Use of Postacute Care by Nursing Home Residents Hospitalized for Stroke or Hip Fracture: How Prevalent and to What End?

OBJECTIVES: To examine nursing home (NH) residents' use of Medicare-paid skilled nursing facility (SNF) services and the outcomes of that care and to identify clinical and non-clinical factors associated with that care. DESIGN: Retrospective cohort. SETTING: United States. PARTICIPANTS: NH residents aged 65 and older with Medicare claims for a hospitalization for hip fracture or stroke during 2001 to 2003. MEASUREMENTS: Resident diagnoses and use of SNF postacute care were measured using Medicare hospital claims. Market and provider characteristics were drawn from the Provider of Services file. Baseline characteristics, institutionalization, and mortality outcomes were drawn from the Minimum Data Set and Medicare Denominator File. RESULTS: Of the NH population hospitalized for hip fracture (49,903) or stroke (23,084), 79.7% and 64.1%, respectively, used the SNF benefit. Residents not using the SNF benefit had poorer baseline health status; their mortality rates and rates of resuming long-term care were similar to the rates of residents who used the SNF benefit. CONCLUSION: NH residents used postacute SNF benefits at high rates yet had similar mortality and institutionalization outcomes as those without SNF care.