Self‐Reported Health and Safety Awareness Improves Prediction of Level of Care Needs in Veterans Discharged From a Postacute Unit
Objectives To evaluate the differential value of a self‐reported health and safety awareness measure relative to other medical, psychosocial, and cognitive factors in predicting level of care (LOC) needs after hospital discharge. Design Retrospective medical record review. Setting Community living c...
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| Veröffentlicht in: | PM & R 2017-11, Vol.9 (11), p.1122-1127 |
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| creator | Stelmokas, Julija Bieliauskas, Linas A. Kitchen Andren, Katherine A. Hogikyan, Robert Alexander, Neil B. |
| description | Objectives
To evaluate the differential value of a self‐reported health and safety awareness measure relative to other medical, psychosocial, and cognitive factors in predicting level of care (LOC) needs after hospital discharge.
Design
Retrospective medical record review.
Setting
Community living center postacute care (CLC‐PAC) unit at a Veterans Affairs hospital.
Participants
A total of 175 veterans admitted to the Veterans Affairs hospital or directly to the CLC‐PAC from home.
Methods
Cognitive status was assessed with the Mini‐Mental State Examination, Digit Span Backward subtest, Trail Making Test (Part B), and Hopkins Verbal Learning Test‐Revised. Self‐report of health and safety awareness was measured with the Independent Living Scales Health and Safety (ILS‐HS) subscale. Additional demographic and admission‐related variables were coded, along with medical comorbidity, with the Charlson Comorbidity Index and depression using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision Depression Checklist.
Main Outcome Measurements
Increased level of care was collected from social work and occupational therapy notes and defined as increased assistance with activities of daily living or nursing home placement comparing prehospitalization with CLC‐PAC discharge.
Results
A total of 19% (n = 34) of residents required increased LOC on CLC‐PAC discharge. The ILS‐HS was a significant predictor of increased LOC above and beyond age and Mini Mental Status Examination score; for each standard deviation decrease in ILS‐HS, there was an increased likelihood of greater LOC (odds ratio 0. 54, 95% confidence interval 0.35‐0.83). Other neuropsychological tests (memory, executive functioning) did not significantly improve the model.
Conclusions
The inclusion of the ILS‐HS to a standard cognitive screen (Mini Mental Status Examination) can improve prediction of increased LOC. Although select aspects of memory and executive functioning independently contribute to increased LOC prediction, the ILS‐HS likely measures a unique aspect of cognitive functioning that may be specific to discharge planning needs in CLC‐PAC residents.
Level of Evidence
II |
| doi_str_mv | 10.1016/j.pmrj.2017.03.013 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1887052808</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1887052808</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3962-b353ee8ecadb3936d5800b022e6e704dd34f589406fc87f0b7cefa1843c14fad3</originalsourceid><addsrcrecordid>eNqNkMtOGzEUhq2qqFDoC3RRedlNhuPLzDhLFEqhCiWC0q3lsY_LRHMJtgPKrlJfoM_YJ8FRgHVX5yy-_9c5HyEfGRQMWHW8LFZ9WBYcWF2AKICJN-SATYWcsLISb192qfg-eR_jEqCSTFXvyD5XEoBzfkD-3GDn__3-e42rMSR09BxNl-6oGRy9MR7Thp48moADxkgv-lUYHzDSRUDX2tSOAx09neMDdttllkH6HdFF2g70JyYMZoj0tI32zoRfuf0sjD01dDHGZOw6Ib0d2nRE9rzpIn54nofk9uzLj9n5ZH719WJ2Mp9YMa34pBGlQFRojWvEVFSuVABNfgMrrEE6J6Qv1VRC5a2qPTS1RW-YksIy6Y0Th-Tzrjd_cb_GmHSfL8OuMwOO66iZUjWUXIHKKN-hNowxBvR6FdrehI1moLfy9VJv5eutfA1CZ_k59Om5f9306F4jL7YzoHbAY9vh5j8q9eLy-htjOfoE6EWU8g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1887052808</pqid></control><display><type>article</type><title>Self‐Reported Health and Safety Awareness Improves Prediction of Level of Care Needs in Veterans Discharged From a Postacute Unit</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Stelmokas, Julija ; Bieliauskas, Linas A. ; Kitchen Andren, Katherine A. ; Hogikyan, Robert ; Alexander, Neil B.</creator><creatorcontrib>Stelmokas, Julija ; Bieliauskas, Linas A. ; Kitchen Andren, Katherine A. ; Hogikyan, Robert ; Alexander, Neil B.</creatorcontrib><description>Objectives
To evaluate the differential value of a self‐reported health and safety awareness measure relative to other medical, psychosocial, and cognitive factors in predicting level of care (LOC) needs after hospital discharge.
Design
Retrospective medical record review.
Setting
Community living center postacute care (CLC‐PAC) unit at a Veterans Affairs hospital.
Participants
A total of 175 veterans admitted to the Veterans Affairs hospital or directly to the CLC‐PAC from home.
Methods
Cognitive status was assessed with the Mini‐Mental State Examination, Digit Span Backward subtest, Trail Making Test (Part B), and Hopkins Verbal Learning Test‐Revised. Self‐report of health and safety awareness was measured with the Independent Living Scales Health and Safety (ILS‐HS) subscale. Additional demographic and admission‐related variables were coded, along with medical comorbidity, with the Charlson Comorbidity Index and depression using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision Depression Checklist.
Main Outcome Measurements
Increased level of care was collected from social work and occupational therapy notes and defined as increased assistance with activities of daily living or nursing home placement comparing prehospitalization with CLC‐PAC discharge.
Results
A total of 19% (n = 34) of residents required increased LOC on CLC‐PAC discharge. The ILS‐HS was a significant predictor of increased LOC above and beyond age and Mini Mental Status Examination score; for each standard deviation decrease in ILS‐HS, there was an increased likelihood of greater LOC (odds ratio 0. 54, 95% confidence interval 0.35‐0.83). Other neuropsychological tests (memory, executive functioning) did not significantly improve the model.
Conclusions
The inclusion of the ILS‐HS to a standard cognitive screen (Mini Mental Status Examination) can improve prediction of increased LOC. Although select aspects of memory and executive functioning independently contribute to increased LOC prediction, the ILS‐HS likely measures a unique aspect of cognitive functioning that may be specific to discharge planning needs in CLC‐PAC residents.
Level of Evidence
II</description><identifier>ISSN: 1934-1482</identifier><identifier>EISSN: 1934-1563</identifier><identifier>DOI: 10.1016/j.pmrj.2017.03.013</identifier><identifier>PMID: 28400222</identifier><language>eng</language><publisher>United States</publisher><subject>Activities of Daily Living ; Aged ; Aged, 80 and over ; Cognition ; Female ; Humans ; Male ; Middle Aged ; Needs Assessment ; Neuropsychological Tests ; Patient Discharge ; Rehabilitation Centers ; Retrospective Studies ; Self Report ; Subacute Care ; Veterans</subject><ispartof>PM & R, 2017-11, Vol.9 (11), p.1122-1127</ispartof><rights>2017 by the American Academy of Physical Medicine and Rehabilitation</rights><rights>Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3962-b353ee8ecadb3936d5800b022e6e704dd34f589406fc87f0b7cefa1843c14fad3</citedby><cites>FETCH-LOGICAL-c3962-b353ee8ecadb3936d5800b022e6e704dd34f589406fc87f0b7cefa1843c14fad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1016%2Fj.pmrj.2017.03.013$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1016%2Fj.pmrj.2017.03.013$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28400222$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stelmokas, Julija</creatorcontrib><creatorcontrib>Bieliauskas, Linas A.</creatorcontrib><creatorcontrib>Kitchen Andren, Katherine A.</creatorcontrib><creatorcontrib>Hogikyan, Robert</creatorcontrib><creatorcontrib>Alexander, Neil B.</creatorcontrib><title>Self‐Reported Health and Safety Awareness Improves Prediction of Level of Care Needs in Veterans Discharged From a Postacute Unit</title><title>PM & R</title><addtitle>PM R</addtitle><description>Objectives
To evaluate the differential value of a self‐reported health and safety awareness measure relative to other medical, psychosocial, and cognitive factors in predicting level of care (LOC) needs after hospital discharge.
Design
Retrospective medical record review.
Setting
Community living center postacute care (CLC‐PAC) unit at a Veterans Affairs hospital.
Participants
A total of 175 veterans admitted to the Veterans Affairs hospital or directly to the CLC‐PAC from home.
Methods
Cognitive status was assessed with the Mini‐Mental State Examination, Digit Span Backward subtest, Trail Making Test (Part B), and Hopkins Verbal Learning Test‐Revised. Self‐report of health and safety awareness was measured with the Independent Living Scales Health and Safety (ILS‐HS) subscale. Additional demographic and admission‐related variables were coded, along with medical comorbidity, with the Charlson Comorbidity Index and depression using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision Depression Checklist.
Main Outcome Measurements
Increased level of care was collected from social work and occupational therapy notes and defined as increased assistance with activities of daily living or nursing home placement comparing prehospitalization with CLC‐PAC discharge.
Results
A total of 19% (n = 34) of residents required increased LOC on CLC‐PAC discharge. The ILS‐HS was a significant predictor of increased LOC above and beyond age and Mini Mental Status Examination score; for each standard deviation decrease in ILS‐HS, there was an increased likelihood of greater LOC (odds ratio 0. 54, 95% confidence interval 0.35‐0.83). Other neuropsychological tests (memory, executive functioning) did not significantly improve the model.
Conclusions
The inclusion of the ILS‐HS to a standard cognitive screen (Mini Mental Status Examination) can improve prediction of increased LOC. Although select aspects of memory and executive functioning independently contribute to increased LOC prediction, the ILS‐HS likely measures a unique aspect of cognitive functioning that may be specific to discharge planning needs in CLC‐PAC residents.
Level of Evidence
II</description><subject>Activities of Daily Living</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cognition</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Needs Assessment</subject><subject>Neuropsychological Tests</subject><subject>Patient Discharge</subject><subject>Rehabilitation Centers</subject><subject>Retrospective Studies</subject><subject>Self Report</subject><subject>Subacute Care</subject><subject>Veterans</subject><issn>1934-1482</issn><issn>1934-1563</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkMtOGzEUhq2qqFDoC3RRedlNhuPLzDhLFEqhCiWC0q3lsY_LRHMJtgPKrlJfoM_YJ8FRgHVX5yy-_9c5HyEfGRQMWHW8LFZ9WBYcWF2AKICJN-SATYWcsLISb192qfg-eR_jEqCSTFXvyD5XEoBzfkD-3GDn__3-e42rMSR09BxNl-6oGRy9MR7Thp48moADxkgv-lUYHzDSRUDX2tSOAx09neMDdttllkH6HdFF2g70JyYMZoj0tI32zoRfuf0sjD01dDHGZOw6Ib0d2nRE9rzpIn54nofk9uzLj9n5ZH719WJ2Mp9YMa34pBGlQFRojWvEVFSuVABNfgMrrEE6J6Qv1VRC5a2qPTS1RW-YksIy6Y0Th-Tzrjd_cb_GmHSfL8OuMwOO66iZUjWUXIHKKN-hNowxBvR6FdrehI1moLfy9VJv5eutfA1CZ_k59Om5f9306F4jL7YzoHbAY9vh5j8q9eLy-htjOfoE6EWU8g</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Stelmokas, Julija</creator><creator>Bieliauskas, Linas A.</creator><creator>Kitchen Andren, Katherine A.</creator><creator>Hogikyan, Robert</creator><creator>Alexander, Neil B.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201711</creationdate><title>Self‐Reported Health and Safety Awareness Improves Prediction of Level of Care Needs in Veterans Discharged From a Postacute Unit</title><author>Stelmokas, Julija ; Bieliauskas, Linas A. ; Kitchen Andren, Katherine A. ; Hogikyan, Robert ; Alexander, Neil B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3962-b353ee8ecadb3936d5800b022e6e704dd34f589406fc87f0b7cefa1843c14fad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Activities of Daily Living</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cognition</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Needs Assessment</topic><topic>Neuropsychological Tests</topic><topic>Patient Discharge</topic><topic>Rehabilitation Centers</topic><topic>Retrospective Studies</topic><topic>Self Report</topic><topic>Subacute Care</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stelmokas, Julija</creatorcontrib><creatorcontrib>Bieliauskas, Linas A.</creatorcontrib><creatorcontrib>Kitchen Andren, Katherine A.</creatorcontrib><creatorcontrib>Hogikyan, Robert</creatorcontrib><creatorcontrib>Alexander, Neil B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>PM & R</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stelmokas, Julija</au><au>Bieliauskas, Linas A.</au><au>Kitchen Andren, Katherine A.</au><au>Hogikyan, Robert</au><au>Alexander, Neil B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Self‐Reported Health and Safety Awareness Improves Prediction of Level of Care Needs in Veterans Discharged From a Postacute Unit</atitle><jtitle>PM & R</jtitle><addtitle>PM R</addtitle><date>2017-11</date><risdate>2017</risdate><volume>9</volume><issue>11</issue><spage>1122</spage><epage>1127</epage><pages>1122-1127</pages><issn>1934-1482</issn><eissn>1934-1563</eissn><abstract>Objectives
To evaluate the differential value of a self‐reported health and safety awareness measure relative to other medical, psychosocial, and cognitive factors in predicting level of care (LOC) needs after hospital discharge.
Design
Retrospective medical record review.
Setting
Community living center postacute care (CLC‐PAC) unit at a Veterans Affairs hospital.
Participants
A total of 175 veterans admitted to the Veterans Affairs hospital or directly to the CLC‐PAC from home.
Methods
Cognitive status was assessed with the Mini‐Mental State Examination, Digit Span Backward subtest, Trail Making Test (Part B), and Hopkins Verbal Learning Test‐Revised. Self‐report of health and safety awareness was measured with the Independent Living Scales Health and Safety (ILS‐HS) subscale. Additional demographic and admission‐related variables were coded, along with medical comorbidity, with the Charlson Comorbidity Index and depression using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision Depression Checklist.
Main Outcome Measurements
Increased level of care was collected from social work and occupational therapy notes and defined as increased assistance with activities of daily living or nursing home placement comparing prehospitalization with CLC‐PAC discharge.
Results
A total of 19% (n = 34) of residents required increased LOC on CLC‐PAC discharge. The ILS‐HS was a significant predictor of increased LOC above and beyond age and Mini Mental Status Examination score; for each standard deviation decrease in ILS‐HS, there was an increased likelihood of greater LOC (odds ratio 0. 54, 95% confidence interval 0.35‐0.83). Other neuropsychological tests (memory, executive functioning) did not significantly improve the model.
Conclusions
The inclusion of the ILS‐HS to a standard cognitive screen (Mini Mental Status Examination) can improve prediction of increased LOC. Although select aspects of memory and executive functioning independently contribute to increased LOC prediction, the ILS‐HS likely measures a unique aspect of cognitive functioning that may be specific to discharge planning needs in CLC‐PAC residents.
Level of Evidence
II</abstract><cop>United States</cop><pmid>28400222</pmid><doi>10.1016/j.pmrj.2017.03.013</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1934-1482 |
| ispartof | PM & R, 2017-11, Vol.9 (11), p.1122-1127 |
| issn | 1934-1482 1934-1563 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1887052808 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Activities of Daily Living Aged Aged, 80 and over Cognition Female Humans Male Middle Aged Needs Assessment Neuropsychological Tests Patient Discharge Rehabilitation Centers Retrospective Studies Self Report Subacute Care Veterans |
| title | Self‐Reported Health and Safety Awareness Improves Prediction of Level of Care Needs in Veterans Discharged From a Postacute Unit |
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