Abstract
Objectives
Increasing recognition of the adverse events older adults experience in post-acute
care in skilled nursing facilities (SNFs) has led to multiple efforts to improve care
integration between hospitals and SNFs. We sought to measure current care integration
activities between hospitals and SNFs.
Design
Cross-sectional survey.
Setting and Participants
A total of 500 randomly selected Medicare-certified SNFs in the United States in 2019.
The survey inquired about 12 care integration activities with the 2 highest volume
referring hospitals for each SNF.
Methods
We collapsed survey responses into 5 categories of integration based on high correlations
between the individual measures. These were: (1) formal integration (co-location or
co-ownership); (2) informal integration (eg, formal affiliation, participation in
SNF collaborative, shared pay for performance, or clinical leadership meetings between
hospital and SNF); (3) shared quality/safety activities (eg, initiatives to improve
medication safety or reduce hospital admission); (4) shared care coordinators; and/or
(5) shared supervising clinicians. We then conducted multivariate regressions to examine
associations between different care integration activities and hospital/SNF characteristics.
Results
Our overall response rate was 53.0%, including 265 SNFs that represented 487 SNF-hospital
pairs. Informal integration was most common (in 53.3% of pairs), whereas shared clinicians
(43.0%), care coordinators (36.5%), shared quality/safety activities (35.1%), and
formal integration (7.4%) were present in a minority. Hospital-SNF pairs had lower
odds of being formally integrated if the SNF was for-profit compared with not-for-profit
[odds ratio (OR) 0.11, 95% confidence interval (CI) 0.03–0.42, adjusted P = .04)] and higher odds of sharing quality improvement activities in metropolitan
rather than rural areas (OR 4.06, 95% CI 1.80–9.17, adjusted P = .02) and in the Midwest compared with West (OR 2.95, 95% CI 1.44–6.06, adjusted
P = .049).
Conclusions and Implications
These findings raise important questions about what is driving variability in hospital-SNF
integration activities, and which activities may be most effective for improving transitional
care outcomes.
Keywords
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Article info
Publication history
Published online: May 29, 2021
Footnotes
JA-M and JP were supported by a grant from The John A. Hartford Foundation (261408–5107206), which supported the development, administration, and analysis of the survey.
The authors declare they do not have relevant conflicts of interest. The sponsor did not have any role in the design, methods, data collection, analysis, or preparation of the paper.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
