PATTERNS AND DETERMINANTS OF HEALTH-SERVICES USE AND MORTALITY AFTER VA NURSING-HOME CARE

Risk factors for institutionalization and death for up to four years f or a nationwide cohort (n = 6,488) of males discharged alive from Depa rtment df Veterans Affairs (DVA) nursing homes were identified through linked records of the DVA. Two-year cumulative probabilities of nursi ng home readmission, hospitalization, and death among nursing home dis chargees were 0.30, 0.61, and 0.24, respectively. Using multivariate s urvival analyses, chronic functional impairments and past nursing home use were important predictors of nursing home readmission, whereas ho spitalizations for exacerbations of chronic medical conditions were pr edictors of hospitalization and death. Past hospitalizations predicted all three outcomes. Differences in risk factors for nursing home read mission as compared with hospitalization or death among DVA nursing ho me dischargees suggest that high-risk patients can be identified at nu rsing home discharge and that different types of interventions will be necessary to decrease nursing home readmission as compared with hospi talization or death. Future development of linked record systems acros s multiple settings, both within and outside the DVA, will help to fur ther characterize persons at high risk of institutionalization or deat h and to design and evaluate targeted interventions to decrease this r isk.