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. 2023 Oct;16(10):e009639.
doi: 10.1161/CIRCOUTCOMES.122.009639. Epub 2023 Sep 13.

Determinants and Outcomes Associated With Skilled Nursing Facility Use After Coronary Artery Bypass Grafting: A Statewide Experience

Michael P Thompson  1   2 , James W Stewart 2nd  1 , Hechuan Hou  1 , Hari Nathan  3   2 , Francis D Pagani  1   4 , Alphonse DeLucia 3rd  1 , Patricia F Theurer  4 , Richard L Prager  1   4 , Robert B Hawkins  1 , Donald S Likosky  1   4
Affiliations

Determinants and Outcomes Associated With Skilled Nursing Facility Use After Coronary Artery Bypass Grafting: A Statewide Experience

Michael P Thompson et al. Circ Cardiovasc Qual Outcomes. 2023 Oct.

Abstract

Background: Skilled nursing facility (SNF) care is frequently used after cardiac surgery, but the patterns and determinants of use have not been well understood. The objective of this study was to evaluate determinants and outcomes associated with SNF use after isolated coronary artery bypass grafting.

Methods: A retrospective analysis of Medicare Fee-For-Service claims linked to the Society of Thoracic Surgeons clinical data was conducted on isolated coronary artery bypass grafting patients without prior SNF use in Michigan between 2011 and 2019. Descriptive analysis evaluated the frequency, trends, and variation in SNF use across 33 Michigan hospitals. Multivariable mixed-effects regression was used to evaluate patient-level demographic and clinical determinants of SNF use and its effect on short- and long-term outcomes.

Results: In our sample of 8614 patients, the average age was 73.3 years, 70.5% were male, and 7.7% were listed as non-White race. An SNF was utilized by 1920 (22.3%) patients within 90 days of discharge and varied from 3.2% to 58.3% across the 33 hospitals. Patients using SNFs were more likely to be female, older, non-White, with more comorbidities, worse cardiovascular function, a perioperative morbidity, and longer hospital lengths of stay. Outcomes were significantly worse for SNF users, including more frequent 90-day readmissions and emergency department visits and less use of home health and rehabilitation services. SNF users had higher risk-adjusted hazard of mortality (hazard ratio, 1.41 [95% CI, 1.26-1.57]; P<0.001) compared with non-SNF users and had 2.7-percentage point higher 5-year mortality rate in a propensity-matched cohort of patients (18.1% versus 15.4%; P<0.001).

Conclusions: The use of SNF care after isolated coronary artery bypass grafting was frequent and variable across Michigan hospitals and associated with worse risk-adjusted outcomes. Standardization of criteria for SNF use may reduce variability among hospitals and ensure appropriateness of use.

Keywords: coronary artery bypass; quality of healthcare; subacute care.

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Conflict of interest statement

Disclosures Dr Thompson, Dr Nathan, Dr Pagani, P. Theurer, Dr Prager, and Dr Likosky received support from a contract from Blue Cross Blue Shield of Michigan. However, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect those of Blue Cross Blue Shield of Michigan or any of its employees. Dr Thompson receives extramural support from the Agency for Healthcare Research and Quality (1K01-HS027830). Dr Likosky receives research funding from the Agency for Healthcare Research and Quality (R01HS026003 AHRQ) and the National Institutes of Health (R01HL146619) and serves as a consultant for the American Society of Extracorporeal Technology. Dr Pagani receives research funding from the Agency for Healthcare Research and Quality (R01HS026003 AHRQ) and the National Institutes of Health (R01HL146619) and serves as a noncompensated scientific advisor for Medtronic, Abbott, FineHeart, and CH Biomedical. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Flow diagram of data sources and final analytic sample.
Figure 2.
Figure 2.
Observed and expected rates of skilled nursing facility use across Michigan hospitals and observed to expected skilled nursing facility rate ratio with confidence intervals comparing hospitals to the state average (n=33 hospitals, ordered from lowest to highest observed use rate).
Figure 3.
Figure 3.
Kaplan-Meier survival curves for skilled nursing users and non-users.
See this image and copyright information in PMC

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