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Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study
- Source :
- Journal of the American Medical Directors Association. 20(4)
- Publication Year :
- 2018
-
Abstract
- Objective Discharge to skilled nursing facilities (SNFs) is common in patients with heart failure (HF). It is unknown whether the transition from SNF to home is risky for these patients. Our objective was to study outcomes for the 30 days after discharge from SNF to home among Medicare patients hospitalized with HF who had subsequent SNF stays of 30 days or less. Design Retrospective cohort study. Setting and participants All Medicare fee-for-service beneficiaries 65 and older admitted during 2012-2015 with a HF diagnosis discharged to SNF then subsequently discharged home. Measures Patients were followed for 30 days following SNF discharge. We categorized patients by SNF length of stay: 1 to 6 days, 7 to 13 days, and 14 to 30 days. For each group, we modeled time to a composite outcome of unplanned readmission or death after SNF discharge. Our model examined 0-2 days and 3-30 days post-SNF discharge. Results Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home. Overall, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge. The hazard rate of the composite outcome for each group was significantly increased on days 0 to 2 after SNF discharge compared to days 3 to 30, as reflected in their hazard rate ratios: for patients with SNF length of stay 1 to 6 days, 4.60 (4.23-5.00); SNF length of stay 7 to 13 days, 2.61 (2.45-2.78); SNF length of stay 14 to 30 days, 1.70 (1.62-1.78). Conclusions/implications The hazard rate of readmission after SNF discharge following HF hospitalization is highest during the first 2 days home. This risk attenuated with longer SNF length of stay. Interventions to improve postdischarge outcomes have primarily focused on hospital discharge. This evidence suggests that interventions to reduce readmissions may be more effective if they also incorporate the SNF-to-home transition.
- Subjects :
- Male
medicine.medical_specialty
genetic processes
Psychological intervention
macromolecular substances
Skilled Nursing
Medicare
Patient Readmission
Risk Assessment
Article
03 medical and health sciences
0302 clinical medicine
Hospital discharge
Medicine
Humans
In patient
030212 general & internal medicine
General Nursing
Aged
Retrospective Studies
Skilled Nursing Facilities
Aged, 80 and over
Heart Failure
business.industry
Health Policy
Hazard ratio
fungi
Retrospective cohort study
General Medicine
After discharge
Length of Stay
medicine.disease
Patient Discharge
United States
enzymes and coenzymes (carbohydrates)
Heart failure
Health Care Surveys
Emergency medicine
Female
Geriatrics and Gerontology
business
human activities
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15389375
- Volume :
- 20
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of the American Medical Directors Association
- Accession number :
- edsair.doi.dedup.....4bff730fb3fc42903be1ddf35a5f7c75