A Multi-Outcome Prognostic Model for Community-Dwelling Older Adults Admitted to Skilled Nursing Facilities for Post-Acute Care.
W James Deardorff, Siqi Gan, Bocheng Jing and 3 others
PMID 40659050WHAT IT FOUND
A model using age, diagnoses, hospital stay and comorbidities estimated death within 6 months and successful return to the community after skilled nursing.
It can guide goals-of-care and discharge planning, but was not tested outside Medicare data.
Key findings
01Among 523,740 older adults admitted to a skilled nursing facility after hospitalization, 114,517 (21.9%) died within 6 months and 281,521 (53.8%) had a successful community discharge.
02The optimism-corrected c-statistic for 6-month mortality was 0.753, and the model was well calibrated with a calibration slope of 0.999 and an integrated calibration index of 0.012.
03The optimism-corrected c-statistic for successful community discharge was 0.692, with good calibration shown by a calibration slope of 0.999 and an integrated calibration index of 0.011.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The model was developed and internally validated only in a 20% sample of US Medicare fee-for-service patients, so it has not been tested in other populations, countries, or Medicare Advantage plans. It does not include functional status from the admission MDS, social support, neighborhood environment, patient preferences, or unforeseen clinical events, all of which can affect death and discharge. The community discharge model had weaker discrimination than the mortality model, with an optimism-corrected c-statistic of 0.692. The estimates are meant as a general guide for shared decision-making, not a substitute for clinical judgment.
Declared interests
Research support from NIH and U.S. government non-PHS funding is listed. The supplied text does not report author conflicts of interest.
The easy way to misread this
Do not use the model to decide that an older adult will die within 6 months or cannot return to the community. It was only internally validated in Medicare fee-for-service data and does not include function, social support, or later clinical events, so individual predictions need clinical judgment.