Abstract
Objectives
Our study examined the proportion of skilled nursing facility (SNF) post-acute care
residents who did not receive timely primary care provider (PCP) services following
discharge, factors associated with lack of timely PCP services, and factors associated
with perfect 30-day home time among those who did not receive timely PCP services.
Design
Longitudinal cohort study; data sources included Medicare claims and other administrative
databases.
Setting and Participants
25,357 fee-for-service New York State Medicare beneficiaries aged 65 years and older
admitted to SNFs for post-acute care in 2014 and then discharged to the community.
Methods
Our outcomes were a timely PCP visit (within 7 days of SNF discharge) and perfect
30-day home time, and we examined their association with patient, SNF, and county
factors.
Results
Among SNF discharges, 60.6% had a timely PCP visit. In multivariate regression analyses,
female sex, nonwhite race, Medicare only status, less functional impairment and medical
comorbidity, a surgical hospitalization, fewer hospital days, more SNF days, absence
of home health services, for-profit SNF status, higher SNF star rating, lower ratio
of registered nurse/total nursing hours, and rural counties were associated with lower
odds of a timely PCP visit following SNF discharge. Among those without a timely PCP
visit, female sex, less cognitive and functional impairment, less medical comorbidity,
a surgical hospitalization, fewer hospital days, receipt of home health services,
and higher SNF star rating were associated with increased odds of perfect 30-day home
time following SNF discharge.
Conclusions and Implications
That 4 in 10 post-acute care SNF patients did not have a timely PCP visit post-SNF
discharge, with racial minority and rural county status associated with decreased
odds of a timely PCP visit, is concerning. Examination of whether the timing and type
of outpatient visit may have varying effects on different post-acute care subpopulations
would build on this work.
Keywords
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Article info
Publication history
Published online: October 26, 2020
Footnotes
AS was supported through the Empire Clinical Research Investigator Program, sponsored by the New York State Department of Health as well as by the National Institute on Aging (grant number K23AG058757).
YL serves as an editor for Springer and a consultant for BCG Inc. and Intermountain Healthcare. The other authors declare no conflicts of interest.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
