Prevalence of delirium on admission to postacute care is associated with a higher number of nursing home deficiencies

Abstract

Objective: To examine the association between the prevalence of delirium among patients admitted to postacute care and the quality of nursing home care as reflected in deficiency counts.

Design: Analysis of screening data from a randomized controlled trial (RCT) of a delirium abatement program.

Setting and participants: We screened 4744 of 6352 RCT-eligible persons admitted to 1 of 8 skilled nursing facilities in the Boston area over a 3-year period. Quality of care was operationalized with the count of deficiencies noted by state surveyors.

Measurements: Prevalence of Confusion Assessment Method (CAM) diagnoses of delirium as completed by trained research interviewers at each facility.

Results: About 1 in 7 persons admitted to postacute care met CAM criteria for delirium, but this varied from 1 in 15 to 1 in 4 across facilities. The correlation of deficiency count per 100 beds and the prevalence of CAM delirium was strong (r=0.45) and significant (95% Confidence interval =0.07, 0.71).

Conclusion: Although this study is limited by small sample size, limited geographic scope, and crude assessment of quality with deficiency counts, we have found that facilities with more deficiencies admit more persons that satisfy CAM criteria for delirium. It is possible that good facilities often choose to admit and/or are referred good candidates for rehabilitation, whereas facilities with more deficiencies are not able to be so selective. The end result may be that delirious patients are being preferentially admitted to poorer quality facilities, increasing their likelihood of poor postacute outcomes.