Skip to main content
Inconsistencies in Level of Care Assignment Decisions in Skilled Nursing Facilities
The American Journal of Public Health (1981)
  • Deborah Monahan, Syracuse University
  • Vernon L. Greene
In Arizona, a non-Medicaid state, we investigated the extent to which unregulated level of care assignments in Skilled Nursing Facilities consistently reflect level and nature of patient impairment. Using Multiple Discriminant Analysis (MDA) to develop optimal prediction functions, approximately 70 per cent of patients could be correctly classified. Factors identified by MDA as discriminating among patients at different levels of care are an Activities of Daily Living (ADL) impairment factor, and a factor defined by confusion, transitory contact with the social environment, and propensity to wander. Results are compared with those of studies using MDA to replicate Multidisciplinary Review Team (MRT) or other expert level of care assignments intended to develop patient classification functions for clinical use. MRT assignments appear to reflect patient impairment characteristics only slightly better than do unregulated institutional assignments, suggesting that such utilization review efforts may result in minimal net gains in appropriateness of placement.
Publication Date
Citation Information
Deborah Monahan and Vernon L. Greene. "Inconsistencies in Level of Care Assignment Decisions in Skilled Nursing Facilities" The American Journal of Public Health Vol. 71 Iss. 9 (1981)
Available at: