Outcomes of Patients Discharged to Skilled Nursing Facilities After Acute Care Hospitalizations

Abstract

Objectives To evaluate previously independent older patients discharged to skilled nursing facilities (SNFs) and identify risk factors for failure to return home and death and development of a predictive tool to determine likelihood of adverse outcome. Background Little is known about the likelihood of return to home, and higher than expected mortality rates in SNFs have recently been described, which may represent an opportunity for quality improvement. Methods Retrospective cohort of older hospitalized patients discharged to SNFs during 2007 to 2009 in 5 states using Centers for Medicare & Medicaid Services linked minimum data set data from SNFs. We assessed mortality, hospital readmission, discharge to home, and logistic regression models for predicting risk of each outcome. Results Of 416,997 patients, 3.8% died during the initial SNF stay, 28.6% required readmission, and 60.5% were ultimately discharged home. Readmission to a hospital was the strongest predictor of death in the years after SNF admission (unadjusted hazard ratio, 28.2; 95% confidence interval, 27.2–29.3; P < 0.001). Among all patients discharged to SNFs, 7.8% eventually died in an SNF and overall 1-year mortality was 26.1%. Risk factors associated with mortality and failure to return home were increasing age, male sex, increasing comorbidities, decreased cognitive function, decreased functional status, parenteral nutrition, and pressure ulcers. Conclusions A large proportion of older patients discharging to SNFs never return home. A better understanding of the natural history of patients sent to SNFs after hospitalization and risk factors for failure to return to home, readmission, and death should help identify opportunities for interventions to improved outcome.

Thirty-day readmission and mortality among Medicare beneficiaries discharged to skilled nursing facilities after vascular surgery

“…The notable difference in mortality among readmitted patients is consistent with previous work demonstrating, for example, a 5-fold increase in mortality among readmitted patients who underwent AAA repair. 19,32 Although readmitted patients as well as patients who die within 60 days of a procedure have preexisting morbidity that predisposes to poorer outcomes, our study shows that many of the factors related to readmission and mortality are potentially modifiable complications of the surgical procedure.…”

Impact of skilled nursing facility quality on postoperative outcomes after pancreatic surgery

“…5 For older patients, acute health care crises such as a major operation can have a substantial impact on functional capacity, often involving a prolonged recovery extending beyond the acute care hospitalization. 27 Given the high costs associated with SNFs, there has been increased interest in defining the overall utilization of SNFs after discharge. Chen et al 28 reported that SNF utilization among Medicare beneficiaries after coronary artery bypass grafting ranged 16%-19%, and SNF use was as great as 40%-46% among patients being discharged after total hip replacement.…”

Hospital transition care for the elderly: an integrative review

“…Studies show the importance of transitional care in the process of rehabilitation, rehabilitation, intervention, promotion and even cure of the elderly during discharge to the destination of origin (5,18) , implying significantly the lower re -hospitalizations of these individuals (12,15,19) .…”