The Nursing Home Pneumonia Risk Index: A Simple, Valid MDS-Based Method of Identifying 6-Month Risk for Pneumonia and Mortality

Philip D Sloane; Sheryl Zimmerman; Kimberly Ward; David Reed; John S Preisser; David J Weber

doi:10.1016/j.jamda.2017.06.008

The Nursing Home Pneumonia Risk Index: A Simple, Valid MDS-Based Method of Identifying 6-Month Risk for Pneumonia and Mortality

J Am Med Dir Assoc. 2017 Sep 1;18(9):810.e11-810.e14. doi: 10.1016/j.jamda.2017.06.008. Epub 2017 Jul 29.

Authors

Philip D Sloane¹, Sheryl Zimmerman², Kimberly Ward³, David Reed³, John S Preisser⁴, David J Weber⁵

Affiliations

¹ Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: Philip_Sloane@med.unc.edu.
² Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC.
³ Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
⁴ Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
⁵ Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.

PMID: 28764875
DOI: 10.1016/j.jamda.2017.06.008

Abstract

Background: Pneumonia is the leading infectious cause of hospitalization and death for nursing home (NH) residents; however, diagnosis is often delayed because classic signs of infection are not present. We sought to identify NH residents at high risk for pneumonia, to identify persons to target for more intensive surveillance and preventive measures.

Methods: Based on a literature review, we identified key risk factors for pneumonia and compiled them for use as prediction tool, limiting risk factors to those available on the Minimum Data Set (MDS). Next, we tested the tool's ability to predict 6-month pneumonia incidence and mortality rates in a sample of 674 residents from 7 NHs, evaluating it both as a continuous and a dichotomous variable, and applying both logistic regression and survival analysis to calculate estimates.

Results: NH Pneumonia Risk Index scores ranged from -1 to 6, with a mean of 2.1, a median of 2, and a mode of 2. For the outcome of pneumonia, a 1-point increase in the index was associated with a risk odds ratio of 1.26 (P = .038) or a hazard ratio of 1.24 (P = .037); using it as a dichotomous variable (≤2 vs ≥3), the corresponding figures were a risk odds ratio of 1.78 (P = .045) and a hazard ratio of 1.82 (P = .025). For the outcome of mortality, a 1-point increase in the NH Pneumonia Risk Index was associated with a risk odds ratio of 1.58 (P = .002) and a hazard ratio of 1.45 (P = .013); using the index as a dichotomous variable, the corresponding figures were a risk odds ratio of 3.71 (P < .001) and a hazard ratio of 3.29 (P = .001).

Conclusions: The NH Pneumonia Risk Index can be used by NH staff to identify residents for whom to apply especially intensive preventive measures and surveillance. Because of its strong association with mortality, the index may also be valuable in care planning and discussion of advance directives.

Keywords: Long-term care; infections; mortality; nursing homes; pneumonia risk.

MeSH terms

Databases, Factual*
Female
Humans
Long-Term Care
Male
North Carolina / epidemiology
Nursing Homes*
Pneumonia / etiology*
Pneumonia / mortality*
Risk Assessment
Risk Factors
Time Factors