TY - JOUR
T1 - Readmission rates and skilled nursing facility utilization after major inpatient surgery
AU - Chen, Lena M.
AU - Acharya, Yubraj
AU - Norton, Edward C.
AU - Banerjee, Mousumi
AU - Birkmeyer, John D.
N1 - Funding Information:
Supported by the National Institute on Aging (Grant No. P01AG019783) and the Agency for Healthcare Research and Quality (AHRQ) (R01HS024698). In addition, Lena Chen was supported by a Career Development Grant Award (K08HS020671) from AHRQ at the time work on the manuscript started.
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: There is widespread interest in reducing use of postacute care (ie, care after hospital discharge) following major surgery, provided that such reductions do not worsen quality outcomes such as readmission rates. Objectives: To describe the association between changes in skilled nursing facility (SNF) use and changes in readmission rates after surgery. Research Design: This was a observational study. Subjects: Fee-for-service Medicare beneficiaries undergoing coronary artery bypass grafting (CABG) or total hip replacement (THR) from 2008 to 2013. Measures: Primary exposure was risk-adjusted SNF use initiated 0-2 days after hospital discharge, and the primary outcome was riskadjusted readmission rates from 3 to 30 days after discharge. Results: Among 176,994 patients who underwent CABG at 804 hospitals and 233,955 patients who underwent THR at 1220 hospitals, hospital-level SNF utilization increased after CABG (16.4%-19.0%, P=0.001) and THR (40.8%-45.5%, P<0.001), from 2008 to 2013. Hospital readmission rates decreased for CABG (14.7%-12.7%, P<0.001) but did not change for THR (4.9%-4.8%, P=0.55), from 2008 to 2013. However, there was wide variation in hospital-level change in readmission rates. After adjusting for hospital characteristics and baseline readmission rates, there was no statistically significant association between change in SNF use and change in readmission rates (0.017 and 0.011 percentage point increase in SNF use for every one percentage point increase in readmission rates for CABG and THR respectively, P=0.58 and 0.32). Conclusions: Changes in use of postacute care after THR and CABG have not been associated with changes in readmission rates.
AB - Background: There is widespread interest in reducing use of postacute care (ie, care after hospital discharge) following major surgery, provided that such reductions do not worsen quality outcomes such as readmission rates. Objectives: To describe the association between changes in skilled nursing facility (SNF) use and changes in readmission rates after surgery. Research Design: This was a observational study. Subjects: Fee-for-service Medicare beneficiaries undergoing coronary artery bypass grafting (CABG) or total hip replacement (THR) from 2008 to 2013. Measures: Primary exposure was risk-adjusted SNF use initiated 0-2 days after hospital discharge, and the primary outcome was riskadjusted readmission rates from 3 to 30 days after discharge. Results: Among 176,994 patients who underwent CABG at 804 hospitals and 233,955 patients who underwent THR at 1220 hospitals, hospital-level SNF utilization increased after CABG (16.4%-19.0%, P=0.001) and THR (40.8%-45.5%, P<0.001), from 2008 to 2013. Hospital readmission rates decreased for CABG (14.7%-12.7%, P<0.001) but did not change for THR (4.9%-4.8%, P=0.55), from 2008 to 2013. However, there was wide variation in hospital-level change in readmission rates. After adjusting for hospital characteristics and baseline readmission rates, there was no statistically significant association between change in SNF use and change in readmission rates (0.017 and 0.011 percentage point increase in SNF use for every one percentage point increase in readmission rates for CABG and THR respectively, P=0.58 and 0.32). Conclusions: Changes in use of postacute care after THR and CABG have not been associated with changes in readmission rates.
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U2 - 10.1097/MLR.0000000000000941
DO - 10.1097/MLR.0000000000000941
M3 - Article
C2 - 29995694
AN - SCOPUS:85050363801
SN - 0025-7079
VL - 56
SP - 679
EP - 685
JO - Medical care
JF - Medical care
IS - 8
ER -