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. 2012 Jan;125(1):100.e1-9.
doi: 10.1016/j.amjmed.2011.06.011.

Skilled nursing facility referral and hospital readmission rates after heart failure or myocardial infarction

Jersey Chen  1 , Joseph S Ross, Melissa D A Carlson, Zhenqiu Lin, Sharon-Lise T Normand, Susannah M Bernheim, Elizabeth E Drye, Shari M Ling, Lein F Han, Michael T Rapp, Harlan M Krumholz
Affiliations

Skilled nursing facility referral and hospital readmission rates after heart failure or myocardial infarction

Jersey Chen et al. Am J Med. 2012 Jan.

Abstract

Background: Substantial hospital-level variation in the risk of readmission after hospitalization for heart failure (HF) or acute myocardial infarction (AMI) has been reported. Prior studies have documented considerable state-level variation in rates of discharge to skilled nursing facilities (SNFs), but evaluation of hospital-level variation in SNF rates and its relationship to hospital-level readmission rates is limited.

Methods: Hospital-level 30-day all-cause risk-standardized readmission rates (RSRRs) were calculated using claims data for fee-for-service Medicare patients hospitalized with a principal diagnosis of HF or AMI from 2006-2008. Medicare claims were used to calculate rates of discharge to SNF following HF-specific or AMI-specific admissions in hospitals with ≥25 HF or AMI patients, respectively. Weighted regression was used to quantify the relationship between RSRRs and SNF rates for each condition.

Results: Mean RSRR following HF admission among 4101 hospitals was 24.7%, and mean RSRR after AMI admission among 2453 hospitals was 19.9%. Hospital-level SNF rates ranged from 0% to 83.8% for HF and from 0% to 77.8% for AMI. No significant relationship between RSRR after HF and SNF rate was found in adjusted regression models (P=.15). RSRR after AMI increased by 0.03 percentage point for each 1 absolute percentage point increase in SNF rate in adjusted regression models (P=.001). Overall, HF and AMI SNF rates explained <1% and 4% of the variation for their respective RSRRs.

Conclusion: SNF rates after HF or AMI hospitalization vary considerably across hospitals, but explain little of the variation in 30-day all-cause readmission rates for these conditions.

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Conflict of interest statement

Conflict of Interest Statement: The analyses on which this publication is based were performed under contracts funded by the Centers for Medicare and Medicaid Services to the Yale Center for Outcomes Research and Evaluation which include Drs. Krumholz, Lin, Bernheim, and Drye. Drs. Ling, Han, and Rapp are employees of CMS. The remaining authors have no relevant financial conflicts of interest to report.

Figures

Figure 1
Figure 1
30-day heart failure risk-standardized readmission rate by skilled nursing facility rate
Figure 2
Figure 2
30-day acute myocardial infarction risk-standardized readmission rate by skilled nursing facility referral rate
See this image and copyright information in PMC

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