Acute Care/Hospitalization

Discharge to skilled nursing facilities after a heart attack or heart failure explains little of variation in hospital readmissions

After a heart attack or heart failure, some patients are sent to skilled nursing facilities (SNFs) to take advantage of intensive monitoring and recuperation. Hospitals vary widely in how many of these patients they send to SNFs after hospitalization. Also, high rates of admission to SNFs had no substantial impact on 30-day readmission rates to hospitals, according to a new study.

The researchers reviewed claims data from fee-for-service Medicare patients admitted to a hospital with a heart attack or heart failure. From these data, rates of admission to SNFs were calculated as well as 30-day readmission rates to hospitals.

Hospital readmission rates were 24.7 percent for heart failure patients and 19.9 percent for heart attack patients. The rate of admission to a SNF ranged considerably among various hospitals for both groups of patients. For heart failure patients, higher rates of SNF use were not associated with lower hospital readmission rates. Hospitals with high SNF usage rates for heart attack patients had higher readmission rates for these patients. However, this relationship was weak, with SNF rates explaining less than 4 percent of the variation in hospital readmission rates. Even hospitals with low readmission rates for both groups had high and low usage of SNFs. The study was supported in part by the Agency for Healthcare Research and Quality (HS18781).

See "Skilled nursing facility referral and hospital readmission rates after heart failure or myocardial infarction," by Jersey Chen, M.D., M.P.H., Joseph S. Ross, M.D., M.H.S., Melissa D.A. Carlson, Ph.D., and others in the January 2012 The American Journal of Medicine 125(1), pp. 100.e1-100.e9.

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