Date of Award

Spring 2020

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Bratt, Marilyn M.

Second Advisor

McCarthy, Donna

Third Advisor

Breakwell, Susan


Problem: Approximately 25% of skilled nursing facility (SNF) patients are diagnosed with heart failure (HF). The heart failure mortality trajectory is non-linear and there are no useable mortality models from clinical records for use by healthcare providers in the SNF setting. A mortality risk model for patients with HF is important so that palliative care interventions may be offered to improve patients’ quality of life during the end stages of dying. Assessment items captured routinely by the SNF Resident Assessment Instrument –Minimum Data Set 3.0 (RAI-MDS) instrument may be useful in identifying those patients whose declining condition warrants discussion of palliative care.Methodology: Data from 1827 eligible HF patient’s RAI-MDS assessments, who resided in Midwest SNFs during 2013-14, were investigated in a retrospective cross-sectional exploratory method. Discrete survival analysis and logistic regression were used to determine which factors predict mortality so as to allow future creation of a model to prompt palliative care discussions. Results: Nine variables embedded in the RAI-MDS were selected based upon a literature review of HF mortality prediction models. Five of the nine variables demonstrated predictive hazard ratios (HR) in the SNF setting. These included re-admission after hospitalization (HR 1.323), reduced renal function (HR 1.187), presence of dyspnea (HR 1.285), age 85 and older (HR 1.828), and having three or more diagnoses (HR 1.345). Not predictive were having diagnoses of diabetes or hypertension, being sixty-five to eighty-four years of age, and gender. Conclusions: The mortality predictors identified in this study may facilitate development of a HF mortality risk model specific to patients in SNFs. Such a model may be useful in making decisions regarding when to institute palliative care discussions with SNF patients and their families.

Included in

Nursing Commons