Structure, process, and outcomes in skilled nursing facilities: understanding what happens to surgical patients when they cannot go home. A systematic review

Abstract

Background The surgical population is aging, and greater numbers of surgical patients are being discharged to skilled nursing facilities. Post-acute care is a poorly understood but very important aspect of our healthcare system. Methods This systematic review examines the current body of literature surrounding the structural, process of care, and outcomes measurements for patients in skilled nursing facilities. English language articles published between 1998 and 2011 that purposed to examine nursing facility structure, process of care, and/or outcomes were included. Results & Conclusions Abstracts (2129) were screened and 102 articles were reviewed in full. Twenty-nine articles were included in the qualitative synthesis. The role of the care setting and care delivery in contributing to outcomes has not been well studied, and no strong conclusions can be made. This area of care currently represents a “black box” to practicing surgeons. An understanding of these factors maybe instrumental to determining future directions for research to maximize positive outcomes for these patients.

Patient complexity by surgical specialty does not correlate with work relative value units

“…Non-home discharge demonstrates that the patient requires a high level of care or rehabilitation and also can complicate discharge planning. 15 Readmissions and complications are linked directly to the primary surgeon and hospital and require additional effort, energy, and work. Furthermore, these metrics affect reimbursement and may play more substantial roles in future models of insurance reimbursement.…”

Challenges to Admitting Residents: Perspectives from Rural Nursing Home Administrators and Staff

“… 7 , 12 As a result, hospital discharge planners and others managing these transitions continue to have limited information about the post-acute environment and how their decisions and discharge processes facilitate or impede high-quality care in that environment, ultimately impacting patient outcomes. 7 , 13 - 15 …”

“…7,12 As a result, hospital discharge planners and others managing these transitions continue to have limited information about the post-acute environment and how their decisions and discharge processes facilitate or impede high-quality care in that environment, ultimately impacting patient outcomes. 7,[13][14][15] These transitional care challenges (eg, rigor and efficiency of communication and coordination workflows) speak to the importance of the process domain of Donabedian's structureprocess-outcome quality of care model. 15,16 However, this model also highlights the importance of structural considerations, including facility characteristics (eg, size, location, and staffing) and community characteristics reflected in the patient population (eg, the average level of need and complexity).…”

“…7,[13][14][15] These transitional care challenges (eg, rigor and efficiency of communication and coordination workflows) speak to the importance of the process domain of Donabedian's structureprocess-outcome quality of care model. 15,16 However, this model also highlights the importance of structural considerations, including facility characteristics (eg, size, location, and staffing) and community characteristics reflected in the patient population (eg, the average level of need and complexity). Structure and process both impact outcomes, directly and through a complex interaction between the 2.…”

Facility-Level Factors and Outcomes After Skilled Nursing Facility Admission for Trauma and Surgical Patients

“…28,29 A volume-outcome relationship suggests that institutions with more experience caring for patients with unique care needs are less likely to incur AEs. To date, however, there has been limited study on volume and outcomes in PAC 30–32 . A 2010 study of SNFs with high volume admissions demonstrated lower rates of functional decline in patients compared with the low volume SNFs.…”