The Contribution of Skilled Nursing Facilities to Hospitals’ Readmission Rate

Rahman, Momotazur; McHugh, John; Gozalo, Pedro; Ackerly, D. Clay; Mor, Vincent

doi:10.1111/1475-6773.12507

Cited by 39 publications

(27 citation statements)

References 33 publications

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“…Similarly, we did not include hospital-type dummies because we included hospital fixed effects. Following prior literature, 21,23 we estimated an ordinary least squares model that is more suitable in the presence of multidimensional fixed effects and easier to interpret than nonlinear models. We reported test statistics based on standard error clustered at the hospital level.…”

Section: Study Data and Methodsmentioning

confidence: 99%

ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals

et al. 2017

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Medicare’s more than 420 accountable care organizations (ACOs) provide care for a considerable percentage of the elderly in the United States. One goal of ACOs is to improve care coordination and thereby decrease rates of rehospitalization. We examined whether ACO-affiliated hospitals were more effective than other hospitals in reducing rehospitalizations from skilled nursing facilities. We found a general reduction in rehospitalizations from 2007 to 2013, which suggests that all hospitals made efforts to reduce rehospitalizations. The ACO-affiliated hospitals, however, were able to reduce rehospitalizations more quickly than other hospitals. The reductions suggest that ACO-affiliated hospitals are either discharging to the nursing facilities more effectively compared to other hospitals or targeting at-risk patients better, or enhancing information sharing and communication between hospitals and skilled nursing facilities. Policy makers expect that reducing readmissions to hospitals will generate major savings and improve the quality of life for the frail elderly. However, further work is needed to investigate the precise mechanisms that underlie the reduction of readmissions among ACO-affiliated hospitals.

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Section: Study Data and Methodsmentioning

confidence: 99%

ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals

et al. 2017

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“…1–3 Whether or not they create formal relationships with postacute care providers, hospitals might be expected to attempt to steer patients toward higher-quality providers from which patients are less likely to be rehospitalized. 4,5 Indeed, research shows that hospitals that discharge patients to fewer SNFs have lower aggregate rehospitalization rates from SNFs, and hospitals that reduced the number of discharge locations most dramatically over time had the greatest reduction in rehospitalization rates. 5 …”

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Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals

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Hospitals are now being held at least partly accountable for Medicare patients’ care after discharge, as a result of regulations and incentives imposed by the Affordable Care Act. However, little is known about how patients select a postacute care facility. We used a multiple case study approach to explore both how patients requiring postacute care decide which skilled nursing facility to select and the role of hospital staff members in this decision. We interviewed 138 staff members of sixteen hospitals and twenty-five skilled nursing facilities and 98 patients in fourteen of the skilled nursing facilities. Most patients described receiving only lists of skilled nursing facilities from hospital staff members, while staff members reported not sharing data about facilities’ quality with patients because they believed that patient choice regulations precluded them from doing so. Consequently, patients’ choices were rarely based on readily available quality data. Proposed changes to the Medicare conditions of participation for hospitals that pertain to discharge planning could rectify this problem. In addition, less strict interpretations of choice requirements would give hospitals flexibility in the discharge planning process and allow them to refer patients to higher-quality facilities.

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“…Rahman, McHugh, and others have recently demonstrated that, among Medicare patients discharged to a skilled nursing facility for post-acute care, the skilled nursing facility’s rehospitalization rate has greater influence on patients’ risk of rehospitalization than does the discharging hospital. (41) Alongside this work, our quantitative estimates of the relative contribution of care provided within individual settings to functional and survival outcomes can provide input to policy-makers and health care providers to help identify targets for quality improvement and inform strategies and to allocate resources within health systems to maximize the value of care that they provide.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Contributions of Acute and Postacute Care Facility Characteristics to Outcomes After Hospitalization for Hip Fracture

et al. 2017

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OBJECTIVE To quantify the contribution of acute versus post-acute care factors to survival and functional outcomes after hip fracture. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using Medicare data; subjects included previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. METHODS We used logistic regression to measure the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility; we quantified the contribution of hospital versus nursing home factors to outcomes via the omega statistic. RESULTS Among 45,996 hospitalized patients, 1,814 (3.9%) died during hospitalization. 42,781 (93%) were discharged alive to a nursing home. Of these, 12,126 (28%) died within 180 days and 20,479 (48%) died or were newly unable to walk within 180 days. Hospital characteristics were not consistently associated with outcomes. Multiple nursing home characteristics predicted 30- and 180-day outcomes, including bed count, chain membership, and performance on selected quality measures. Nursing home factors explained three times more variation in the odds of 30-day mortality than did hospital factors (omega, hospital versus nursing home: 0.32, 95% confidence interval (CI) 0.11, 0.96), seven times more variation in the odds of 180-day mortality (omega: 0.15, 95% CI 0.04, 0.61), and eight times more variation in the odds of 180-day death or new dependence in locomotion (omega: 0.12, 95% CI 0.05, 0.31). CONCLUSIONS Nursing home factor sex plain a larger proportion of the variation in clinical outcomes following hip fracture than do hospital factors.

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The Contribution of Skilled Nursing Facilities to Hospitals’ Readmission Rate

Abstract: The SNF rehospitalization rate has greater influence on patients' risk of rehospitalization than the discharging hospital. Identifying high-performing SNFs may be a powerful strategy for hospitals to reduce rehospitalizations.

Cited by 39 publications

References 33 publications

ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals

ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals

Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals

Comparing the Contributions of Acute and Postacute Care Facility Characteristics to Outcomes After Hospitalization for Hip Fracture

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