Abstract
Objectives
The objectives of this study were to determine the association between patients’ functional
status at discharge from skilled nursing facility (SNF) care and 30-day potentially
preventable hospital readmissions, and to examine common reasons for potentially preventable
readmissions.
Design
Retrospective cohort study.
Setting
SNFs and acute care hospitals submitting claims to Medicare.
Participants
National cohort of Medicare fee-for-service beneficiaries discharged from SNF care
between July 15, 2013, and July 15, 2014 (n = 693,808). Average age was 81.4 (SD 8.1)
years, 67.1% were women, and 86.3% were non-Hispanic white.
Measurements
Functional items from the Minimum Data Set 3.0 were categorized into self-care, mobility,
and cognition domains. We used specifications for the SNF potentially preventable 30-day
postdischarge readmission quality metric to identify potentially preventable readmissions.
Results
The overall observed rate of 30-day potentially preventable readmissions following
SNF discharge was 5.7% (n = 39,318). All 3 functional domains were independently associated
with potentially preventable readmissions in the multivariable models. Odds ratios
for the most dependent category versus the least dependent category from multilevel
models adjusted for patients’ sociodemographic and clinical characteristics were as
follows: mobility, 1.54 (95% confidence interval [CI] 1.49–1.59); self-care, 1.50
(95% CI 1.44–1.55); and cognition, 1.12 (95% CI 1.04–1.20). The 5 most common conditions
were congestive heart failure (n = 7654, 19.5%), septicemia (n = 7412, 18.9%), urinary
tract infection/kidney infection (n = 4297, 10.9%), bacterial pneumonia (n = 3663,
9.3%), and renal failure (n = 3587, 9.1%). Across all 3 functional domains, septicemia
was the most common condition among the most dependent patients and congestive heart
failure among the least dependent.
Conclusions
Patients with functional limitations at SNF discharge are at increased risk of hospital
readmissions considered potentially preventable. Future research is needed to determine
whether improving functional status reduces risk of potentially preventable readmissions
among this vulnerable population.
Keywords
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Article info
Publication history
Published online: January 19, 2018
Footnotes
The authors declare no conflicts of interest.
The study was funded by the National Institutes of Health (R01AG33134; K05CA134923; R01HD069443; K12HD055929; U54GM104941; P2CHD065702, and P30AG024832), the Agency for Healthcare Research and Quality (R24HS22134), and the Foundation for Physical Therapy's Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant.
Identification
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© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
