Background
Methods
Data sources and participants
Nursing home status agreement
Mortality
Statistical analyses
Results
Nursing home status reporting on the CMS-2728
MDS (n)
|
Sensitivity
|
Specificity
|
PPV
|
NPV
| ||
---|---|---|---|---|---|---|
CMS-2728 (n)
|
Yes
|
No
| ||||
Yes
| 2,565 | 656 | 0.33 | 0.97 | 0.80 | 0.79 |
No
| 5,236 | 19,456 | (0.32, 0.34) | (0.96, 0.97) | (0.78, 0.81) | (0.78, 0.79) |
ESRD patient characteristics and nursing home status
MDS (n = 7,801)
|
No MDS (n = 20,112)
| |||
---|---|---|---|---|
2728
|
No 2728
|
2728
|
No 2728
| |
(n = 2,565) |
(n = 5,236)
|
(n = 656) |
(n = 19,456)
| |
Demographic characteristics
| ||||
Age, mean (SD) | 81.7 (4.7) | 81.6 (4.6) | 81.0 (4.5) | 80.5 (4.3) |
Women, (%) | 55.3 | 51.1 | 50.3 | 43.3 |
Hispanic or Latino | 5.8 | 5.7 | 7.0 | 9.7 |
Race | ||||
White | 76.8 | 81.4 | 77.0 | 78.5 |
Black | 20.8 | 15.3 | 19.5 | 16.9 |
American Indian/Alaskan | 0.1 | 0.4 | 0.3 | 0.4 |
Asian | 1.8 | 2.4 | 2.9 | 3.3 |
Other | 0.5 | 0.5 | 0.3 | 0.9 |
Medicaid | 28.8 | 17.5 | 23.8 | 15.1 |
Region of residence | ||||
Northeast | 21.9 | 28.7 | 24.2 | 20.2 |
South | 35.2 | 28.6 | 35.7 | 36.3 |
Midwest | 31.4 | 25.0 | 25.9 | 22.9 |
West | 11.6 | 17.6 | 14.3 | 20.6 |
Health characteristics
| ||||
Primary cause of renal failure | ||||
Diabetes | 39.2 | 36.0 | 39.5 | 34.4 |
Glomerular nephritis | 3.0 | 3.8 | 2.1 | 4.7 |
Secondary glomerulonephritis /vasculitis | 0.7 | 1.0 | 0.9 | 0.9 |
Interstitial nephritis | 3.9 | 3.0 | 2.6 | 3.7 |
Hypertension/large vessel | 37.3 | 40.2 | 35.8 | 42.1 |
Cystic/hereditary/congenital | 0.4 | 0.5 | 0.5 | 1.5 |
Neoplasms/tumors | 1.8 | 2.2 | 1.7 | 3.0 |
Other | 13.8 | 13.4 | 16.9 | 9.6 |
CVD Comorbidity | ||||
Congestive heart failure | 53.3 | 52.4 | 54.1 | 41.9 |
Atherosclerotic heart disease | 32.6 | 35.0 | 35.4 | 32.7 |
Cerebrovascular disease | 19.7 | 14.4 | 21.7 | 11.0 |
Peripheral vascular disease | 21.1 | 20.2 | 27.3 | 18.3 |
Other | 30.0 | 23.2 | 35.2 | 21.3 |
Functional impairment | ||||
Inability to ambulate | 41.4 | 8.0 | 51.5 | 5.2 |
Inability to transfer | 25.3 | 3.3 | 34.2 | 2.2 |
Needs assistance with daily activities | 56.3 | 11.7 | 58.8 | 11.3 |
Serum albumin, g/dL, mean (SD) | 2.9 (0.6) | 3.0 (0.6) | 2.8 (0.7) | 3.3 (0.7) |
Serum creatinine, mg/dL, mean (SD) | 5.1 (2.3) | 5.2 (2.4) | 5.0 (2.3) | 5.5 (2.4) |
Hemoglobin, g/dL, mean (SD) | 10.2 (1.6) | 10.2 (1.6) | 10.1 (1.6) | 10.4 (1.6) |
Treatment characteristics
| ||||
Primary dialysis setting | ||||
Home | 1.6 | 0.8 | 1.5 | 4.8 |
Dialysis facility/Center | 94.1 | 98.0 | 92.5 | 95.1 |
Skilled nursing facility/Long term care facility | 4.3 | 1.2 | 6.0 | 0.1 |
Primary type of dialysis | ||||
Hemodialysis | 99.1 | 99.4 | 99.4 | 95.4 |
CAPD | 0.7 | 0.4 | 0.2 | 3.1 |
CCPD | 0.2 | 0.2 | 0.5 | 1.5 |
Other | 0.0 | 0.0 | 0.0 | 0.0 |
Predialysis nephrology care | 41.4 | 45.4 | 34.6 | 64.7 |
Initial type of hemodialysis access | ||||
AVF | 4.2 | 5.1 | 3.5 | 16.0 |
Graft | 3.3 | 2.7 | 3.1 | 5.3 |
Catheter | 91.4 | 90.7 | 91.9 | 77.4 |
Other | 1.2 | 1.6 | 1.5 | 1.3 |
CVD = cardiovascular disease |
Sensitivity (n = 7,801)
|
Specificity (n = 20,112)
| |||
---|---|---|---|---|
Crude
|
Multivariable adjusted
|
Crude
|
Multivariable adjusted
| |
Age, years
| ||||
75 – 79 | 1.00 | 1.00 | 1.00 | 1.00 |
80 – 84 | 1.01 (0.90, 1.13) | 1.08 (0.92, 1.26) | 0.81 (0.68, 0.96) | 0.80 (0.64, 1.01) |
85 – 89 | 0.98 (0.86, 1.12) | 1.04 (0.86, 1.25) | 0.71 (0.57, 0.88) | 0.77 (0.58, 1.02) |
≥90 | 1.24 (1.01, 1.51) | 1.22 (0.92, 1.62) | 0.86 (0.55, 1.34) | 0.81 (0.48, 1.38) |
Women (vs. men)
| 1.18 (1.08, 1.30) | 1.07 (0.94, 1.23) | 0.76 (0.65, 0.88) | 1.06 (0.86, 1.31) |
Hispanic or Latino (vs. non-Hispanic)
| 1.01 (0.83, 1.24) | 0.90 (0.67, 1.21) | 1.42 (1.05, 1.92) | 2.01 (1.31, 3.06) |
Race
| ||||
White
| 1.00 | 1.00 | 1.00 | 1.00 |
Black/African American
| 1.44 (1.28, 1.63) | 1.08 (0.90, 1.30) | 0.85 (0.70, 1.04) | 1.29 (0.97, 1.72) |
American Indian/Alaska
| 0.28 (0.09, 0.94) | 0.16 (0.03, 0.81) | 1.14 (0.28, 4.67) | 1.40 (0.18, 10.90) |
Native Asian
| 0.79 (0.56, 1.11) | 1.27 (0.80, 2.03) | 1.12 (0.71, 1.79) | 1.17 (0.66, 2.07) |
Other*
| 1.08 (0.54, 2.17) | 0.80 (0.29, 2.21) | 3.02 (0.75, 12.2) | -- |
Medicaid (vs. no Medicaid)
| 1.91 (1.70, 2.13) | 1.88 (1.59, 2.22) | 0.57 (0.47, 0.69) | 0.76 (0.58, 0.99) |
Region of residence
| ||||
Northeast | 1.16 (0.98, 1.36) | 1.12 (0.89, 1.40) | 0.58 (0.45, 0.76) | 0.72 (0.52, 1.00) |
South | 1.87 (1.60, 2.18) | 1.55 (1.24, 1.94) | 0.71 (0.56, 0.90) | 1.07 (0.78, 1.46) |
Midwest | 1.90 (1.63, 2.23) | 1.96 (1.56, 2.46) | 0.62 (0.48, 0.80) | 0.88 (0.63, 1.24) |
West | 1.00 | 1.00 | 1.00 | 1.00 |
Primary cause of ESRD (diabetes vs. other)
| 1.15 (1.04, 1.26) | 1.16 (1.00, 1.33) | 0.81 (0.69, 0.94) | 0.81 (0.65, 1.01) |
CVD Comorbidity (vs. no CVD comorbidity)
| ||||
Congestive heart failure
| 1.04 (0.84, 1.14) | 0.89 (0.77, 1.02) | 0.61 (0.52, 0.72) | 0.99 (0.80, 1.23) |
Atherosclerotic heart disease
| 0.90 (0.81, 0.99) | 0.88 (0.76, 1.03) | 0.89 (0.75, 1.04) | 1.25 (0.99, 1.58) |
Cerebrovascular disease
| 1.45 (1.28, 1.65) | 1.14 (0.96, 1.36) | 0.45 (0.37, 0.54) | 0.75 (0.58, 0.96) |
Peripheral vascular disease
| 1.06 (0.94, 1.19) | 0.87 (0.73, 1.03) | 0.60 (0.50, 0.71) | 0.69 (0.55, 0.88) |
Other
| 1.41 (1.27, 1.57) | 1.15 (0.99, 1.33) | 0.50 (0.42, 0.59) | 0.80 (0.64, 0.99) |
Functional impairment (vs. no functional impairment)**
| 11.21 (10.02, 12.53) | 10.42 (9.10, 11.93) | 0.06 (0.05, 0.08) | 0.09 (0.07, 0.11) |
Serum albumin (per 1 g/dL)
| 0.87 (0.80, 0.94) | 0.96 (0.86, 1.07) | 2.66 (2.34, 3.02) | 1.80 (1.54, 2.10) |
Serum creatinine (per 1 mg/dL)
| 0.98 (0.96, 1.00) | 1.00 (0.97, 1.02) | 1.13 (1.08, 1.17) | 1.07 (1.01, 1.12) |
Hemoglobin (per 1 g/dL)
| 0.99 (0.96, 1.03) | 1.00 (0.96, 1.05) | 1.14 (1.08, 1.20) | 1.01 (0.94, 1.08) |
Dialysis facility/Center (vs. SNF)***
| 0.28 (0.21, 0.38) | 0.51 (0.33, 0.81) | -- | -- |
Predialysis nephrology care (vs. No care)
| 0.83 (0.75, 0.92) | 0.86 (0.75, 1.00) | 3.19 (2.67, 3.82) | 2.04 (1.62, 2.57) |
Arteriorvenous fistula (vs. Graft)
| 0.68 (0.47, 0.96) | 0.80 (0.50, 1.28) | 2.61 (1.43, 4.77) | 1.83 (0.90, 3.76) |
Nursing home status and mortality
Crude
|
Multivariable adjusted
| |
---|---|---|
NH Status – by MDS*
| ||
No MDS (n = 20,112) |
1 (ref)
|
1 (ref)
|
MDS (n = 7,801) |
1.81 (1.76, 1.86)
|
1.47 (1.42, 1.52)
|
NH Status – by CMS-2728 **
| ||
No 2728 (n = 24,692) |
1 (ref)
|
1 (ref)
|
2728 (n = 3,221) |
1.85 (1.78, 1.92)
|
1.35 (1.28, 1.42)
|
NH status agreement***
| ||
MDS/2728 | 2.08 (1.99, 2.17) | 1.55 (1.46, 1.64) |
MDS/No 2728 | 1.75 (1.69, 1.81) | 1.48 (1.42, 1.54) |
No MDS/2728 | 1.97 (1.82, 2.13) | 1.38 (1.25, 1.52) |
No MDS/No 2728 | 1 (ref) | 1(ref) |
Age, years
| ||
75 – 79 | 1 (ref) | 1 (ref) |
80 – 84 | 1.23 (1.19, 1.26) | 1.17 (1.13, 1.21) |
85 – 89 | 1.51 (1.46, 1.57) | 1.40 (1.34, 1.46) |
≥90 | 1.93 (1.81, 2.06) | 1.69 (1.57, 1.82) |
Women | 0.96 (0.93, 0.98) | 0.87 (0.85, 0.90) |
Hispanic or Latino | 0.85 (0.81, 0.89) | 0.75 (0.70, 0.79) |
Race | ||
White | 1 (ref) | 1 (ref) |
Black or African American | 0.79 (0.76, 0.81) | 0.77 (0.74, 0.81) |
American Indian/Alaska Native | 0.82 (0.67, 1.02) | 0.89 (0.70, 1.14) |
Asian | 0.71 (0.66, 0.77) | 0.77 (0.70, 0.84) |
Other | 0.72 (0.62, 0.83) | 0.65 (0.53, 0.79) |
Medicaid | 1.01 (0.97, 1.04) | 1.03 (0.99, 1.08) |
Region of residence | ||
Northeast | 1.10 (1.06, 1.14) | 0.97 (0.92, 1.01) |
South | 1.15 (1.11, 1.19) | 1.09 (1.04, 1.14) |
Midwest | 1.11 (1.07, 1.15) | 0.95 (0.90, 0.99) |
West | 1 (ref) | 1 (ref) |
Primary cause of ESRD (diabetes vs. other) | 1.01 (0.98, 1.03) | 1.02 (0.99, 1.06) |
CVD Comorbidity | ||
Congestive heart failure | 1.37 (1.34, 1.41) | 1.18 (1.14, 1.22) |
Atherosclerotic heart disease | 1.16 (1.13, 1.19) | 1.03 (0.99, 1.06) |
Cerebrovascular disease | 1.22 (1.17, 1.26) | 1.06 (1.01, 1.11) |
Peripheral vascular disease | 1.21 (1.17, 1.24) | 1.08 (1.03, 1.12) |
Other | 1.26 (1.22, 1.29) | 1.09 (1.06, 1.13) |
Functional impairment† | 1.60 (1.55, 1.65) | 1.25 (1.20, 1.31) |
Serum albumin (g/dL) | 0.75 (0.73, 0.76) | 0.85 (0.83, 0.87) |
Serum creatinine (mg/dL) | 0.95 (0.95, 0.96) | 0.97 (0.96, 0.97) |
Hemoglobin (g/dL) | 0.97 (0.97, 0.98) | 0.99 (0.98, 1.00) |
Dialysis facility/Center (vs. SNF) | 0.65 (0.57, 0.74) | 1.17 (0.99, 1.38) |
Predialysis nephrology care (vs. No care) | 0.74 (0.72, 0.76) | 0.90 (0.87, 0.94) |
Arteriorvenous fistula (vs. Graft) | 0.92 (0.86, 0.99) | 0.91 (0.84, 0.99) |