title: Preliminary derivation of a Nursing Home Confusion Assessment Method based on data from the Minimum Data Set.
abstract: 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.
authors.affiliation: Department of Medicine, Brown University, Providence, Rhode Island, USA. ddosa@lifespan.org
authors.forename: David
authors.initials: D
authors.lastname: Dosa
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.forename: Lynn
authors.initials: L
authors.lastname: McNicoll
authors.forename: Yuwei
authors.initials: Y
authors.lastname: Cang
authors.forename: Joan
authors.initials: J
authors.lastname: Teno
mesh_terms: 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