Abstract
Objectives
We examined whether better patient safety culture (PSC) in skilled nursing facilities
was associated with higher likelihood of successful community discharge for post-acute
care residents.
Design
Cross-sectional study.
Setting and Participants
Medicare beneficiaries who were newly admitted for post-acute care (N = 53,929) to
skilled nursing facilities participating in PSC survey (N = 818).
Methods
Facility-level PSC scores were obtained from a national, random survey conducted in
2017. Survey data was linked to Minimum Dataset 3.0, Medicare Provider Analysis and
Review, Master Beneficiary Summary File, Nursing Home Compare File, Payroll-Based
Journal, and Areal Health Resources File. Successful discharge to community was the
outcome of interest. Facility-level PSC scores were the key covariate. We controlled
for individual-level, facility-level, and area-level characteristics. Separate logistic
regression models for each of the 12 PSC domains and for the overall score were fit.
Results
Post-acute care residents who were successfully discharged to community were more
likely to be female (63.7%), white (87.1%), Medicare-only (88.1%), cognitively intact
(87.8%), and admitted following a surgery (40.9%) The multivariable analyses showed
that teamwork (odds ratio 1.09, P = .02) and supervisor expectations and actions promoting resident safety (odds ratio
1.11, P = .01) were significantly associated with the increased likelihood of successful
community discharge.
Conclusions and Implications
This is the first study to analyze the relationship between patient safety culture
and successful discharge among post-acute care residents. Our results suggest that
nursing home leaders may want to focus their quality and safety improvement efforts
on specific PSC domains (eg, teamwork) as means for improving community discharge
for post-acute care residents.
Keywords
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Article info
Publication history
Published online: May 21, 2021
Footnotes
This study was funded by Agency for Healthcare Research and Quality (AHRQ) Grant R01HS024923. The views expressed in this article do not necessarily represent the view of AHRQ.
The authors declare no conflicts of interests.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
