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Prusynski RA, Pradhan S, Mroz TM. Skilled Nursing Facility Organizational Characteristics Are More Strongly Associated With Multiparticipant Therapy Provision Than Patient Characteristics. Phys Ther 2022; 102:pzab292. [PMID: 34972865 PMCID: PMC9097255 DOI: 10.1093/ptj/pzab292] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/25/2021] [Accepted: 11/19/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Multiparticipant physical and occupational therapy provision has fluctuated significantly in skilled nursing facilities (SNFs) under shifts in Medicare reimbursement policy. Multiparticipant therapy includes group (2-6 individuals per therapist) and concurrent therapy (2 individuals per therapist). This study uses recent patient-level data to characterize multiparticipant therapy provision in SNFs to help anticipate shifts under new Medicare policy and the COVID-19 pandemic. METHODS This secondary analysis used data on 1,016,984 post-acute rehabilitation stays in SNFs in 2018. This analysis identified patient predictors (eg, demographic, clinical) and organizational predictors (eg, ownership, quality, staffing) of receiving multiparticipant therapy using mixed-effects logistic regression. Among individuals who received any multiparticipant therapy, those patient or facility factors associated with high rates of multiparticipant therapy provision were also determined. RESULTS Less than 3% of individuals received multiparticipant therapy in 2018. Patient functional and cognitive impairment and indicators of market regulation were associated with lower odds of multiparticipant therapy. Effect sizes for organizational factors associated with multiparticipant therapy provision were generally larger compared with patient factors. High multiparticipant therapy provision was concentrated in <2% of SNFs and was positively associated with for-profit ownership, contract staffing, and low 5-star quality ratings. CONCLUSION SNF organizational characteristics tended to have stronger associations with multiparticipant therapy provision than patient factors, suggesting that changes in patient case-mix, as expected during the COVID-19 pandemic, may have less of an impact on multiparticipant therapy provision than organizational factors. Results suggest that for-profit SNFs in states with higher market regulation, SNFs providing high volumes of therapy, and SNFs utilizing high proportions of assistants and contract staff may be more responsive to Medicare policy by increasing multiparticipant therapy provision. IMPACT This study may help identify SNFs that are more likely to increase multiparticipant therapy provision under new Medicare payment policy.
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Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Sujata Pradhan
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Braun RT, Yun H, Casalino LP, Myslinski Z, Kuwonza FM, Jung HY, Unruh MA. Comparative Performance of Private Equity-Owned US Nursing Homes During the COVID-19 Pandemic. JAMA Netw Open 2020; 3:e2026702. [PMID: 33112402 PMCID: PMC7593807 DOI: 10.1001/jamanetworkopen.2020.26702] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE It is not known whether nursing homes with private equity (PE) ownership have performed better or worse than other nursing homes during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE To evaluate the comparative performance of PE-owned nursing homes on COVID-19 outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 11 470 US nursing homes used the Nursing Home COVID-19 Public File from May 17, 2020, to July 2, 2020, to compare outcomes of PE-owned nursing homes with for-profit, nonprofit, and government-owned homes, adjusting for facility characteristics. EXPOSURE Nursing home ownership status. MAIN OUTCOMES AND MEASURES Self-reported number of COVID-19 cases and deaths and deaths by any cause per 1000 residents; possessing 1-week supplies of personal protective equipment (PPE); staffing shortages. RESULTS Of 11 470 nursing homes, 7793 (67.9%) were for-profit; 2523 (22.0%), nonprofit; 511 (5.3%), government-owned; and 543 (4.7%), PE-owned; with mean (SD) COVID-19 cases per 1000 residents of 88.3 [2.1], 67.0 [3.8], 39.8 [7.6] and 110.8 [8.1], respectively. Mean (SD) COVID-19 deaths per 1000 residents were 61.9 [1.6], 66.4 [3.0], 56.2 [7.3], and 78.9 [5.9], respectively; mean deaths by any cause per 1000 residents were 78.1 [1.3], 91.5 [2.2], 67.6 [4.5], and 87.9 [4.8], respectively. In adjusted analyses, government-owned homes had 35.5 (95% CI, -69.2 to -1.8; P = .03) fewer COVID-19 cases per 1000 residents than PE-owned nursing homes. Cases in PE-owned nursing homes were not statistically different compared with for-profit and nonprofit facilities; nor were there statistically significant differences in COVID-19 deaths or deaths by any cause between PE-owned nursing homes and for-profit, nonprofit, and government-owned facilities. For-profit, nonprofit, and government-owned nursing homes were 10.5% (9.1 percentage points; 95% CI, 1.8 to 16.3 percentage points; P = .006), 15.0% (13.0 percentage points; 95% CI, 5.5 to 20.6 percentage points; P < .001), and 17.0% (14.8 percentage points; 95% CI, 6.5 to 23.0 percentage points; P < .001), respectively, more likely to have at least a 1-week supply of N95 masks than PE-owned nursing homes. They were 24.3% (21.3 percentage points; 95% CI, 11.8 to 30.8 percentage points; P < .001), 30.7% (27.0 percentage points; 95% CI, 17.7 to 36.2 percentage points; P < .001), and 29.2% (25.7 percentage points; 95% CI, 16.1 to 35.3 percentage points; P < .001) more likely to have a 1-week supply of medical gowns than PE-owned nursing homes. Government nursing homes were more likely to have a shortage of nurses (6.9 percentage points; 95% CI, 0.0 to 13.9 percentage points; P = .049) than PE-owned nursing homes. CONCLUSIONS AND RELEVANCE In this cross-sectional study, PE-owned nursing homes performed comparably on staffing levels, resident cases, and deaths with nursing homes with other types of ownership, although their shortages of PPE may warrant monitoring.
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Affiliation(s)
- Robert Tyler Braun
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Hyunkyung Yun
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Lawrence P. Casalino
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Zachary Myslinski
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Farai M. Kuwonza
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Mark Aaron Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
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Gutman R, Intrator O, Lancaster T. A Bayesian procedure for estimating the causal effects of nursing home bed-hold policy. Biostatistics 2019; 19:444-460. [PMID: 29028991 DOI: 10.1093/biostatistics/kxx049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/22/2017] [Indexed: 11/13/2022] Open
Abstract
Nursing home bed-hold policies provide continuity of care for Medicaid beneficiaries by paying nursing homes to reserve beds so residents can return to their facility of occupancy following an acute hospitalization. In 2001, Michigan implemented bed-hold policies in nursing homes. We investigated the impact of these policies on mortality and hospitalizations using 1999-2004 quarterly data from nursing homes in Michigan and nursing homes in 11 states that did not implement such policies. Synthetic Control has been used to estimate the effects of policies by accounting for changes over time unrelated to the intervention. Synthetic Control is intended for scalar continuous outcome at each period, and assumes a single treated unit and multiple control units. We propose a Bayesian procedure to overcome these limitations. It imputes the outcomes of nursing homes in Michigan if they were not exposed to the policy by matching to non-exposed nursing homes that are associated with the exposed ones in the pre-policy period. Because sampling from a Bayesian model is computationally challenging, we describe an approximation procedure that can be implemented using existing software. Our approach can be applied to other studies that examine the impact of policies.
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Affiliation(s)
- Roee Gutman
- Department of Biostatistics, Brown University, 121 South Main Street, Providence, RI, USA
| | - Orna Intrator
- University of Rochester Medical Center, Public Health Sciences, 265 Crittenden Blvd., Rochester, NY, USA
| | - Tony Lancaster
- Department of Economics, Box B, Brown University, Providence, RI, USA
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Weatherall CD, Hansen AT, Nicholson S. The effect of assigning dedicated general practitioners to nursing homes. Health Serv Res 2019; 54:547-554. [PMID: 30653660 DOI: 10.1111/1475-6773.13112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether assigning a dedicated general practitioner (GP) to a nursing home reduces hospitalizations and readmissions. DATA SOURCES/STUDY SETTING Secondary data on hospitalizations and deaths by month for the universe of nursing home residents in Denmark from January 2011 through February 2014. STUDY DESIGN In 2012, Denmark initiated a program in seven nursing homes that volunteered to participate. We used a difference-in-differences model to estimate the effect of assigning a dedicated GP to a nursing home on the likelihood that a nursing home resident will be hospitalized, will experience a preventable hospitalization, and will be readmitted. The unit of observation is a resident-month. DATA COLLECTION/EXTRACTION METHODS Data were extracted from the Danish public administrative register dataset. PRINCIPAL FINDINGS We found that assigning a GP to a nursing home was associated with a 0.55 [95 percent CI, 0.08 to 1.02] percentage point reduction in the monthly probability of a preventable hospitalization, which was a 26 percent reduction from the preintervention level of 2.13 percentage points. The associated reduction in the monthly probability of a readmission was 0.68 [95 percent CI, -0.01 to 1.37] percentage points, which was a 25 percent reduction from the baseline level of 2.68 percentage points. Survey results indicated that the likely mechanism for the effect was more efficient and consistent communication between GPs and nursing home personnel. CONCLUSIONS Assigning a dedicated physician in a nursing home can reduce medical spending and improve patients' health.
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Affiliation(s)
| | - Anne Toft Hansen
- University of Copenhagen and VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Sean Nicholson
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York
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Vest JR, Jung HY, Wiley K, Kooreman H, Pettit L, Unruh MA. Adoption of Health Information Technology Among US Nursing Facilities. J Am Med Dir Assoc 2018; 20:995-1000.e4. [PMID: 30579920 DOI: 10.1016/j.jamda.2018.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/30/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Nursing facilities have lagged behind in the adoption of interoperable health information technology (ie technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption. DESIGN Cross-sectional survey. SETTING & PARTICIPANTS We surveyed members of the Society for Post-Acute & Long-Term Care Medicine (AMDA) about their organizations' health information technology usage and characteristics. MEASUREMENTS Using questions adopted from existing instruments, the survey measured nursing home's EHR adoption, the ability to send, receive, search and integrate electronic information, as well as barriers to usage. Additionally, we linked survey responses to public use secondary data sources to construct measurements for 8 determinants known to be associated with organizational adoption: innovativeness, functional differentiation, role specialization, administrative intensity, professionalism, complexity, technical knowledge resources, and slack resources. A series of regression models estimated the association between potential determinants and technology adoption. RESULTS 84% of nursing facilities reported using an EHR. After controlling for all other factors, respondents who characterized their organization as more innovative had more than 6 times the odds (adjusted odds ratio = 6.39, 95% confidence interval = 2.69, 15.21) of adopting an EHR. Organization innovativeness was also associated with an increased odds of being able to send, integrate, and search for electronic information. The most commonly identified barrier to sharing clinical information among nursing facilities with an EHR was a reported absence of interoperability (57%). CONCLUSIONS/IMPLICATIONS An organizational culture that fosters innovation and awareness campaigns by professional societies may facilitate further adoption and effective use of technology. This will be increasingly important as policy makers continue to emphasize the use of EHRs and interoperability to improve the quality of care in nursing facilities.
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Affiliation(s)
- Joshua R Vest
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN.
| | - Hye-Young Jung
- Division of Health Policy and Economics, Weill Cornell Medical College, New York, NY
| | - Kevin Wiley
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN
| | - Harold Kooreman
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN
| | - Lorren Pettit
- Healthcare Information and Management Systems Society (HIMSS), Chicago, IL
| | - Mark A Unruh
- Division of Health Policy and Economics, Weill Cornell Medical College, New York, NY
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Ogarek JA, McCreedy EM, Thomas KS, Teno JM, Gozalo PL. Minimum Data Set Changes in Health, End-Stage Disease and Symptoms and Signs Scale: A Revised Measure to Predict Mortality in Nursing Home Residents. J Am Geriatr Soc 2018; 66:976-981. [PMID: 29500822 PMCID: PMC5992077 DOI: 10.1111/jgs.15305] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To revise the Minimum Data Set (MDS) Changes in Health, End-stage disease and Symptoms and Signs (CHESS) scale, an MDS 2.0-based measure widely used to predict mortality in institutional settings, in response to the release of MDS 3.0. DESIGN Development of a predictive scale using observational data from the MDS and Medicare Master Beneficiary Summary File. SETTING All Centers for Medicare and Medicaid Services (CMS)-certified nursing homes in the United States. PARTICIPANTS Development cohort of 1.3 million Medicare beneficiaries newly admitted to a CMS-certified nursing home during 2012. Primary validation cohort of 1.2 million Medicare recipients who were newly admitted to a CMS-certified nursing home during 2013. MEASUREMENTS Items from the MDS 3.0 assessments identified as likely to predict mortality. Death information was obtained from the Medicare Master Beneficiary Summary File. RESULTS MDS-CHESS 3.0 scores ranges from 0 (most stable) to 5 (least stable). Ninety-two percent of the primary validation sample with a CHESS scale score of 5 and 15% with a CHESS scale of 0 died within 1 year. The risk of dying was 1.63 times as great (95% CI=1.628-1.638) for each unit increase in CHESS scale score. The MDS-CHESS 3.0 is also strongly related to hospitalization within 30 days and successful discharge to the community. The scale predicted death in long-stay residents at 30 days (C=0.759, 95% confidence interval (CI)=0.756-0.761), 60 days (C=0.716, 95% CI=0.714-0.718) and 1 year (C=0.655, 95% CI=0.654-0.657). CONCLUSION The MDS-CHESS 3.0 predicts mortality in newly admitted and long-stay nursing home populations. The additional relationship to hospitalizations and successful discharges to community increases the utility of this scale as a potential risk adjustment tool.
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Affiliation(s)
- Jessica A Ogarek
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Ellen M McCreedy
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Kali S Thomas
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island
- U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island
| | - Joan M Teno
- Oregon Health and Sciences University, Portland, Oregon
| | - Pedro L Gozalo
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island
- U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island
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Unruh MA, Jung HY, Kaushal R, Vest JR. Hospitalization event notifications and reductions in readmissions of Medicare fee-for-service beneficiaries in the Bronx, New York. J Am Med Inform Assoc 2018; 24:e150-e156. [PMID: 28395059 DOI: 10.1093/jamia/ocw139] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/23/2016] [Indexed: 11/14/2022] Open
Abstract
Objective Follow-up with a primary care provider after hospital discharge has been associated with a reduced likelihood of readmission. However, primary care providers are frequently unaware of their patients' hospitalizations. Event notification may be an effective tool for reducing readmissions by notifying primary care providers when their patients have been admitted to and discharged from a hospital. Materials and Methods We examined the effect of an event notification system on 30-day readmissions in the Bronx, New York. The Bronx has among the highest readmission rates in the country and is a particularly challenging setting to improve care due to the low socioeconomic status of the county and high rates of poor health behaviors among its residents. The study cohort included 2559 Medicare fee-for-service beneficiaries associated with 14 141 hospital admissions over the period January 2010 through June 2014. Linear regression models with beneficiary-level fixed-effects were used to estimate the impact of event notifications on readmissions by comparing the likelihood of rehospitalization for a beneficiary before and after event notifications were active. Results The unadjusted 30-day readmission rate when event notifications were not active was 29.5% compared to 26.5% when alerts were active. Regression estimates indicated that active hospitalization alert services were associated with a 2.9 percentage point reduction in the likelihood of readmission (95% confidence interval: -5.5, -0.4). Conclusions Alerting providers through event notifications may be an effective tool for improving the quality and efficiency of care among high-risk populations.
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Affiliation(s)
- Mark Aaron Unruh
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Hye-Young Jung
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Rainu Kaushal
- Department of Healthcare Policy and Research, Department of Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Joshua R Vest
- Department of Healthcare Policy & Management, Indiana University Richard M. Fairbanks School of Public Health - Indianapolis, Affiliated Scientist, Regenstrief Institute, Inc., Indianapolis, IN, USA
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Unruh MA, Jung HY, Kaushal R, Vest JR. Hospital participation in Meaningful Use and racial disparities in readmissions. THE AMERICAN JOURNAL OF MANAGED CARE 2018; 24:38-42. [PMID: 29350507 PMCID: PMC6386151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To measure the impact of hospital participation in Meaningful Use (MU) on disparities in 30-day readmissions associated with race. STUDY DESIGN A retrospective cohort study that compared the likelihood of 30-day readmission for Medicare beneficiaries discharged from hospitals participating in Stage 1 of MU with the likelihood of readmission for beneficiaries concurrently discharged from hospitals that were not participating in the initiative. METHODS Inpatient claims for 2,414,205 Medicare beneficiaries from Florida, New York, and Washington State were used as the primary data source. The study period (2009-2013) included at least 2 years of baseline data prior to each hospital initiating participation in MU. Estimates were derived with linear regression models that included hospital and time fixed effects. By including both hospital and time fixed effects, estimates were based on discharges from the same hospital in the same time period. RESULTS MU participation among hospitals was not associated with a statistically significant change in readmissions for the broader Medicare population (percentage points [PP], 0.6; 95% CI, -0.2 to 1.4), but hospitals' participation in the initiative was associated with a lower likelihood of readmission for African American beneficiaries (PP, -0.9; 95% CI, -1.5 to -0.4). CONCLUSIONS Hospital participation in MU reduced disparities in 30-day readmissions for African American Medicare beneficiaries.
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Affiliation(s)
- Mark Aaron Unruh
- Weill Cornell Medical College, 402 E 67th St, New York, NY 10065.
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Does More Therapy in Skilled Nursing Facilities Lead to Better Outcomes in Patients With Hip Fracture? Phys Ther 2016; 96:81-9. [PMID: 26586858 PMCID: PMC4706596 DOI: 10.2522/ptj.20150090] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 11/05/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Skilled nursing facilities (SNFs) have increasingly been providing more therapy hours to beneficiaries of Medicare. It is not known whether these increases have improved patient outcomes. OBJECTIVE The study objectives were: (1) to examine temporal trends in therapy hour volumes and (2) to evaluate whether more therapy hours are associated with improved patient outcomes. DESIGN This was a retrospective cohort study. METHODS Data sources included the Minimum Data Set, Medicare inpatient claims, and the Online Survey, Certification, and Reporting System. The study population consisted of 481,908 beneficiaries of Medicare fee-for-service who were admitted to 15,496 SNFs after hip fracture from 2000 to 2009. Linear regression models with facility and time fixed effects were used to estimate the association between the quantity of therapy provided in SNFs and the likelihood of discharge to home. RESULTS The average number of therapy hours increased by 52% during the study period, with relatively little change in case mix at SNF admission. An additional hour of therapy per week was associated with a 3.1-percentage-point (95% confidence interval=3.0, 3.1) increase in the likelihood of discharge to home. The effect of additional therapy decreased as the Resource Utilization Group category increased, and additional therapy did not benefit patients in the highest Resource Utilization Group category. LIMITATIONS Minimum Data Set assessments did not cover details of therapeutic interventions throughout the entire SNF stay and captured only a 7-day retrospective period for measures of the quantity of therapy provided. CONCLUSIONS Increases in the quantity of therapy during the study period cannot be explained by changes in case mix at SNF admission. More therapy hours in SNFs appear to improve outcomes, except for patients with the greatest need.
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Jung HY, Trivedi AN, Grabowski DC, Mor V. Integrated Medicare and Medicaid managed care and rehospitalization of dual eligibles. THE AMERICAN JOURNAL OF MANAGED CARE 2015; 21:711-7. [PMID: 26633095 PMCID: PMC4714706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Healthcare expenditures for dually eligible individuals covered by both Medicare and Medicaid constitute a disproportionate share of spending for the 2 programs. Fragmentation, inefficiency, and low-quality care have been long standing issues for this population. The objective of this study was to conduct an early evaluation of an innovative program that coordinates benefits for elderly dual eligibles. STUDY DESIGN Longitudinal cohort study. METHODS Comparable sources of administrative claims from 2007 to 2009 were used to examine differences in 30-day rehospitalization between dual eligibles in Massachusetts participating in Senior Care Options (SCO), an integrated managed care program, and dual eligibles in Medicare fee-for-service. Multivariable logistic regression models with county and time fixed effects were used for estimation. RESULTS We found no statistically significant effect of SCO on rehospitalization, an area where coordinated care would be expected to make a substantial difference. CONCLUSIONS Our results suggest that coordinating the financing and delivery of services through an integrated managed program may not sufficiently address the problems of inefficiency and fragmentation in care for hospitalized dual eligible enrollees.
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Affiliation(s)
- Hye-Young Jung
- Weill Cornell Medical College, 402 E 67th St, New York, NY 10065. E-mail:
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Thomas KS, Rahman M, Mor V, Intrator O. Influence of hospital and nursing home quality on hospital readmissions. THE AMERICAN JOURNAL OF MANAGED CARE 2014; 20:e523-e531. [PMID: 25730351 PMCID: PMC4692800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine whether the quality of the hospital and of the nursing home (NH) to which a patient was discharged were related to the likelihood of rehospitalization. STUDY DESIGN Retrospective cohort study of 1,382,477 individual hospitalizations discharged to 15,356 NHs from 3683 hospitals between 2006 and 2008. METHODS Data come from Medicare claims and enrollment records, Minimum Data Set, Online Survey Certification and Reporting Dataset, Hospital Compare, and the American Hospital Association Database. Cross-classified random effects models were used to test the association of hospital and NH quality measures and the likelihood of 30-day rehospitalization. RESULTS Patients discharged from higher-quality hospitals (as indicated by higher scores on their accountability process measures and high nurse staffing levels) and patients who received care in higher-quality NHs (as indicated by high nurse staffing levels and lower deficiency scores) were less likely to be rehospitalized within 30 days. CONCLUSIONS The passage of the Affordable Care Act changed the accountability of hospitals for patients' outcomes after discharge. This study highlights the joint accountability of hospitals and NHs for rehospitalization of patients.
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Affiliation(s)
- Kali S Thomas
- Brown University and Providence VA Medical Center, 121 S Main St, Box G121 (6), Providence, RI 01912. E-mail:
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Hirth RA, Grabowski DC, Feng Z, Rahman M, Mor V. Effect of nursing home ownership on hospitalization of long-stay residents: an instrumental variables approach. INTERNATIONAL JOURNAL OF HEALTH CARE FINANCE AND ECONOMICS 2014; 14:1-18. [PMID: 24234287 PMCID: PMC3969758 DOI: 10.1007/s10754-013-9136-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
Hospitalizations among nursing home residents are frequent, expensive, and often associated with further deterioration of resident condition. The literature indicates that a substantial fraction of admissions is potentially preventable and that nonprofit nursing homes are less likely to hospitalize their residents. However, the correlation between ownership and hospitalization might reflect unobserved resident differences rather than a causal relationship. Using national minimum data set assessments linked with Medicare claims, we use a national cohort of long-stay residents who were newly admitted to nursing homes within an 18-month period spanning January 1, 2004 and June 30, 2005. After instrumenting for ownership status, we found that IV estimates of the effect of nonprofit ownership on hospitalization are at least as large as the non-instrumented effects, indicating that selection bias does not explain the observed relationship. We also found evidence suggesting the lower rate of hospitalizations among nonprofits was due to a different threshold for transfer.
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Affiliation(s)
- Richard A. Hirth
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | | | - Zhanlian Feng
- Research Triangle Institute, Research Triangle Park, NC, USA. Brown University, Providence, RI, USA
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Unruh MA, Trivedi AN, Grabowski DC, Mor V. Does reducing length of stay increase rehospitalization of medicare fee-for-service beneficiaries discharged to skilled nursing facilities? J Am Geriatr Soc 2013; 61:1443-8. [PMID: 23926902 DOI: 10.1111/jgs.12411] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To analyze the relationship between length of stay and rehospitalization. DESIGN Retrospective cohort study. SETTING Six thousand five hundred thirty-seven hospitals nationwide from January 1999 through September 2005. PARTICIPANTS Medicare fee-for-service beneficiaries associated with 2,101,481 hospitalizations. MEASUREMENTS Thirty-day rehospitalization derived from Medicare hospital claims using the implementation of Medicare's post-acute care transfer policy as a quasi-experiment. RESULTS Medicare's post-acute care transfer policy led to immediate declines in length of stay. A 1-day decrease in length of stay was associated with an absolute increase in 30-day rehospitalization of 1.56 percentage points (95% confidence interval (CI) = 0.30-2.82) for acute myocardial infarction (AMI) with major complications and 0.81 percentage points (95% CI = 0.03-1.60) for kidney infection or urinary tract infection (UTI) without major complications. Individuals hospitalized for AMI without major complications, heart failure, or kidney infection or UTI with major complications had no increase in 30-day rehospitalization. CONCLUSION A 1-day reduction in hospital length of stay was not consistently associated with a higher rate of rehospitalization.
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Affiliation(s)
- Mark A Unruh
- Center for Healthcare Informatics and Policy, Weill Medical College, Cornell University, New York, New York; Department of Public Health, Weill Cornell Medical College, New York, New York
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