Nursing Home Star Ratings and New Onset of Depression in Long-Stay Nursing Home Residents
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UMass Chan Affiliations
Department of Population and Quantitative Health SciencesClinical and Population Health Research Program, Graduate School of Biomedical Sciences
Document Type
Journal ArticlePublication Date
2019-10-01Keywords
Nursing home star ratingdepression
depressive symptoms
long-stay nursing home residents
quality of care
Diagnosis
Geriatrics
Health Services Administration
Health Services Research
Mental and Social Health
Psychiatry and Psychology
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OBJECTIVES: To examine the association between nursing home (NH) quality and new onset of depression and severity of depressive symptoms in a national cohort of long-stay NH residents in the United States. DESIGN: Cohort study. SETTING AND PARTICIPANTS: 129,837 long-stay residents without indicators of depression admitted to 13,921 NHs. METHODS: NH quality was measured by Nursing Home Compare star ratings (overall, health inspection, staffing, quality measures) closest to admission. Study outcomes at 90 days from the Minimum Data Set 3.0 included depression diagnosis and severity of depressive symptoms (minimal; mild; moderate; moderately severe/severe). Symptoms were measured by resident self-report Patient Health Questionnaire (PHQ-9) or a staff-report observational version (PHQ-9-OV). Logistic and multinomial logistic models with generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: At 90 days postadmission, 14.1% of residents had a new diagnosis of depression, and odds did not differ across star ratings. Nearly 90% of these residents had minimal depressive symptoms, with only 8.5% reporting mild symptoms and 2.6% with moderate to severe symptoms. Using minimal depressive symptoms as the reference, residents in NHs with 5-star overall ratings were 12% less likely than those in 3-star NHs to experience mild (95% CI: 0.81-0.96) and 31% less likely to experience moderate symptoms (95% CI: 0.58-0.82). In NHs with 1-star staffing compared to 3-star, residents had 37% higher odds of moderate symptoms (95% CI: 1.14-1.64) and 57% higher odds of moderately severe to severe depressive symptoms (95% CI: 1.17-2.12). The odds of any above-minimal depressive symptoms decreased as quality measure ratings increased. CONCLUSIONS/IMPLICATIONS: Lower NH quality ratings were associated with more severe depressive symptoms. Further investigation is warranted to identify potential mechanisms for a targeted intervention to improve quality and provide more equitable care.Source
J Am Med Dir Assoc. 2019 Oct;20(10):1335-1339.e10. doi: 10.1016/j.jamda.2019.05.004. Available online 4 July 2019. Link to article on publisher's site
DOI
10.1016/j.jamda.2019.05.004Permanent Link to this Item
http://hdl.handle.net/20.500.14038/46820PubMed ID
31281113Related Resources
ae974a485f413a2113503eed53cd6c53
10.1016/j.jamda.2019.05.004