Evidence map›Paper›PMID 40659050›Full record

ArticleJournal of the American Medical Directors Association2025

A Multi-Outcome Prognostic Model for Community-Dwelling Older Adults Admitted to Skilled Nursing Facilities for Post-Acute Care.

W James Deardorff, Siqi Gan, Bocheng Jing, W John Boscardin, Alexander K Smith, Sei J Lee

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Medical Directors Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

W James DeardorffDivision of Geriatrics, University of California, San Francisco, San Francisco, CA, USA. Electronic address: william.deardorff@ucsf.edu.
Siqi GanDivision of Geriatrics, University of California, San Francisco, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA.
Bocheng JingDivision of Geriatrics, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA.
W John BoscardinDivision of Geriatrics, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Alexander K SmithDivision of Geriatrics, University of California, San Francisco, San Francisco, CA, USA; Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
Sei J LeeDivision of Geriatrics, University of California, San Francisco, San Francisco, CA, USA; Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.

Funding

VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KENNETH E. COVINSKY · 2013 to 2026
$19.9M
Institutional Career Development Core SupplementKL2TR001870 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KANAYA, ALKA M., SARKAR, URMIMALA · 2016 to 2025
$19.7M
Prognostic Indices for Hospitalized Older Adults with and without Alzheimer’s Disease and Related DementiasR01AG079982 · NIA · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI Sei Lee, Alexander Keliimoeanu Smith · 2023 to 2026
$3.1M
Mentoring Researchers in Prognosis Research in Alzheimer’s Disease and Related DementiasK24AG068312 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Alexander Keliimoeanu Smith · 2020 to 2026
$1.2M
Mentoring Patient-Oriented Research to Individualize Care for Hospitalized Older Adults with and without Alzheimer's Disease and Related DementiasK24AG066998 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Sei Lee · 2021 to 2026
$1.1M
A comprehensive prognostic model for older adults discharged to skilled nursing facilities.R03AG082859 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI DEARDORFF, WILLIAM JAMES · 2023 to 2024
$323k
NCATS NIH HHS KL2 TR001870NIA NIH HHS K24 AG066998NIA NIH HHS K24 AG068312NIA NIH HHS P30 AG044281NIA NIH HHS R01 AG079982NIA NIH HHS R03 AG082859
6 · The paper itself

Abstract

objectivesNearly 20% of hospitalized older adults are discharged to a skilled nursing facility (SNF) for short-term rehabilitation. Many subsequently experience adverse outcomes, such as hospital readmissions, transitioning to long-term care rather than returning home, or death. To guide shared decision making, we developed a prognostic model for multiple outcomes for older adults admitted to SNFs.

designRetrospective cohort study. SETTING AND

participantsTwenty percent national Medicare sample of community-dwelling older adults aged ≥66 discharged to an SNF after a hospitalization between 2017 and 2019.

methodsWe predicted 2 outcomes: 6-month all-cause mortality and "successful community discharge" (discharge to the community without subsequent rehospitalization or death within 30 days). Model predictors were pre-specified as age, sex, Elixhauser comorbidity score, hospital length of stay, elective vs urgent/emergency hospitalization, Medicaid status, principal hospital discharge diagnosis, surgical procedures, and hospitalizations in the past year. We used LASSO to reduce the 38 Elixhauser comorbidities to 12 comorbidities and logistic regression to determine separate predictor coefficients for the mortality and successful discharge outcomes. Model performance was assessed by discrimination [concordance statistic (c-statistic)] and calibration (calibration plots). Internal validation was performed via bootstrapping.

resultsThe cohort included 523,740 individuals (median age 81, 62% female, 8% Black). Overall, 22% died by 6 months and 54% experienced a successful community discharge. Adjusted odds ratios varied based on outcome (eg, hospital length of stay was a stronger predictor of community discharge than mortality). The optimism-corrected c-statistics for the final model were 0.753 (95% CI, 0.752-0.755) for 6-month mortality and 0.692 (95% CI, 0.691-0.694) for successful community discharge. Calibration plots showed that the model was well calibrated for both outcomes. CONCLUSIONS AND IMPLICATIONS: In a national sample of older adults, this multi-outcome SNF prognostic model showed good discrimination and calibration. Risk predictions can help guide shared decision making and future planning among SNF clinicians, patients, and caregivers.

Indexed as

Independent LivingSkilled Nursing FacilitiesSubacute CareAgedAged, 80 and overFemaleHumansMaleMedicarePatient DischargePrognosisRetrospective StudiesUnited Statesmortalitypost-acute carePrognostic modelskilled nursing facility

Identifiers

PMID40659050
PMCPMC12790408

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.