{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:11:15Z","timestamp":1791886275394,"version":"4.3.4"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act aimed to improve postacute care quality and outcomes. This study examines changes in delirium, a key quality indicator, over 5 years following its implementation.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the persistence and resolution of delirium within skilled nursing facilities (SNFs) between 2014 and 2019.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study included SNF admissions from a 5% Medicare random sample, with delirium assessments conducted between January 1 and December 31 in 2014 and 2019. The analysis of persistent delirium consisted of patients with delirium at SNF admission and a subsequent delirium assessment during their SNF stay. Analyses were conducted from December 2023 to October 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Year 2019 compared with year 2014.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Delirium was measured using the Minimum Data Set (MDS) Confusion Assessment Method at SNF admission and at a subsequent assessment within 30 days of admission. Multinomial logistic regression was used to compare the rates of resolved delirium, persistent delirium, and death between 2014 and 2019 after adjusting for patient characteristics and SNF care factors.<\/jats:p><\/jats:sec>Results<\/jats:title>The sample included a total of 432\u202f037 SNF admissions before exclusions and 306\u202f998 after exclusions. For SNF admissions in 2014, 6933 of 162\u202f161 patients (4.3%) had delirium at admission, compared with 3595 of 144\u202f837 patients (2.5%) in 2019. In 2014, there were 6096 patients (mean [SD] age, 80.6 [11.0] years; 3565 women [58.5%]), and in 2019, there were 2778 patients (mean [SD] age, 80.2 [10.7] years; 1546 women [55.7%]) with delirium and follow-up assessments. The adjusted prevalence of persistent delirium decreased from 3347 of 6096 patients (62.3%; 95% CI, 60.2%-64.4%) in 2014 to 1316 of 2778 patients (54.7%; 95% CI, 52.0%-57.4%) in 2019, whereas delirium resolution increased from 1734 of 6096 patients (29.1%; 95% CI, 27.1%-31.1%) in 2014 to 1010 of 2778 patients (37.4%; 95% CI, 34.7%-40.0%) in 2019.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cross-sectional study found a reduction in the prevalence of delirium at SNF admission and an improvement in delirium resolution during the stay in the 5 years following the IMPACT Act. However, the high prevalence of persistent delirium warrants further efforts to improve delirium management in SNF.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.0860","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T15:32:07Z","timestamp":1742225527000},"page":"e250860","source":"Crossref","is-referenced-by-count":3,"title":["Persistence of Delirium in Postacute Care at Skilled Nursing Facilities"],"prefix":"10.1001","volume":"8","author":[{"given":"Chan Mi","family":"Park","sequence":"first","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Shi","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard N.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eran D.","family":"Metzger","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarinnapha M.","family":"Vasunilashorn","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Fong","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon K.","family":"Inouye","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,3,17]]},"reference":[{"issue":"12","key":"zoi250066r3","doi-asserted-by":"publisher","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: the confusion assessment method\u2014a new method for detection of delirium.","volume":"113","author":"Inouye","year":"1990","journal-title":"Ann Intern Med"},{"issue":"1","key":"zoi250066r4","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1034\/j.1601-5215.2002.51002.x","article-title":"Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery.","volume":"51","author":"Marcantonio","year":"2003","journal-title":"J Am Geriatr Soc"},{"issue":"7598","key":"zoi250066r5","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1136\/bmj.39169.706574.AD","article-title":"Delirium in older people.","volume":"334","author":"Young","year":"2007","journal-title":"BMJ"},{"issue":"5","key":"zoi250066r7","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1111\/j.1532-5415.2008.01674.x","article-title":"The Confusion Assessment Method: a systematic review of current usage.","volume":"56","author":"Wei","year":"2008","journal-title":"J Am Geriatr Soc"},{"issue":"6","key":"zoi250066r9","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1111\/j.1532-5415.2005.53305.x","article-title":"Outcomes of older people admitted to postacute facilities with delirium.","volume":"53","author":"Marcantonio","year":"2005","journal-title":"J Am Geriatr Soc"},{"issue":"6","key":"zoi250066r10","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1111\/j.1532-5415.2010.02871.x","article-title":"Randomized trial of a delirium abatement program for postacute skilled nursing facilities.","volume":"58","author":"Marcantonio","year":"2010","journal-title":"J Am Geriatr Soc"},{"issue":"6","key":"zoi250066r11","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1111\/j.1532-5415.2012.03958.x","article-title":"Complications in postacute care are associated with persistent delirium.","volume":"60","author":"Anderson","year":"2012","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"zoi250066r12","doi-asserted-by":"publisher","first-page":"201","DOI":"10.12788\/jhm.3130","article-title":"Association between inpatient delirium and hospital readmission in patients =65 years of age: a retrospective cohort study.","volume":"14","author":"LaHue","year":"2019","journal-title":"J Hosp Med"},{"issue":"4","key":"zoi250066r13","doi-asserted-by":"publisher","first-page":"398","DOI":"10.9758\/cpn.2018.16.4.398","article-title":"Increased readmission risk and healthcare cost for delirium patients without immediate hospitalization in the emergency department.","volume":"16","author":"Ma","year":"2018","journal-title":"Clin Psychopharmacol Neurosci"},{"issue":"7","key":"zoi250066r14","doi-asserted-by":"publisher","first-page":"1470","DOI":"10.1111\/jgs.14823","article-title":"Delirium during postacute nursing home admission and risk for adverse outcomes.","volume":"65","author":"Kosar","year":"2017","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"zoi250066r15","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1111\/jgs.17644","article-title":"The IMPACT Act of 2014: standardizing patient assessment data to support care coordination, quality outcomes, and interoperability.","volume":"70","author":"McMullen","year":"2022","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"zoi250066r16","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1111\/jgs.17648","article-title":"Developing standardized patient assessment data elements for Medicare post-acute care assessments.","volume":"70","author":"Chen","year":"2022","journal-title":"J Am Geriatr Soc"},{"issue":"3","key":"zoi250066r18","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igaa018","article-title":"National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.","volume":"4","author":"Crystal","year":"2020","journal-title":"Innov Aging"},{"issue":"9","key":"zoi250066r24","doi-asserted-by":"publisher","first-page":"e68","DOI":"10.1097\/MLR.0000000000000334","article-title":"The Minimum Data Set 3.0 Cognitive Function Scale.","volume":"55","author":"Thomas","year":"2017","journal-title":"Med Care"},{"issue":"5","key":"zoi250066r25","doi-asserted-by":"publisher","first-page":"1610","DOI":"10.1111\/j.1475-6773.2011.01277.x","article-title":"Identifying chronic conditions in Medicare claims data: evaluating the Chronic Condition Data Warehouse algorithm.","volume":"46","author":"Gorina","year":"2011","journal-title":"Health Serv Res"},{"issue":"7","key":"zoi250066r26","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1093\/gerona\/glx229","article-title":"Measuring frailty in Medicare data: development and validation of a claims-based frailty index.","volume":"73","author":"Kim","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"8","key":"zoi250066r27","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1093\/gerona\/gly197","article-title":"Validation of a claims-based frailty index against physical performance and adverse health outcomes in the health and retirement study.","volume":"74","author":"Kim","year":"2019","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"4","key":"zoi250066r29","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1111\/jgs.17644","article-title":"The IMPACT Act of 2014: standardizing patient assessment data to support care coordination, quality outcomes, and interoperability.","volume":"70","author":"McMullen","year":"2022","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"zoi250066r30","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1097\/00001786-200410000-00013","article-title":"Measuring healthcare outcomes to improve quality of care across post-acute care provider settings.","volume":"19","author":"Bryant","year":"2004","journal-title":"J Nurs Care Qual"},{"issue":"3","key":"zoi250066r31","doi-asserted-by":"publisher","first-page":"7003090010p1","DOI":"10.5014\/ajot.2016.703003","article-title":"Coming to terms with the IMPACT Act of 2014.","volume":"70","author":"DeJong","year":"2016","journal-title":"Am J Occup Ther"},{"issue":"1","key":"zoi250066r32","doi-asserted-by":"publisher","first-page":"7201090010p1","DOI":"10.5014\/ajot.2018.721002","article-title":"Justifying rehabilitation intensity through functional performance measures in postacute care.","volume":"72","author":"Kroll","year":"2018","journal-title":"Am J Occup Ther"},{"issue":"12","key":"zoi250066r35","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1001\/jama.2017.12067","article-title":"Delirium in older persons: advances in diagnosis and treatment.","volume":"318","author":"Oh","year":"2017","journal-title":"JAMA"},{"issue":"6","key":"zoi250066r36","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005594.pub3","article-title":"Antipsychotics for treatment of delirium in hospitalised non-ICU patients.","volume":"6","author":"Burry","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"7","key":"zoi250066r37","doi-asserted-by":"publisher","first-page":"485","DOI":"10.7326\/M19-1860","article-title":"Antipsychotics for treating delirium in hospitalized adults: a systematic review.","volume":"171","author":"Nikooie","year":"2019","journal-title":"Ann Intern Med"},{"issue":"10","key":"zoi250066r38","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.1111\/j.1532-5415.2006.00869.x","article-title":"Dissemination of the hospital elder life program: implementation, adaptation, and successes.","volume":"54","author":"Inouye","year":"2006","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"zoi250066r39","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1001\/jamainternmed.2014.7779","article-title":"Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis.","volume":"175","author":"Hshieh","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"1","key":"zoi250066r40","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1001\/jamainternmed.2019.4446","article-title":"Effect of the tailored, family-involved hospital elder life program on postoperative delirium and function in older adults: a randomized clinical trial.","volume":"180","author":"Wang","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"9920","key":"zoi250066r43","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people.","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"issue":"5","key":"zoi250066r44","doi-asserted-by":"publisher","first-page":"M441","DOI":"10.1093\/gerona\/58.5.M441","article-title":"Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity.","volume":"58","author":"Kiely","year":"2003","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"2","key":"zoi250066r45","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1007\/s11606-022-07760-6","article-title":"Patient outcomes after delirium screening and incident Alzheimer\u2019s disease or related dementias in skilled nursing facilities.","volume":"38","author":"Vo","year":"2023","journal-title":"J Gen Intern Med"},{"key":"zoi250066r6","volume-title":"Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices","author":"Hoffman","year":"2020"},{"key":"zoi250066r8","volume-title":"Quality and Safety Challenges in Critical Care: Preventing and Treating Delirium in the Intensive Care Unit. PSNet","author":"Vasilevskis","year":"2012"},{"key":"zoi250066r1","unstructured":"National Center for Health Statistics. Post-acute and long-term care providers and services users in the United States, 2017-2018. May 2022. Accessed July 1, 2023. https:\/\/www.cdc.gov\/nchs\/data\/series\/sr_03\/sr03-047.pdf"},{"key":"zoi250066r2","unstructured":"Biniek? JF, Cubanski? J, Neuman? T. Amid the COVID-19 pandemic, Medicare spending on skilled nursing facilities increased more than 4% despite an overall decline in utilization. Kaiser Family Foundation. June 1, 2022. Accessed July 1, 2023. https:\/\/www.kff.org\/medicare\/issue-brief\/amid-the-covid-19-pandemic-medicare-spending-on-skilled-nursing-facilities-increased-more-than-4-despite-an-overall-decline-in-utilization\/#:~:text=Approximately%201.3%20million%20(4.1%25),and%202020%20(Figure%202)"},{"key":"zoi250066r17","unstructured":"American Association of Post-Acute Care Nursing. Updated variables in MDS. Accessed March 1, 2024. https:\/\/www.aapacn.org\/wp-content\/uploads\/2023\/10\/11166-MDS-3.0-CHANGE-TABLE-Chapter-3-Section-N-v1.18.11.pdf"},{"key":"zoi250066r19","unstructured":"US Department of Health and Human Services, Office of Inspector General. CMS could improve the data it uses to monitor antipsychotic drugs in nursing homes. May 2021. Accessed March 1, 2024. https:\/\/oig.hhs.gov\/oei\/reports\/oei-07-19-00490.pdf"},{"key":"zoi250066r20","unstructured":"Centers for Medicare & Medicaid Services. The skilled nursing facility value-based purchasing (SNF VBP) program. Accessed December 1, 2024. https:\/\/www.cms.gov\/medicare\/quality\/nursing-home-improvement\/value-based-purchasing"},{"key":"zoi250066r21","unstructured":"Centers for Medicare & Medicaid Services. Minimum Data Set (MDS) 3.0 for Nursing Homes and Swing Bed Providers. Accessed March 1, 2024. https:\/\/www.cms.gov\/medicare\/quality\/nursing-home-improvement\/minimum-data-sets-swing-bed-providers"},{"key":"zoi250066r22","unstructured":"Centers for Medicare & Medicaid Services. CMS fast facts. March 2023. Accessed June 1, 2024. https:\/\/data.cms.gov\/sites\/default\/files\/2023-03\/CMSFastFactsMar2023.pdf"},{"key":"zoi250066r23","unstructured":"MedPac. Skilled nursing facility services. Accessed June 1, 2024. https:\/\/www.medpac.gov\/wp-content\/uploads\/import_data\/scrape_files\/docs\/default-source\/reports\/mar20_medpac_ch8_sec.pdf"},{"key":"zoi250066r28","unstructured":"Centers for Medicare & Medicaid Services. IMPACT Act of 2014 data standardization & cross setting measures. Accessed February 6, 2025. https:\/\/www.cms.gov\/medicare\/quality\/initiatives\/pac-quality-initiatives\/impact-act-2014-data-standardization-cross-setting-measures"},{"key":"zoi250066r33","unstructured":"Health Services Advisory Group. Antipsychotic medication measure methodology. Accessed May 1, 2024. https:\/\/www.cdph.ca.gov\/Programs\/CHCQ\/LCP\/CDPH%20Document%20Library\/SNF_QASP_AntipsychoticMedicationMeasureMethodology_May%202017.pdf?"},{"key":"zoi250066r34","unstructured":"Centers for Medicare & Medicaid Services. 2017 RAI user\u2019s manual provider updates. October 1, 2017. Accessed May 1, 2024. https:\/\/downloads.cms.gov\/files\/5-MDS-RAI-Users-Manual-Provider-Updates-10-01-2017.pdf"},{"key":"zoi250066r41","unstructured":"The John A. Hartford Foundation. Age-friendly health systems. Accessed December 1, 2024. https:\/\/www.johnahartford.org\/grants-strategy\/current-strategies\/age-friendly\/age-friendly-health-systems-initiative?t"},{"key":"zoi250066r42","unstructured":"Institute for Healthcare Improvement. Age-friendly health systems recognition. Accessed December 1, 2024. https:\/\/www.ihi.org\/age-friendly-health-systems-recognition?t"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2831647\/park_2025_oi_250066_1741626323.50837.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T15:32:12Z","timestamp":1742225532000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2831647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,17]]},"references-count":45,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.0860","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,17]]}}}