After using logistic regression to adjust for case-mix differences between TNHs and CNHs (i.e., differences in risk factors for hospitalization) the net difference of 11.9 percentage points in the change in before-after TNH and CNH hospitalization rates increased to 17.2 percentage points, due partly to an increase in sub-acute case-mix intensity resulting from the TNH program.
Once again, the decrease in hospitalization rates for live discharges from TNHs is greater (p = .055) than the (approximately) unchanged rates for CNH patients.
Hospitalization rates declined in five of the six TNHs, while the rate for the sixth TNH remained virtually unchanged.
The results in Table 1 show no significant before-after differences between TNHs and CNHs in terms of changes in community discharge rates.
The finding that the TNHP reduced hospitalization rates prompted analyses to assess reasons for the intervention-period differences between TNHs and CNHs (case-mix-adjusted differences for the intervention period were significant at p <.05).
However, case-mix adjustment renders the outcome differences between TNHs and CNHs insignificant.
The difference in restraint use and the greater likelihood that restrained TNH patients were checked at least every 30 minutes, after adjusting for case mix, suggest more appropriate care of such patients in TNHs.
Indicators of the use of psychotropic medications suggest that care for patients with psychiatric problems may have been better in TNHs. The mean daily dose of neuroleptics (converted to milligrams of thorazine in Table 3) was significantly lower in TNHs after adjusting for case-mix differences, reflecting a tendency to use lower doses of major tranquilizers in TNHs.
After case-mix adjustment, TNHs were more likely to avoid incontinent episodes by providing timed voiding for incontinent patients.