Association Between Skilled Nursing Facility Quality Indicators and Hospital Readmissions

Abstract

Importance Hospital readmissions are common, costly, and potentially preventable. Little is known about the association between available SNF performance measures and the risk of hospital readmission. Objective To measure the association between SNF performance measures and hospital readmissions among Medicare beneficiaries receiving post-acute care at U.S. SNFs. Design Using national Medicare data, we examined the association between SNF performance on publicly available metrics (SNF staffing intensity, performance on required facility site inspections, and the percentages of SNF patients with delirium, moderate-to-severe pain, and new or worsening pressure ulcers) and the risk of readmission or death 30 days after discharge to a SNF. Adjusted analyses controlled for patient case-mix, SNF facility factors, and the discharging hospital. Participants Fee-for-service Medicare beneficiaries discharged to a SNF following an acute-care hospitalization between September 1, 2009 and August 31, 2010. Main outcomes and measures Readmission to an acute-care hospital or death within 30 days of the index hospital discharge. Results Out of 1,530,824 discharges, 357,752 (23.4%;99% CI: 23.3%, 23.5%) were readmitted or died within 30 days; 4.7% (72,472 discharges) died within 30 days (99% CI: 4.7%, 4.8%), and 21.0%(N=321,709) were readmitted (99% CI: 20.9%, 21.1%). The unadjusted risk of readmission or death was lower at SNFs with better staffing ratings (lowest (19.2% of SNFs) vs. highest (6.7% of SNFs): 25.5%; 99% CI: 25.3%, 25.8% vs 19.8%; 99% CI: 19.5%, 20.1%, p<0.001) and better facility inspection ratings (lowest (20.1% of SNFs) vs. highest (9.8% of SNFs): 24.9%; 99% CI: 24.7%,25.1%; vs. 21.5%; 99% CI: 21.2%, 21.7%; p<0.001). Adjustment for patient factors, SNF facility factors, and the discharging hospital attenuated these associations; we observed small differences in the adjusted risk of readmission or death according to SNF facility inspection ratings (lowest vs. highest rating: 23.7%; 99% CI: 23.7%, 23.7%; vs 23.0%; 99% CI:23.0%, 23.1%; p<0.001). Other measures did not predict clinically meaningful differences in the adjusted risk of readmission or death. Conclusions and relevance Among fee-for-service Medicare beneficiaries discharged to a SNF following an acute care hospitalization, available performance measures were not consistently associated with differences in the adjusted risk of readmission or death.

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