Abstract
Objectives
Health care providers at hospitals and skilled nursing facilities (SNFs) are increasingly
expected to optimize care of post-acute patients to reduce hospital readmissions and
contain costs. To achieve these goals, providers need to understand their patients’
risk of hospital readmission and how this risk is associated with health care costs.
A previously developed risk prediction model identifies patients’ probability of 30-day
hospital readmission at the time of discharge to an SNF. With a computerized algorithm,
we translated this model as the Skilled Nursing Facility Readmission Risk (SNFRR)
instrument. Our objective was to evaluate the relationship between 30-day health care
costs and hospital readmissions according to the level of risk calculated by this
model.
Design
This retrospective cohort study used SNFRR scores to evaluate patient data.
Setting and Participants
The patients were discharged from Mayo Clinic Rochester hospitals to 11 area SNFs.
Methods
We compared the outcomes of all-cause 30-day standardized direct medical costs and
hospital readmissions between risk quartiles based on the distribution of SNFRR scores
for patients discharged to SNFs for post-acute care from April 1 through November
30, 2017.
Results
Mean 30-day all-cause standardized costs were positively associated with SNFRR score
quartiles and ranged from $9199 in the fourth quartile (probability of readmission,
0.27-0.66) to $2679 in the first quartile (probability of readmission, 0.07-0.13)
(P ≤ .05). Patients in the fourth SNFRR score quartile had 5.68 times the odds of 30-day
hospital readmission compared with those in the first quartile.
Conclusions and Implications
The SNFRR instrument accurately predicted standardized direct health care costs for
patients on discharge to an SNF and their risk for 30-day hospital readmission. Therefore,
it could be used to help categorize patients for preemptive interventions. Further
studies are needed to confirm its validity in other institutions and geographic areas.
Keywords
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Article info
Publication history
Published online: January 11, 2021
Footnotes
Funding: The work on this project was supported by the small grants program at our institution (Mayo Clinic Center for Clinical and Translational Science grant number UL1TR002377) and by discretionary funds from our institution's Division of Community Internal Medicine.
The authors declare no conflicts of interest.
This project was completed with partial support from the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
