Latent health profiles associated with institutional admission after snf stay among medicare plwh
INNOVATION IN AGING(2023)
摘要
Abstract Background Health profiles may help identify PLWH at risk for institutional admission after a short-term skilled nursing facility (SNF) stay. Methods We estimated rates of institutional admission in one-year follow-up after discharge from a SNF stay (<100 days) among Medicare FFS beneficiaries with HIV (2014-2019). Latent profile analysis identified subgroups based on prevalent conditions one year prior to discharge including 8 indices: mental health (MH range 0-6), substance use (SU 0-4), cardiovascular conditions (CV 0-9), sensory (SE 0-4), musculoskeletal (MU 0-10), pulmonary (PU 0-2), learning disabilities (LD 0-9), and other chronic conditions (OCC 0-11). Cox models estimated the association between latent profiles and time to institution admission (hospital, nursing home), adjusting for demographics, dual eligibility, HIV treatment; censoring included death and study end. Results The 618 PLWH studied were male (73%), with mean age 60 (standard deviation [sd] 11). Two latent health profiles were: CV+OCC+MH (n=77), median values CV=3, OCC=2, MH=1; healthy (n=541), median 0 for all. Compared to the healthy group, the CV+OCC+MH group had similar days spent in an institute (60 days [96] vs 66 days [96]), and similar hazards for institutional admission in adjusted models (HR:1.09, 95% CI [0.81-1.46]) in one-year after SNF discharge. HIV treatment for ≥80% of the time prior to discharge had lower hazards (HR:0.76 [0.59-0.98]) and dual eligibility had higher hazards (HR:1.32 [1.09, 1.61]) of returning to an institutional setting. Conclusions Latent profiles had similar risk for institutional admission in one-year after discharge from a SNF stay, despite having significantly different contributing factors.
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