National Trends in 30-Day Re-hospitalization Rates of Skilled Nursing Facilities with Disproportionate Shares of Racial
- PDF / 296,361 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 1 Downloads / 159 Views
Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA; 2Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05521-6 © Society of General Internal Medicine 2019
INTRODUCTION
Re-hospitalization of patients receiving post-acute care (PAC) in skilled nursing facilities (SNFs) has emerged as a leading health policy issue. PAC is the greatest source of geographic variation in Medicare spending.1 Among hospitalized Medicare fee-for-services beneficiaries, over 20% are discharged to SNFs2 and nearly a quarter of these patients are re-hospitalized.3 SNFs are segregated along racial lines4 and previous research has shown that there are marked racial variations in the odds of rehospitalization among select surgical patients discharged to these facilities.5 It is not clear how widespread racial disparities in re-hospitalizations among SNF patients are and whether other factors such as Medicaid participation influence the risk of them. We used a national dataset to examine risk-adjusted SNF re-hospitalization rates stratified by the racial composition and the proportion of Medicaid patients in these facilities.
METHODS
We used 2011–2015 data from “Long Term Care: Facts on Care in the US” which include facility-level measures aggregated from the Minimum Data Set (MDS), Medicare Fee-forService claims, and the Online Survey, Certification, and Reporting System (now known as CASPER). The data include demographic and clinical characteristics of SNF patients and facility characteristics. 6 To analyze temporal trends, we stratified the adjusted 30-day SNF re-hospitalization rates by (1) quartiles based on the distribution of the proportions of non-Hispanic white patients and (2) quartiles based on the distribution of the proportion of Medicaid patients, reflecting dual eligibility, where the first quartile represents the lowest Received October 15, 2019 Accepted October 25, 2019
percentages and the fourth quartile the highest percentages. The re-hospitalization rate was adjusted for patient demographics, functional status, prognosis, clinical conditions, diagnoses, and services received.6 Trends were analyzed by comparing differences in re-hospitalization rates between the first and fourth quartiles over time using linear regression. Statistical analyses were performed using R, version 3.5.3.
RESULTS
Changes in patient and facility characteristics were observed over the study period (Table 1). The total number of SNFs declined from 15,564 in 2011 to 15,282 in 2015 (− 1.8%, P = 0.04). Total SNF beds declined by 1.2% (P = 0.10) and the proportion of hospital-based SNFs declined from 6.1 to 5.2% (P = 0.37). The mean proportion of white patients declined by 1.7% (P < 0.001), and patients under age 65 increased by 2.3% (P < 0.001). The median proportion of Medicare beneficiaries and Medicaid patients declined by 5.0% (P = 0.01) and 2.0% (P = 0.02), respectively. Downward trends in SNF 30-da
Data Loading...
