Risk Factors for Venous Thromboembolism in Nursing Home Residents

Leibson, Cynthia L.; Petterson, Tanya M.; Bailey, Kent R.; Melton, III, L. Joseph; Heit, John A.
February 2008
Mayo Clinic Proceedings;Feb2008, Vol. 83 Issue 2, p151
Academic Journal
OBJECTIVE: To determine risk factors for venous thromboemboilsm (VIE) among nursing home (NH) residents. PARTICIPANTS AND METHODS: This population-based historical cohort study used Minnesota Case Mix Review Program (MCMRP) Public Research Flies to identify all unique Olmsted County, Minnesota, residents in any local NH from January 1, 1988, through December 31, 1994. Cases were defined as residents with a VIE diagnosis at any NH assessment. For each case, we identified 2 age- and sex-matched controls, defined as NH residents who did not have VTE but were assessed in the year of the case's earliest VIE diagnosis (ie, index assessment). Cases and controls were compared for preindex assessment characteristics. Accuracy of MCMRP VIE ascertainment was explored by comparing MCMRP cases with members of the Rochester Epidemiology Project incident cohort who were objectively diagnosed with VIE from January 1, 1988, through December 31, 1994, while residing in an Olmsted County NH. RESULTS: At the preindex assessment, cases were more likely than controls to have returned from hospital; to require assistance with grooming, tolleting, transferring, bed positioning, or wheel-chair use; or to need physical therapy, rehabilitation, clinical monitoring, or wound care and were less likely to have neurologic disease. There were 53 MCMRP VIE cases vs 161 Rochester Epidemiology Project NH VIE cases; the proportion with pulmonary embolism was 21% vs 62%; 1-year mortality was 24% vs 55%. CONCLUSION: Administrative data from NHs reveal important VIE risk factors not routinely documented in hospital or ambulatory records. However, ascertainment of VIE from NH administrative data appears biased toward surviving cases, highlighting concerns about using such data to assess provider quality and pointing to the need for studies that track individuals through multiple data sources across Institutional settings.


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