Patients discharged from higher‐quality skilled nursing facilities spend more days at home

Abstract

Objective To evaluate the association of skilled nursing facility (SNF) quality with days spent alive in nonmedical settings (“home time”) after SNF discharge to the community. Data Sources Secondary data are from Medicare claims for New York State (NYS) Medicare beneficiaries, the Area Health Resources File, and Nursing Home Compare. Study Design We estimate home time in the 30‐ and 90‐day periods following SNF discharge. Two‐part zero‐inflated negative binomial regression models characterize the association of SNF quality with home time. Data Extraction Methods We use Medicare claims data to identify 25 357 NYS fee‐for‐service Medicare beneficiaries aged 65 years and older with an SNF admission for postacute care who were subsequently discharged to home in 2014. Principal Findings Following 30 and 90 days after SNF discharge, the average home time is 28.0 (SD = 6.1) and 81.6 (SD = 20.2) days, respectively. A number of patient‐ and SNF‐level factors are associated with home time. In particular, within 30 and 90 days of discharge, respectively, patients discharged from 2‐ to 5‐star SNFs spend 1.2‐1.5 (P < .001) and 3.2‐4.3 (P < .001) more days at home than those discharged from 1‐star (lowest quality) SNFs. Conclusions Improved understanding of what is contributing to differences in home time could help guide efforts into optimizing post‐SNF discharge outcomes.

Skilled Nursing Facility Organizational Characteristics Are More Strongly Associated With Multiparticipant Therapy Provision Than Patient Characteristics

“…Although multiparticipant therapy was not lucrative for SNFs in 2018, lower rates of multiparticipant therapy in non-profit SNFs may reflect more individualized patient-centered care because non-profit SNFs have historically been shown to provide higher quality-services with better patient outcomes. 12 , 49–53 Additionally, non-profit SNFs tend to have better overall staffing and lower employment of therapy assistants, 12 , 48 , 50 factors associated with lower multiparticipant therapy provision in this study.…”

Development of an Injury Burden Prediction Model in Professional Baseball Pitchers

“…To predict the number of days lost (up to 90 days) to arm injury in professional pitchers a zero inflated negative binomial regression model was utilized. 42 An alternative model, a hurdle model was developed, to demonstrate similar prediction performance (Appendix 3). Predictor variables included were chosen based on the baseball injury prevention literature and included: 1) age, 2) BMI, 3) pitching role (starter versus reliever), 4) seasonal number of pitches, 5) number of pitching appearances in a season, 6) HT difference between dominant and nondominant shoulder (in degrees), 7) dominant shoulder TROM (in degrees), 8) dominant HA (in degrees), 9) lower extremity or trunk injury in the same year, 10) any previous arm injury history, 11) years played professionally, 12) received individualized injury prevention programs, 13) continent of origin, and 14) days practiced and competed in the season (exposure).…”

Care delivery approaches and perceived barriers to improving quality of care: A national survey of skilled nursing facilities

“…5 In contrast, patients receiving care from SNFs with higher quality ratings spent more time at home in the 30 and 90 days after SNF discharge. 6 There have been many recent public and private initiatives to improve SNF quality, 7,8 but few have made significant or reproducible progress. Perhaps the most prominent federal effort has been the bundled payments for care improvement (BPCI) program, which created incentives for hospitals and SNFs to better coordinate their services and redesign care delivery through a global payment covering the initial SNF stay and all subsequent care during the 90 days following SNF admission.…”