Does Reducing Length of Stay Increase Rehospitalization of Medicare Fee‐for‐Service Beneficiaries Discharged to Skilled Nursing Facilities?

Unruh, Mark Aaron; Trivedi, Amal N.; Grabowski, David C.; Mor, Vincent

doi:10.1111/jgs.12411

Cited by 26 publications

(19 citation statements)

References 23 publications

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“…For cardiovascular disease as a whole, some large studies have been reported, mostly positive [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23], although longer term translation of findings into actual clinical care within those systems is unknown.…”

Section: Monitoring Patients Status and Response To Treatmentmentioning

confidence: 99%

Why it Remains Difficult for Remote Cardiologist to Obtain the Locus of Control for Ambulatory Health Care Conditions Such as Congestive Heart Failure? A Tug of War between General Practice, Administrators and Implementable Research Findings

Iyngkaran¹,

Brown²,

Cass

et al. 2014

J Gen Pract

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Section: Monitoring Patients Status and Response To Treatmentmentioning

confidence: 99%

Why it Remains Difficult for Remote Cardiologist to Obtain the Locus of Control for Ambulatory Health Care Conditions Such as Congestive Heart Failure? A Tug of War between General Practice, Administrators and Implementable Research Findings

Iyngkaran¹,

Brown²,

Cass

et al. 2014

J Gen Pract

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“…Patients and hospitals with longer length of stay showed reduced readmission rate in HF patients [37]. Alternatively, individuals hospitalized for heart failure, had no increase in 30-day re-hospitalization when LOS was decreased by a day [38].…”

Section: Literature Reviewmentioning

confidence: 99%

Factors associated with heart failure readmissions from skilled nursing facilities

Ak¹

2017

Interventional-Cardiology

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Background: Despite guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital re-admission of heart failure patients and associated costs remain unacceptably high in the SNF populations. Transfer to SNF is one strategy to limit hospitalizations. As such, 25% of patients are still symptomatic at time of discharge.Purpose: The objective of this study is to identify patient factors affecting re-admissions of HF patients residing in SNF within 30-days.Methods: A retrospective electronic chart review was completed on patients > 65 years with HF who were admitted into large medical center between 2012 and 2014. Descriptive statistics and univariate analyses using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney test for continuous data was used to compare patients readmitted within 30 days vs. those who were not readmitted within 30 days. Significant factors associated with readmission in the univariate analysis (p < 0.10) were included for a multivariate logistic regression model. The analysis of LOS was accomplished by applying standard methods of survival analysis, i.e., computing the Kaplan-Meier product limit curves, where the data were stratified by readmission within 30 days (Yes vs. No). No data were considered 'censored'. The groups were compared using the log-rank test. The median rates for each group were obtained from the Kaplan-Meier/Product-Limit Estimates and their corresponding 95% confidence intervals were computed, using Greenwood's formula to calculate the standard error. Unless otherwise specified, a result was considered statistically significant at the p < 0.05 level of significance.Results: Fifteen variables: creatinine, weight difference, CKD, Angina, Arrhythmia, VHD, Tobacco, ADL, independent in bathing, independent in the toilet, S3 Heart sounds present, HJR, AF, Nitrates, and Hydralazine, were identified for the multivariate logistic regression as potential risk factors associated with "readmission within 30 days". Based on 23 readmissions within 30 days, our final model included only 2 predictor variables. Creatinine and ADLs were included in the final model as this subset of predictors was found to be the best for prediction of "readmission within 30 days". Creatinine (p < 0.0087) and ADLs (p < 0.0077) were both significantly associated with readmission within 30 days in the final logistic regression model. Every 1-unit increase in creatinine was associated with an 87% increase in the odds of being readmitted within 30 days (OR = 1.87). Those patients who require assistance with ADLs were over 9 times more likely to be readmitted within 30 days (OR = 9.25) as compared to patients who are independent.

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“…8,9 Twenty-two percent of Medicare beneficiaries experience such an event during a PAC stay, of which more than half (59%) are preventable. 9 For short-stay patients, such an event often leads to a rehospitalization, 9–11 which may limit their ability to achieve their goal of returning to the community; however, no study has systematically looked at the achievement of this rehabilitation outcome.…”

Section: Introductionmentioning

confidence: 99%

What Happens to Patients When They Fracture Their Hip During a Skilled Nursing Facility Stay?

Leland

Gozalo

Bynum

et al. 2015

Journal of the American Medical Directors Association

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Objectives To characterize outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home (NH) receiving skilled nursing facility (SNF) services. Design Observational study. Participants Short-stay fee-for-service Medicare beneficiaries who experienced their first hip fracture during a SNF stay. Measurements Outcomes measured in the 90 days after the hip fracture hospitalization included community discharge (with a stay in the community < 30 days), successful community discharge (in the community ≥30 days), death, and institutionalization. Results Between 1999 and 2007, 27,305 hip fractures occurred among short-stay nursing home patients receiving SNF care. After surgical repair of the hip fracture, 83.9% of these patients were discharged from the hospital back to a SNF, with most (99%) returning to the facility where the hip fracture occurred. In the first 90 days after hospitalization, 24.1% of patients died, 7.3% were discharged to the community but remained less than 30 days, 14.0% achieved successful community discharge, and 54.6% were still in a health care institution with almost 46.4% having transitioned to long-term care. Conclusion SNF care aims to maximize the short-stay patient’s independence and facilitate a safe community transition. However, experiencing a fall and hip fracture during the SNF stay was a sentinel event that limited the achievement of this goal. There is an urgent need to ensure the integration of fall prevention into the patient’s plan of care. Further, falls among SNF patients may serve as indicator of quality, which consumers and payers can use to make informed healthcare decisions.

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Does Reducing Length of Stay Increase Rehospitalization of Medicare Fee‐for‐Service Beneficiaries Discharged to Skilled Nursing Facilities?

Cited by 26 publications

References 23 publications

Why it Remains Difficult for Remote Cardiologist to Obtain the Locus of Control for Ambulatory Health Care Conditions Such as Congestive Heart Failure? A Tug of War between General Practice, Administrators and Implementable Research Findings

Why it Remains Difficult for Remote Cardiologist to Obtain the Locus of Control for Ambulatory Health Care Conditions Such as Congestive Heart Failure? A Tug of War between General Practice, Administrators and Implementable Research Findings

Factors associated with heart failure readmissions from skilled nursing facilities

What Happens to Patients When They Fracture Their Hip During a Skilled Nursing Facility Stay?

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