Clinician Specialization in Skilled Nursing Facility Practice and Post-Acute Outcomes of Patients With Dementia

To evaluate the effects of physician and advanced practitioner specialization in skilled nursing facility (SNF)-based practice (SNFists) on the outcomes of patients with Alzheimer's disease and related dementias (ADRD) admitted to SNF for post-acute care.

Taking advantage of the natural experiment provided by the growth of SNFists, we conducted a within-SNF difference-in-differences analysis with cross-temporal matching. Our primary outcome was functional improvement at SNF discharge, measured using a validated activities of daily living (ADL) score. Secondary outcomes included unplanned rehospitalization, emergency department (ED) visits, observational stays within 30 days of SNF admission, successful discharge to the community, SNF length of stay, admission into long-term nursing home care within 6 months of SNF discharge, and 30- and 60-day Medicare payments for professional and facility services.

Medicare facility and professional claims and Nursing Home Minimum Data Set (MDS) data from 2012 and 2019 were used. The study sample included 338,574 community-dwelling fee-for-service Medicare beneficiaries with ADRD, age 65 or older, discharged from an acute care hospital to one of the 5196 SNFs that experienced an increase in patients treated by SNFists.

We did not observe an association between SNFist care and patient post-acute care outcomes or costs.

Specialization in SNF-based practice among physicians and advanced practitioners alone may not be an effective strategy to improve post-acute care outcomes or reduce costs to Medicare for patients with ADRD.