TY - JOUR
T1 - Institutional Special Needs Plans and Hospice Enrollment in Nursing Homes
T2 - A National Analysis
AU - Dhingra, Lara
AU - Lipson, Karen
AU - Dieckmann, Nathan F.
AU - Chen, Jack
AU - Bookbinder, Marilyn
AU - Portenoy, Russell
N1 - Funding Information:
We wish to thank Seth Retig and Stuart Geller and Metropolitan Jewish Health System (MJHS) Information Systems for their assistance with data management, James Clyne at LeadingAge New York for supporting this research collaboration, and Linda Spokane and Dr Rui Cheng for their input on the planned methods. Financial Disclosure: We gratefully acknowledge The Patrick and Catherine Weldon Donaghue Medical Research Foundation for their generous support of our work. Conflict of Interest: The authors have no conflicts. Author Contributions: All authors have participated sufficiently in this study to take responsibility for authorship and publication. Lara Dhingra, Russell Portenoy, Karen Lipson, Jack Chen, and Marilyn Bookbinder made substantial contributions to the design of the study and writing of the manuscript. Nathan Dieckmann made substantial contributions to the data analysis and writing of the manuscript. All authors contributed to interpreting the results and have approved the final manuscript. Sponsor's Role: None
Funding Information:
Financial Disclosure: We gratefully acknowledge The Patrick and Catherine Weldon Donaghue Medical Research Foundation for their generous support of our work.
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2019/12/1
Y1 - 2019/12/1
N2 - BACKGROUND: Institutional Special Needs Plans (I-SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship. OBJECTIVE: To determine whether I-SNP availability has been associated with changes in hospice utilization. DESIGN: Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I-SNP–, resident-, and facility-related variables as predictors of hospice utilization. SETTING: All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732). PARTICIPANTS: Nursing home residents enrolled in Medicare or in both Medicare and Medicaid. MEASUREMENTS: Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report. RESULTS: The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I-SNP contracts in nursing homes increased between 2011 and 2013, from 55.2% (N = 8691) to 61.1% (N = 9605), respectively (P <.001). In multivariate analyses, greater hospice enrollment in nursing homes was associated with having at least one I-SNP enrollee per month; year (2013 higher than 2011); smaller facility size; urban (vs rural) setting; location in the Northeast (vs Midwest); lower average resident mental status; higher average resident mobility; younger residents, on average; and facilities with higher proportions of residents with specific diagnoses (cancer, cirrhosis, and dementia). After adjusting for resident and nursing home characteristics, the association between monthly I-SNP presence and hospice enrollment was found only in nursing homes with 50 or greater beds and there was a positive relationship with increasing size. CONCLUSIONS: Growth of I-SNPs has been associated with changes in hospice utilization, and the relationship varies by facility size. Studies are needed to clarify the nature of this association and determine whether care may be improved through coordination of these programs. J Am Geriatr Soc 67:2537–2544, 2019.
AB - BACKGROUND: Institutional Special Needs Plans (I-SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship. OBJECTIVE: To determine whether I-SNP availability has been associated with changes in hospice utilization. DESIGN: Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I-SNP–, resident-, and facility-related variables as predictors of hospice utilization. SETTING: All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732). PARTICIPANTS: Nursing home residents enrolled in Medicare or in both Medicare and Medicaid. MEASUREMENTS: Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report. RESULTS: The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I-SNP contracts in nursing homes increased between 2011 and 2013, from 55.2% (N = 8691) to 61.1% (N = 9605), respectively (P <.001). In multivariate analyses, greater hospice enrollment in nursing homes was associated with having at least one I-SNP enrollee per month; year (2013 higher than 2011); smaller facility size; urban (vs rural) setting; location in the Northeast (vs Midwest); lower average resident mental status; higher average resident mobility; younger residents, on average; and facilities with higher proportions of residents with specific diagnoses (cancer, cirrhosis, and dementia). After adjusting for resident and nursing home characteristics, the association between monthly I-SNP presence and hospice enrollment was found only in nursing homes with 50 or greater beds and there was a positive relationship with increasing size. CONCLUSIONS: Growth of I-SNPs has been associated with changes in hospice utilization, and the relationship varies by facility size. Studies are needed to clarify the nature of this association and determine whether care may be improved through coordination of these programs. J Am Geriatr Soc 67:2537–2544, 2019.
KW - Institutional Special Needs Plans
KW - Medicare
KW - aging
KW - hospice enrollment
KW - nursing homes
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U2 - 10.1111/jgs.16103
DO - 10.1111/jgs.16103
M3 - Article
C2 - 31403706
AN - SCOPUS:85071178446
SN - 0002-8614
VL - 67
SP - 2537
EP - 2544
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 12
ER -