Journal of the American Medical Directors Association
Original StudyPatient Characteristics Are Not Associated With Documentation of Weight and Heart Failure Related Sign and Symptom Assessment in Skilled Nursing Facilities
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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This project is made possible through grant NIH 5R01HL113387-02.
The authors declare no conflicts of interest.