Skilled Nursing Facility Use and Hospitalizations in Heart Failure

Abstract

Objective To examine the impact of skilled nursing facility (SNF) use on hospitalizations among heart failure (HF) patients and to examine predictors of hospitalization among HF patients admitted to a SNF. Patients and Methods Olmsted County, MN residents with first-ever HF from 1/1/2000-12/31/2010 were identified and clinical data were linked to SNF utilization data from CMS. Andersen-Gill models were used to determine the association between SNF use and hospitalizations and to determine predictors of hospitalization. Results Among 1,498 incident HF patients (mean age 75±14, 45% male), 605 (40.4%) were admitted to a SNF after HF diagnosis (median (min, max) follow-up 3.6 (0-13.0) years). Among those with a SNF admission, 225 (37%) had 2 or more admissions. After adjustment for age, sex, ejection fraction and comorbidities, being in a SNF was associated with a 50% increased risk of hospitalization compared to not being in a SNF (adjusted HR, 95% CI: 1.52, 1.31-1.76). Among SNF users, arrhythmia, asthma, chronic kidney disease, and the number of activities of daily living (ADLs) requiring assistance were independently associated with an increased risk of hospitalization. Conclusion Approximately 40% of HF patients were admitted to a SNF at some point after diagnosis. Compared to patients not in a SNF, SNF users were more likely to be hospitalized. Characteristics associated with hospitalization among the SNF users were mostly non-cardiovascular, including reduced ability to perform ADLs. These findings underscore the impact of physical functioning on hospitalizations among HF patients in SNFs and the importance of strategies to improve physical functioning.

Hospital Readmissions Reduction Program: Intended and Unintended Effects

“…In terms of discharge status, our study finds AMI patients were less likely to be discharged to an SNF. This is consistent with prior studies that report no correlation or positive relationship between SNF rates and readmission rates for AMI or heart failure patients (Allen et al, 2011;Chen et al, 2012;Manemann et al, 2017), which challenges perceptions that SNF care will necessarily reduce readmissions. A recent study has also found that deliberate reduction in intensive post-acute care discharges because of incentives created by the Bundled Payment for Care Improvement model is not associated with increase in readmission rates (Jubelt, Goldfeld, Chung, Blecker, & Horwitz, 2016).…”

Risk of 30-Day Hospital Readmission Among Patients Discharged to Skilled Nursing Facilities: Development and Validation of a Risk-Prediction Model

“…Hospitalized patients discharged to SNFs have greater functional dependence than those discharged to home, and therefore, the presence of impaired mobility loses its discriminative value in this high-risk group relative to community-dwelling patients 38 or to those with impaired functional status (or declining status while at a postacute-care rehabilitation facility). 29,33,[39][40][41] This study has several limitations. It was a retrospective study from a single integrated health care delivery system in the upper Midwest with a largely white population.…”

A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: Retrospective Analysis

“…Although community HF readmission rates average 22%, 30-day HF readmission rates in the SNF setting range from 27% to 43% [ 3 , 5 , 6 ]. There is great interest in reducing this “revolving door” phenomenon within the growing SNF population, as patients are living longer with greater disease severity and multiple comorbidities [ 4 , 7 ]. These readmissions also come at great expense to the health care system, averaging over US $9000 for a typical HF readmission [ 8 ].…”