Causes of Increasing Mortality in a Nursing Home Population

摘要: OBJECTIVE: To examine the roles played by changes in case-mix, quality of care, and aggressiveness care explaining 42% increase mortality Medicaid nursing home population Hennepin County, Minnesota, between 1984 1988. DESIGN: Retrospective chart review. SETTING: All homes MN, that for patients. PATIENTS: A random sample 1605 residents from 1988 stratified year whether resident died year. Sampling was disproportionate to allow approximately 400 individuals per stratum. total 1405 charts (87%) were reviewed; remainder either lost or destroyed. MAIN OUTCOME MEASURES: Measures included case-mix (Charlson index, functional status, implicit reviewer assigned severity [range 1–4]), (orders limiting care), (process tracer conditions 1–5], falls), death. RESULTS: Implicitly rated illness worsened (2.77 vs 2.91; P = .009), but other measures unchanged. greater percentage had a DNR order (12% 37% 1988; < .001), more received less aggressive (31% 40%; .006). Overall process improved (2.88 3.01; .05). With adjustment rates with logistic regression controlling age gender, alone accounted than 5% rate change 1988, 49%, nearly 100%. CONCLUSIONS: The became sicker improved. These modest effect on rate. accounts all mortality. J Am Geriatr Soc 44:258–264, 1996.