – 1.49). Conclusions and implications Our findings suggest that resident-level clinical factors drive the provision of medical care visits following NH admission. Clinical factors associated with medical care visits align with the minimum competencies expected of physicians in NH practice, including managing safety risks, infections, medications, and death. Ensuring that NH physicians have opportunities to acquire and strengthen these competencies may be transformative to meet the ongoing needs of NH residents.https://doi.org/10.1186/s12877-022-03011-9Medical visitsNursing homeLong-term careNursing home physician |
| spellingShingle | Rebecca H. Correia Fabrice I. Mowbray Darly Dash Paul R. Katz Andrea Moser Ryan P. Strum Aaron Jones Ahmad von Schlegell Andrew P. Costa Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study BMC Geriatrics Medical visits Nursing home Long-term care Nursing home physician |
| title | Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study |
| title_full | Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study |
| title_fullStr | Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study |
| title_full_unstemmed | Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study |
| title_short | Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study |
| title_sort | clinical factors associated with recent medical care visits in nursing homes a multi site cross sectional study |
| topic | Medical visits Nursing home Long-term care Nursing home physician |
| url | https://doi.org/10.1186/s12877-022-03011-9 |
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