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ADL performances: A comparison between VA community living centers and VA-contracted community nursing home

Jia H, Sullivan CT, Cowper Ripley DC, Wu SS, Vogel WB, Wang X, Hale-Gallardo JL, Bates BE. ADL performances: A comparison between VA community living centers and VA-contracted community nursing home. The journal of nursing home research sciences. 2017 Sep 14; 2017(3):81-87.

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Background: Department of Veterans Affairs (VA) community living centers (CLCs) and community nursing homes (CNHs) are the two major sources of institutional post-acute care for Veterans with stroke. However, information about Veterans' functional outcomes in these facilities is limited. Objectives: This study was to evaluate the activities of daily living (ADL) performances between Veterans at CLCs and Veterans at VA-contracted CNHs by comparing the change in ADL scores between baseline and various follow-up time points. Design: This is a retrospective, observational study. Setting: the study included all Veterans diagnosed with stroke, admitted to CLCs or VA-contracted CNHs during the study period, and had at least 2 ADL assessments completed post-admission. Measurements: ADL change score was the ADL scale sum score difference between the baseline and 3-month, 6-month, 9-month and 12-month follow-up time points. Statistical Analysis: Generalized linear mixed model with repeated ADL change scores were fitted to assess the effects of time-dependent facility type adjusting for propensity score, rehabilitation utilization, and regional districts. Results: Our pared comparison results showed that CLC (vs. CNH) Veterans had significantly better ADL performance at 3 month, but significantly worse ADL performance at 9 month and 12 month. Our risk-adjusted longitudinal analysis results demonstrated that, at the 12-month follow-up, CLC Veterans had developed better ADL performance (Coefficient SD: -0.71 0.18, p < 0.001) than the CNH Veterans. Conclusions: Significant differences in the changes of ADL score within the 12-month follow-up time were observed between the CLC Veterans and CNH Veterans. These longitudinal analytical findings suggest that the CLC Veterans experienced more positive changes in their ADL score compared with their counterpart CNH Veterans, even after adjusting for potential risk factors. As CNHs are more likely to provide longer term care of older Veterans, further investigation is warranted to compare other related outcomes between the two types of facilities.

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