The Association Between Skilled Nursing Facility Care Quality and 30-Day Readmission Rates After Hospitalization for Heart Failure

Abstract

The objective of the study was to assess the association between care quality of skilled nursing facilities (SNFs) and 30-day risk-adjusted readmission rate (RAR) for patients with acute decompensated heart failure (ADHF). A retrospective cohort study was conducted involving 603 discharges from a tertiary care hospital to 17 SNFs after hospitalization for ADHF. SNF quality was assessed based on the CMS 5-star quality rating and a survey of SNF characteristics and processes of care. In all, 20% of cases were readmitted within 30-days; 9.4% were for ADHF. The all-cause RARs for higher- and lower-quality SNFs were 18% (95% confidence interval [CI]=14%-23%) and 22% (95% CI=17%-26%), respectively, and the ADHF RARs were 8.8% (95% CI=6.0%-11.6%) and 10.2% (95% CI=7.0%-12.9%), respectively. There were no significant associations between ADHF RARs and individual processes of care or structural characteristics. Quality ratings of SNF or processes of care did not correlate with RAR.

Associations between nursing home performance and hospital 30‐day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States

“…Our results extend previous studies (Unroe et al., ; Allen et al., ; Ogunneye, ; Sandvik et al., ; Russell et al., ; Veilleux et al., ; Tuso et al., ; Neuman et al., ), which focused on the association between nursing home performance and hospital readmissions at the patient level. For example, Ogunneye et al.…”

“…For example, Ogunneye et al. () studied the relationship between quality ratings of skilled nursing facilities and 30‐day risk‐adjusted readmission rate for 603 patients discharged from a single hospital to 17 skilled nursing facilities after hospitalisation for acute decompensated heart failure and found that the all‐cause readmission rate was 18% for higher quality and 22% for lower quality skilled nursing facilities. Our finding about that the staffing ranking score is the most important measure associated with readmission is consistent with the findings reported by Neuman et al.…”

“…Previous studies have shown that nursing home performance may play an important role in hospital readmissions (Unroe, Greiner, Colón‐Emeric, Peterson, & Curtis, ; Allen et al., ; Ogunneye et al, ; Sandvik, Bade, Dunham, & Hendrickson, ; Russell, Rosati, Rosenfeld, & Marren, ; Veilleux, Wight, Cannon, Whalen, & Bachman, ; Tuso et al., ; Neuman, Wirtalla, & Werner, ). However, it is unclear whether nursing homes' performance is associated with hospital 30‐day readmission rates at the community level.…”

Home Health Agency Performance in the United States: 2011–15

“…The association between nursing home and home health performance in quality of care and outcomes has been studied . For example, one study found that individuals receiving care in higher‐quality skilled nursing facilities had lower readmission rates (18%) than those in lower‐quality skilled nursing facilities (22%) . Another study found that improving nursing home and home health performance was associated with lower community‐level risk‐standardized readmission rates .…”

“…Medicare‐certified home health agencies, which provide a comprehensive array of in‐home services, including home health aide assistance, social work, nursing, occupational therapy, physical therapy, and speech therapy, serve a critical role in caring for individuals receiving ongoing outpatient care or who have been discharged from a nursing home or hospital . High‐quality home health care can benefit individuals and health systems by improving individuals' health status and quality of life, shortening hospital stays, lowering hospital costs, and preventing unplanned readmissions . As the population in the United States ages and the number of elderly individuals grows (from 45 million in 2015 to a projected 84 million in 2050), the provision of high‐quality home health care is an increasingly important component of the U.S. healthcare system.…”