Transitions between SNF and home-based care in patients with multiple sclerosis.
OBJECTIVE
To assess patient characteristics and risk factors associated with care transitions between skilled nursing facility (SNF) and home care for patients with multiple sclerosis (MS) in an effort to improve outcomes and optimize patient care pathways.


BACKGROUND
MS is a chronic neurologic illness of younger adults that is associated with physical disability, cognitive impairment and a high need for supportive services.


METHODS
The study was based on the 2005 Nursing Home Minimum Data Set and the Outcome and Assessment Information Set data (n = 10,064). We performed multivariate evaluation of patient risk factors for skilled nursing facility (SNF) admission and disposition while controlling for potential patient self-selection and other characteristics that affect care utilization.


RESULTS
MS patients with recent history of home care use were less likely to be admitted to an acute care hospital and had higher physical disability at SNF admission than SNF patients who did not use home care. Insurance type (Medicaid) and availability of informal caregivers were associated with the use of homecare services after a SNF stay, while patient demographic and clinical characteristics did not explain SNF disposition.


CONCLUSIONS
Future studies should explore the association between the local availability and affordability of home-based services and physician attitude about community-based care management of disabled patients.
Department of Surgery, University of Rochester School of Medicine, Rochester, NY, USA Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY, USA.
Katia
K
Noyes
Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY, USA.
Alina
A
Bajorska
Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY, USA.
Erin B
EB
Wasserman
Jacobs Neurologic Institute, State University of New York at Buffalo, New York, NY, USA.
Bianca
B
Weinstock-Guttman
Department of Medicine and Health Policy Research Institute, University of California, Irvine, CA, USA.
Dana
D
Mukamel
D017028:Caregivers; D003072:Cognition Disorders / Q000451:nursing; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000451:nursing*; D015999:Multivariate Analysis; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012307:Risk Factors; D012866:Skilled Nursing Facilities; D012959:Socioeconomic Factors; D014481:United States
Multiple Sclerosis (MS); Skilled nursing facility (SNF); cognitive impairment; disability; home health care (HHC)