Association between skilled nursing facility quality indicators and hospital readmissions

Area of Science:

• Health Services Research
• Gerontology
• Public Health

Background:

• Hospital readmissions are a significant concern, representing a substantial cost and potential for preventable adverse patient outcomes.
• Skilled nursing facility (SNF) performance metrics are increasingly scrutinized, yet their association with readmission risk remains underexplored.

Purpose of the Study:

• To investigate the relationship between publicly reported SNF performance measures and the risk of hospital readmission or death within 30 days for Medicare beneficiaries.
• To determine if SNF staffing, health deficiencies, or patient outcomes (delirium, pain, pressure ulcers) predict readmission risk.

Main Methods:

• Analysis of national Medicare fee-for-service data (2009-2010) for beneficiaries discharged to SNFs post-hospitalization.
• Examined associations between SNF performance metrics (staffing, inspection deficiencies, patient outcomes) and 30-day readmission or death.
• Adjusted for patient case mix, SNF facility characteristics, and discharging hospital factors.

Main Results:

• A total of 1,530,824 patients were analyzed; 23.3% experienced readmission or death within 30 days.
• Unadjusted analyses indicated lower readmission/death risk with higher SNF staffing and better facility inspection ratings.
• After adjustments, SNF facility inspection ratings showed a small association with readmission/death risk; other measures did not predict clinically meaningful differences.

Conclusions:

• Current publicly available SNF performance measures, including staffing and health deficiencies, were not consistently associated with significant differences in the adjusted risk of 30-day hospital readmission or death.
• Further research is needed to identify reliable performance indicators that effectively predict and reduce readmission risk for post-acute care patients.