Preliminary derivation of a Nursing Home Confusion Assessment Method based on data from the Minimum Data Set.
OBJECTIVE
To develop a Nursing Home Confusion Assessment Method (NH-CAM) for diagnosing delirium using items found on the Minimum Data Set (MDS) and to compare its performance with that of the delirium Resident Assessment Protocol (RAP) trigger and to an additive score of six of the RAP items.


METHODS
Retrospective cohort study using MDS and Medicare claims data.


METHODS
Free-standing NHs in urban markets in the 48 contiguous U.S. states.


METHODS
Long-stay residents who returned to their NHs after acute hospitalizations between April and September 2000 (N=35,721).


METHODS
Mortality and rehospitalization rates within 90 days of readmission to the NH from the hospital.


RESULTS
Almost one-third (31.8%) of the residents were identified as having delirium according to the RAP; 1.4% had full delirium, 13.2% had Subsyndromal II delirium, and 17.2% had Subsyndromal I delirium. More-severe NH-CAM scores were associated with greater risks of mortality and rehospitalization. NH-CAM levels were strong independent risk factors for survival and rehospitalization in a Cox model (hazard ratios ranging from 1.5 to 1.9 for mortality and 1.1 to 1.3 for rehospitalization) adjusting for cognitive and physical function, diagnoses, inpatient care parameters, care preferences, and sociodemographic factors.


CONCLUSIONS
The NH-CAM successfully stratified NH residents' risk of mortality and rehospitalization. If validated clinically, the NH-CAM may be useful in care planning and in further research on the determinants and consequences of delirium in the NH.
Dosa
David
D
Department of Medicine, Brown University, Providence, Rhode Island, USA. ddosa@lifespan.org
Intrator
Orna
O
McNicoll
Lynn
L
Cang
Yuwei
Y
Teno
Joan
J
D000369:Aged, 80 and over; D003221:Confusion / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003693:Delirium / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D005260:Female; D006304:Health Status; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology