Integrating data from nursing home electronic health records (EHRs) and claims in addition to the minimum data set (MDS) — data required for nursing home residents — could be better than just relying on the MDS sources to produce an accurate prognosis for nursing home residents with Alzheimer’s disease and related dementias (ADRD), according to a report published Thursday in the Journal of the American Geriatrics Society.
Most families with a loved one in the late stages of dementia prioritize comfort-focused treatment. Understanding their loved one’s prognosis can help them better align treatments.
Authors of the report noted that a recent review of prognostic models for late-stage ADRD found that assessments commonly used to evaluate prognosis-based eligibility for hospice weren’t reliable. This included the commonly used Functional Assessment Staging (FAST) phase 7c. Other assessments are made to give an ADRD diagnosis at the final stage, so nursing home residents often die of a primary life-limiting diagnosis like heart failure and have co-occurring moderate-to-late-stage ADRD.
Only 15% of people enrolled in hospice have a primary diagnosis of ADRD. That’s because it’s challenging to estimate the six-month prognosis required to be eligible for hospice, and dementias have a prognosis of 12 to 18 months when they are in the late stage, the authors pointed out.
“While low rates of live discharges from hospice are a regulatory requirement for hospices, people who are increasingly experiencing ADRD progression lose access to those beneficial hospice services,” the authors wrote.
In the current model of hospice care, accurate six-month prognostication in nursing homes can enhance access to hospice services for people living with dementia, including those who have a primary diagnosis along with co-occurring ADRD at any stage, they added.
Integrating data from nursing home EHRs and claims may be a better method that can be used in addition to the minimum data set (MDS) which is data required for nursing home residents, the authors wrote.
“Current prognostic models for ADRD in nursing homes lack the accuracy necessary to improve clinical prognostication for hospice access,” they added.
