Skilled Nursing Facility Star Rating, Patient Outcomes, and Readmission Risk After Total Joint Arthroplasty

J Arthroplasty. 2018 Oct;33(10):3130-3137. doi: 10.1016/j.arth.2018.06.020. Epub 2018 Jun 27.

Abstract

Background: This study examined the correlation between publicly reported indicators of skilled nursing facility (SNF) quality and clinical outcomes after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Methods: This retrospective analysis used Medicare claims from the Centers for Medicare and Medicaid Services 100% Standard Analytic File (2014-2015) that were linked to SNF quality star ratings from the Centers for Medicare and Medicaid Services Nursing Home Compare database. Overall SNF rating and subcomponents of the rating were evaluated for correlation to 30-day and 90-day risk of readmission. Ratings were based upon a 5-star rating system (1 representing the lowest quality). Cox proportional hazards regressions controlled for age, race, census division, hospital location, comorbidities, and SNF length of stay.

Results: A total of 9418 SNFs, 58,064 TKA patients, and 26,837 THA patients met criteria. As SNF overall star rating increased from 1 to 5, incidence of all-cause 30-day readmission decreased from 6.4% to 5.0% for TKA (relative reduction [RR] 22%; P < .001) and from 9.1% to 6.2% for THA (RR 32%; P < .001). As nurse staffing rating increased, incidence of all-cause readmission decreased from 6.8% to 4.7% for the TKA cohort (30.9% RR; P < .001), and from 7.7% to 6.0% for the THA cohort (22.1% RR; P = .003). Regression analysis demonstrated that a higher star rating was associated with decreased risk of readmission (both cohorts P < .05).

Conclusions: For patients undergoing TKA or THA, the overall SNF star rating, nurse staffing ratios, and physical therapy intensity were significantly correlated with risk of readmission within 30 days of SNF admission.

Keywords: readmissions; skilled nursing facility; star ratings; total hip arthroplasty; total joint arthroplasty; total knee arthroplasty.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / economics
  • Arthroplasty, Replacement, Knee / rehabilitation*
  • Arthroplasty, Replacement, Knee / statistics & numerical data
  • Cohort Studies
  • Comorbidity
  • Female
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Male
  • Medicare / economics
  • Medicare / statistics & numerical data
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data*
  • Quality Indicators, Health Care / economics
  • Quality Indicators, Health Care / statistics & numerical data
  • Retrospective Studies
  • Skilled Nursing Facilities / economics
  • Skilled Nursing Facilities / standards*
  • Skilled Nursing Facilities / statistics & numerical data*
  • United States / epidemiology