Key result
Connected SNF care model linked to ~24% lower 30-day readmissions vs usual care.
Why the study?
Readmissions from skilled nursing facilities after hospital discharge are common, but interventions to reduce these readmissions are scarce.
Does a connected care model with frequent visits by hospital-employed providers reduce 30-day hospital readmission rates in patients discharged to skilled nursing facilities?
Cohort (n=13,544)
Yes
Does a connected care model with frequent visits by hospital-employed providers reduce 30-day hospital readmission rates in patients discharged to skilled nursing facilities?
Absolute Event Rate: 21.7% vs 28.5%
p-value: p=<0.001
A connected care model involving frequent visits by hospital-employed providers to skilled nursing facilities significantly reduces 30-day hospital readmission rates.
May support connected care models to reduce readmissions from skilled nursing facilities; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: About one-fifth of hospitalized Medicare beneficiaries are discharged to skilled nursing facilities (SNFs) for post-acute care. Readmissions are common but interventions to reduce readmissions are scarce. OBJECTIVE: To assess the impact of a connected care model on 30-day hospital readmission rates among patients discharged to SNFs. DESIGN: Retrospective cohort. SETTING: SNFs that receive referrals from an academic medical center in Cleveland, Ohio. PARTICIPANTS: All patients admitted to Cleveland Clinic main campus between January 1, 2011 and December 31, 2014 and subsequently discharged to 7 intervention SNFs or 103 control SNFs. INTERVENTIONS: Hospital-employed physicians and advanced practice professionals (nurse practitioners and physician assistants) visited SNF patients 4 to 5 times per week. RESULTS: During the study period, 13,544 patients were discharged to SNFs within a 25-miles radius of Cleveland Clinic main campus. Of these, 3334 were discharged to 7 intervention SNFs and 10,201 were discharged to 103 usualcare SNFs. During the intervention phase (2013-2014), adjusted 30-day readmission rates declined at the intervention SNFs (28.1% to 21.7%, P < 0.001), while there was a slight increase at control SNFs (27.1 % to 28.5%, P < 0.001). The absolute reductions ranged from 4.6% for patients at low risk for readmission to 9.1% for patients at high risk, and medical patients benefited more than surgical patients. CONCLUSIONS: A program of frequent visits by hospital employed physicians and advanced practice professionals at SNFs can reduce 30-day readmission rates. Journal of Hospital Medicine 2017;12:238-244.
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Kim et al. (2017) conducted a cohort in Patients discharged to skilled nursing facilities (n=13,544). Connected care model vs. Usual care was evaluated on 30-day hospital readmission rates (p=<0.001). A connected care model with frequent provider visits at skilled nursing facilities reduced adjusted 30-day readmission rates to 21.7%, compared to 28.5% at control facilities.
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