Characteristics of Skilled Nursing Facilities Associated with Healthcare-Associated Infections Requiring Hospitalization, October 1, 2020 - September 31, 2021 Open Access
Walker, Lindsey (Spring 2024)
Abstract
Introduction
The burden of healthcare-associated infections (HAIs) among skilled nursing facilities is high. The Centers for Medicare and Medicaid Services (CMS) reports a risk standardized rate of HAIs requiring hospitalization per 100 resident stays annually for nursing homes in the United States. We aimed to identify associations between skilled nursing facility characteristics and the HAI rate.
Methods
Nursing home facility characteristics and quality measures from October 1, 2020 – September 31, 20201 for 15,082 SNFs were extracted from Nursing Home Compare. We described the risk standardized risk of HAIs requiring hospitalization overall and by nursing home characteristics including nursing home region, ownership, bed size, urbanicity, ventilator care capability, location within hospital, and the minority health social vulnerability index of the county the nursing home resided in. Multivariable linear regression models were used to assess which characteristics associated with increased rate of HAIs requiring hospitalization.
Results
A risk-standardized rate of HAIs requiring hospitalization was reported for 11,883 nursing homes (77%); the overall mean was 7.70 (95% CI: 7.67, 7.73). In multivariable models, we identified region, urbanicity, bed size, and MH-SVI as associated with the HAI rate. Notably, the rate of HAIs requiring hospitalization increased as the social vulnerability of the county the nursing home was located in increased. Additionally, an increase in 0.1 RN hours per resident per day (i.e., one additional RN 8-hour shift at nursing home with 80 beds) leads to 4% fewer HAIs requiring hospitalization.
Conclusion
An increase in star rating (quality, short-stay, long-stay, staffing, and health inspection) is associated with a decrease in HAI rate. Increased vulnerabilities and comorbidities of short-stay residents (i.e., residents with pressure ulcers and prescribed antipsychotic medications) are associated with a higher HAI rate.
Interventions and outreach efforts from federal and state HAI programs targeting improvements in resident discharge, standardization of care, increased RN staffing hours, and support of communities with high levels of vulnerability should be prioritized for better quality of care and infection reduction among nursing homes.
Table of Contents
Abstract .................................................................................................................................4
Introduction .........................................................................................................................9
Nursing Homes and their Residents in the United States ...................................................9
Vulnerabilities of Nursing Home Residents .....................................................................9
Healthcare-associated Infections and Infection Prevention in Nursing Home Settings...........9
Nursing Home Quality and Regulation ..........................................................................11
CMS Quality Measures Related to Preventable Infections and HAIs...................................11
Minimum Data Set .....................................................................................................12
Medicare Claims Quality Measures...............................................................................12
Components of the CMS Five-Star Rating Measures........................................................13
Quality .....................................................................................................................13
Health Inspection Five-Star Rating ...............................................................................13
Staffing Five-Star Rating..............................................................................................13
Skilled Nursing Facility Quality Reporting Program..........................................................14
Healthcare-Associated Infections Requiring Hospitalizations Measure ...............................14
Analytic Objectives.....................................................................................................16
Methods ................................................................................................................................16
Data Source ...............................................................................................................16
Analytic Methods ........................................................................................................17
Objective One..............................................................................................................18
Objective Two .............................................................................................................18
Results ...................................................................................................................................20
Characteristics of Nursing Homes...................................................................................20
Correlation of Continuous Quality Measures ...................................................................26
Short-Stay Elements ....................................................................................................26
Long-Stay Elements .................................................................................................... 26
Staffing Elements.........................................................................................................27
Multivariable Regression Models ...................................................................................27
Components of Overall Five-Star Rating .........................................................................27
Subcomponents of Short-Stay Five-Star Rating.................................................................30
Subcomponents of Long-Stay Five-Star Rating ................................................................31
Subcomponents of Staffing Five-Star Rating.................................................................... 32
Discussion...............................................................................................................................32
Novel Findings.............................................................................................................32
Limitations .................................................................................................................35
Strengths ...................................................................................................................37
Public Health Implications ...........................................................................................37
References..............................................................................................................................38
Tables and Figures................................................................................................................42
Appendix...............................................................................................................................62
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