Background Patterns in access to specialists among patients in skilled nursing facilities (SNFs) have not been previously described. Objective To measure access to outpatient specialty follow‐up and subsequent emergency department (ED) visits by patient characteristics, including race/ethnicity and those who received specialty care during the hospitalization that preceded the SNF stay. Design, Settings, and Participants This retrospective cohort study used the minimum data set and 100% Medicare fee‐for‐service claims for beneficiaries admitted to an SNF between 2012 and 2014. Hospital stays for surgical procedures were excluded. Main Outcome and Measures: The associations between ED visits, follow‐up, and race/ethnicity were measured using logistic and linear regression, adjusting for patient demographic and clinical characteristics. Results The sample included 1,117,632 hospitalizations by Medicare beneficiaries ≥65 with a consult by a medical subspecialist followed by discharge to SNF. Of the sample, 85.4% were non‐Hispanic White (NHW) and 14.6% were Black, indigenous, and people of color (BIPOC), according to Medicare beneficiary records. During the SNF stay, BIPOC patients had lower odds of specialty follow‐up compared to NHW patients (odds ratio [OR]: 0.96, 95% confidence intervals [CI]: 0.94–0.99, p = .004). BIPOC patients had higher rates of ED visits compared to NHW patients (with follow‐up: 24.1% vs. 23.4%, and without follow‐up: 27.4% vs. 25.9%, p < .001). Lack of follow‐up was associated with a 0.8 percentage point difference in ED visits between BIPOC and NHW patients (95% CI: 0.3–1.3, p = .003). Conclusions There is a racial/ethnic disparity in subspecialty follow‐up after hospital discharge to SNF that is associated with a higher rate of subsequent ED visits by BIPOC patients.
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