JSM 2004 - Toronto

Abstract #300442

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Activity Number: 83
Type: Contributed
Date/Time: Monday, August 9, 2004 : 8:30 AM to 10:20 AM
Sponsor: Section on Health Policy Statistics
Abstract - #300442
Title: A Markov Chain Model of Functional Decline in Activities of Daily Living Among Nursing Home Patients Using MDS Quarterly Assessment Data
Author(s): Richard C. Gardiner*+ and Colene Byrne and Hailing Li
Companies: New York Association of Homes and Services for the Aging and New York Association of Homes and Services for the Aging and New York Association of Homes and Services for the Aging
Address: 150 State St., Albany, NY, 12207-1698,
Keywords: Markov chain ; nursing homes ; functional decline ; MDS data
Abstract:

A Markov Chain is used to model decline in functional independence of residents in Nursing Homes. The model transition matrix is adjusted for risks that uniquely effect individual resident transition probabilities. Multinomial logistic regression is used to construct the risk adjusted transition matrices. Five stages of functional independence were identified using 11 MDS assessment variables measuring activities of daily living. MDS assessment records for 1.1 million New York State nursing home residents for the period April 1, 2000, to December 31, 2002, were used to derive the normative quarterly transition probabilities between the five stages of functional independence. Separate models are needed to accurately reflect functional decline in residents afflicted with Alzheimer's disease or dementia and all other residents. Model outcome vectors very closely replicate actual outcomes even after the passage of 10 quarterly transition intervals. The models have application in a number of health policy areas including, monitoring nursing home quality of care, program evaluation of nursing care strategies to deter functional decline, and simulation of current nursing home practice.

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