Specialty care in skilled nursing facilities: Tackling a hidden disparity

Abstract

Upon hospital discharge, many patients continue their care in postacute care facilities such as skilled nursing facilities (SNFs).These patients are generally frailer than those discharged home, placing them at an increased risk of readmission. In fact, one in five patients discharged to postacute care facilities is readmitted to a hospital within 30 days. 1 Unnecessary readmissions and emergency department (ED) visits disrupt patients' clinical care progression, are costly to the healthcare system, and unfortunately are borne unequally across racial lines. 2,3 In this issue of Journal of Hospital Medicine, Krickus et al. 4 unearth a previously unidentified driver of ED visits among patients discharged to SNFs: lack of access to specialty follow-up-a type of healthcare resource with disparate access across racial and socioeconomic strata. In their study of Medicare fee-for-service beneficiaries admitted to a SNF between 2012 and 2014 who had received an inpatient consult, they found that Black, Indigenous, and people of color (BIPOC) patients had lower odds of outpatient specialty care follow-up during their SNF stay compared to non-Hispanic White (NHW) patients. This lack of follow-up was associated with a significant difference in ED visits between BIPOC and NHW patients.

Causes and Solutions for Emergency Department Crowding: A Qualitative Study of Healthcare Staff Perspectives

“…Insufficient healthcare system including unable to get appointment from outpatient clinics, lack of out-of-hours services, and having problems with GPs lead to patients seeking care in the ED, which could contribute to ED crowding. These results are consistent with the existing literature (15,(20)(21)(22)(23)(24). Therefore, improving healthcare system by addressing these issues could potentially alleviate ED crowding.…”