Original Study
Patient Characteristics Are Not Associated With Documentation of Weight and Heart Failure Related Sign and Symptom Assessment in Skilled Nursing Facilities

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Abstract

Objective

Monitoring body weight and signs and symptoms related to heart failure (HF) can alert clinicians to a patient's worsening condition but the degree to which these practices are performed in skilled nursing facilities (SNFs) is unknown. This study analyzed the frequency of these monitoring practices in SNFs and explored associated factors at both the patient and SNF level.

Design

An observational study of data from the usual care arm of the SNF Connect Trial, a randomized cluster trial of a HF disease management intervention. The data extracted from charts were combined with publicly available facility data. A linear regression model was estimated to evaluate the frequency of HF disease management conditional on patient and facility covariates.

Setting

Data from 28 SNFs in Colorado.

Participants

Patients discharged from hospital to SNFs with a primary or secondary diagnosis of HF.

Measurements

Patient-level covariates included demographics, New York Heart Association class, type of HF, and Charlson comorbidity index. Facility-level covariates were from Nursing Home Compare.

Results

The sample (n = 320) was majority female (66%), white (93%), with mean age 80 ± 10 years and a Charlson comorbidity index of 3.2 ± 1.5. Seventy percent had HF with preserved ejection fraction, mean ejection fraction of 50 ± 16% and 40% with a New York Heart Association class III-IV. On average, patients were weighed 40% of their days in the SNF and had documentation of at least 1 HF-related sign or symptom 70% of their days in the SNF. Patient-level factors were not associated with frequency of documenting weight and assessments of HF-related signs/symptoms. Health Inspection Star Rating was positively associated with weight monitoring (P < .05) but not associated with symptom assessment.

Conclusions and Implications

Patient-level factors are not meaningfully associated with the documentation of weight tracking or sign/symptom assessment. Monitoring weight was instead associated with the Health Inspection Star Rating.

Section snippets

Data

We used data from the SNF Connect Trial, a randomized cluster trial designed to assess the effectiveness of a HF-DM program to improve outcomes for patients with HF in SNFs compared with usual care in Colorado.19 Our sample included data from patients randomized into the usual care arm of the trial since the goal of this study was to measure HF-DM practice as they occur in the absence of an intervention. The study period was from April 2014 to November 2017. Usual care data were collected in 28

Results

Baseline characteristics are described in Table 1. The sample (n = 320) was 66% women, mean age 80 ± 10 years and 70% HFpEF (mean EF 50 ± 16%). Facility characteristics, data publicly reported by CMS Nursing Home Compare, are described in Table 2. Compared with national figures, our sample had a higher proportion of for-profit and chain-affiliated facilities,37 and a lower proportion of Medicaid residents.38

Patients were weighed 40% of their days in the SNF (range: 0%‒100%). A minority of the

Discussion

This study measured how often SNFs document HF patients' weight and assessments of their HF-related signs and symptoms. We found that these practices, helpful in monitoring HF, were not performed often. The frequency of practice was highly variable. Only some facility-level characteristics, Health Inspection Star Ratings, and the percent of Medicaid patients, were positively associated with the frequency of weight monitoring. Characteristics thought to make monitoring practices more

Conclusions and Implications

Patient weights and assessments of HF-related signs and symptoms are inconsistently documented by SNF staff. These nonpharmacologic and noninvasive care practices can provide valuable information to clinical decision-makers. Although it is clinically plausible that patient-level characteristics should affect these practices, our results suggest they do not. High frequency of weight tracking does not appear to be an issue related to the patient. We hypothesized that cognitive impairment would

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  • Cited by (0)

    This project is made possible through grant NIH 5R01HL113387-02.

    The authors declare no conflicts of interest.

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