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Vasilevskis EE, Ouslander JG, Mixon AS, Bell SP, Jacobsen JML, Saraf AA, Markley D, Sponsler K, Shutes J, Long E, Kripalani S, Simmons SF, Schnelle JF. Potentially Avoidable Readmissions of Patients Discharged to Post-Acute Care: Perspectives of Hospital and Skilled Nursing Facility Staff. J Am Geriatr Soc 2017; 65:269-276. [PMID: 27981557 PMCID: PMC5311021 DOI: 10.1111/jgs.14557] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hospital readmissions from skilled nursing facilities (SNFs) are common. Previous research has not examined how assessments of avoidable readmissions differ between hospital and SNF perspectives. OBJECTIVES To determine the percentage of readmissions from post-acute care that are considered potentially avoidable from hospital and SNF perspectives. DESIGN Prospective cohort study. SETTING One academic medical center and 23 SNFs. PARTICIPANTS We included patients from a quality improvement trial aimed at reducing hospital readmissions among patients discharged to SNFs. We included Medicare patients who were discharged to one of 23 regional SNFs between January 2013 and January 2015, and readmitted to the hospital within 30 days. MEASUREMENTS Hospital-based physicians and SNF-based staff performed structured root-cause analyses (RCA) on a sample of readmissions from a participating SNF to the index hospital. RCAs reported avoidability and factors contributing to readmissions. RESULTS The 30-day unplanned readmission rate to the index hospital from SNFs was 14.5% (262 hospital readmissions of 1,808 discharges). Of the readmissions, 120 had RCA from both the hospital and SNF. The percentage of readmissions rated as potentially avoidable was 30.0% and 13.3% according to hospital and SNF staff, respectively. Hospital and SNF ratings of potential avoidability agreed for 73.3% (88 of the 120 readmissions), but readmission factors varied between settings. Diagnostic problems and improved management of changes in conditions were the most common avoidable readmission factors by hospitals and SNFs, respectively. CONCLUSION A substantial percentage of hospital readmissions from SNFs are rated as potentially avoidable. The ratings and factors underlying avoidability differ between hospital and SNF staff. These data support the need for joint accountability and collaboration for future readmission reduction efforts between hospitals and their SNF partners.
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Affiliation(s)
- Eduard E. Vasilevskis
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph G. Ouslander
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Amanda S. Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
| | - Susan P. Bell
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - J. Mary Lou Jacobsen
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Avantika A. Saraf
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel Markley
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Kelly Sponsler
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jill Shutes
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Emily Long
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - S. Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
| | - Sandra F. Simmons
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - John F. Schnelle
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Rolland Y, Resnick B, Katz PR, Little MO, Ouslander JG, Bonner A, Geary CR, Schumacher KL, Thompson S, Martin FC, Wilbers J, Zúñiga F, Ausserhofer D, Schwendimann R, Schüssler S, Dassen T, Lohrmann C, Levy C, Whitfield E, de Souto Barreto P, Etherton-Beer C, Dilles T, Azermai M, Bourgeois J, Orrell M, Grossberg GT, Kergoat H, Thomas DR, Visschedijk J, Taylor SJ, Handajani YS, Widjaja NT, Turana Y, Rantz MJ, Skubic M, Morley JE. Nursing Home Research: The First International Association of Gerontology and Geriatrics (IAGG) Research Conference. J Am Med Dir Assoc 2014; 15:313-25. [DOI: 10.1016/j.jamda.2014.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 11/25/2022]
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