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P02 - Use of Admission MDS Data to Capture Unrecognized Cognitive Impairment in Heart Failure and the Implications for Discharge Planning

Background: Up to 80% of skilled nursing facility residents with heart failure (HF) also have comorbid cognitive impairment (CI). Concurrent HF with CI complicates residents’ self-care after discharge from short-term rehabilitation. More research exploring the characteristics of skilled nursing facility residents with comorbid HF and CI is needed.

Purpose: This study aimed to compare the clinical characteristics of HF residents with and without CI admitted for short-term rehabilitation in one of five skilled nursing facilities within the same organization in a midwest metropolitan city.

Method: Following institutional review board exemption from the University of Louisville (22.0241), we conducted a secondary data analysis of 2021-2022 admission MDS data with primary or secondary diagnoses for HF (n = 32) using ICD-10 diagnosis reports. Data were analyzed for comorbid conditions, complexity of care, caregiver involvement, and discharge planning using Fisher’s exact tests and measures of central tendency. MDS records indicating delirium or serious mental illness were excluded.

Results: Eleven (34%) brief interview of mental status (BIMS) scores indicated HF with CI; cognitive impairment. Of those, seven (64%) were undiagnosed, with average BIM scores indicative of moderate CI (M = 10, SD 2.4) in comparison to those with diagnosed CI (M = 7, SD 6.4). We found no statistically or clinically significant differences between the two groups’ complexity of symptoms or care. Family member involvement overall was low (n=5, 16%), but was higher for residents with CI (n = 4, 36%) than without CI (n = 1, 5%), p = .037. Although 97% planned to return to the community, none of the records indicated a need for referrals to community agencies.

Implications: These findings support the value of underutilized MDS data for planning medical and nursing care. Missed opportunities to diagnose CI have implications for primary care following facility discharge and possibly 30-day hospital readmissions.

Limitations: Limitations of this study include the format of the MDS questionnaire (different scales of measures), limited sample size, and the quality of data originally entered. Although primary caregiver involvement is critical to outcomes, admission MDS data are not designed to capture residents’ sociocultural barriers critical to successful discharge planning.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.


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