The Contribution of Skilled Nursing Facilities to Hospitals’ Readmission Rate

• Published in: Health services research Vol. 52; no. 2; pp. 656 - 675
• Main Authors: Rahman, Momotazur, McHugh, John, Gozalo, Pedro L., Ackerly, Dana Clay, Mor, Vincent
• Format: Journal Article
• Language: English
• Published: United States Health Research and Educational Trust 01.04.2017; Blackwell Publishing Ltd; John Wiley and Sons Inc
• Subjects: 30‐day rehospitalization rate; Admission and discharge; Aged, 80 and over; Analysis; Beneficiaries; Discharge; Discharged; Female; Geriatrics; Government programs; Health care; Hospital admission and discharge; Hospital care; hospital discharge; Hospitalization; Hospitals; Humans; Male; Medicare; Medicare - statistics & numerical data; Nurses; Nursing; Older people; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Patients; Quality, Outcomes, and Innovation; Quartiles; Ratings & rankings; Readmission; Services; skilled nursing facilities; Skilled Nursing Facilities - statistics & numerical data; Studies; United States; United States; 30-day rehospitalization rate; hospital discharge; skilled nursing facilities
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12507

Objective To examine the relative influence of hospital and skilled nursing facilities (SNFs) on 30‐day rehospitalization. Data Sources/Settings Elderly Medicare beneficiaries newly admitted to a SNF following hospitalization. Study Design We ranked hospitals and SNFs into quartiles based on previous years’ adjusted rehospitalization rates (ARRs) and examined how rehospitalizations from a given hospital vary depending upon the admitting SNF ARR quartile. We examined whether the availability of SNFs with low rehospitalization rates influenced hospitals’ SNF readmission rates and whether changes in a hospital's ARR over 3 years is associated with changes in the SNFs to which they discharge. Principal Findings Hospital readmission rates from SNFs varied 5 percentage points between patients discharged to SNFs in the lowest and the highest rehospitalization quartiles. Low rehospitalization rate hospitals sent a larger fraction of their patients to the lowest rehospitalization SNFs available in the area. A 10 percent increase in hospital's share of discharges to the lowest rehospitalization quartile SNFs is associated with a 1 percentage point reduction in hospital's ARR. Conclusions 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.