Factors affecting nursing home medical review Implications for program and facility planning

Area of Science:

• Gerontology
• Health Services Research
• Public Health Policy

Background:

• The Rhode Island Medical Review system, operational since 1973, assesses nursing home patient care levels.
• Understanding factors influencing care recommendations is crucial for optimizing resource allocation and patient outcomes.

Purpose of the Study:

• To analyze the factors affecting the recommended level of care for skilled nursing patients.
• To investigate the relationship between patient characteristics, facility type, and reviewer recommendations.

Main Methods:

• Review of 1,309 skilled nursing patients' medical records and reviewer recommendations.
• Statistical analysis correlating patient medical condition, need for skilled nursing care, and facility characteristics with care level assignments.

Main Results:

• Patient medical condition and need for skilled nursing care strongly correlated with recommended care levels.
• Facility licensing status significantly influenced recommendations; patients in multi-level (SN/ICF) facilities were more likely to receive lower care level recommendations than those in single-level (SN) facilities.
• This facility effect persisted even after controlling for patient characteristics, particularly for patients with questionable need for skilled nursing care.

Conclusions:

• A reluctance to relocate patients may contribute to lower care level recommendations in certain facility types.
• Facilities offering a spectrum of services and multiple care levels may be best suited for long-term care patients with complex medical and social needs.