Bradley T Rosen1,2, Ronald J Halbert3,4, Kelley Hart3, Marcio A Diniz3, Sharon Isonaka3, Jeanne T Black3. 1. Cedars-Sinai Health System, Los Angeles, California, USA. RosenB@cshs.org. 2. David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. 3. Cedars-Sinai Health System, Los Angeles, California, USA. 4. Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
Abstract
BACKGROUND: Increased acuity of skilled nursing facility (SNF) patients challenges the current system of care for these patients. OBJECTIVE: Evaluate the impact on 30-day readmissions of a program designed to enhance the care of patients discharged from an acute care facility to SNFs. DESIGN: An observational, retrospective cohort analysis of 30-day hospital readmissions for patients discharged to 8 SNFs between January 1, 2014, and June 30, 2015. SETTING: A collaboration between a large, acute care hospital in an urban setting, an interdisciplinary clinical team, 124 community physicians, and 8 SNFs. PATIENTS: All patients discharged from Cedars-Sinai Medical Center to 8 partner SNFs were eligible for participation. INTERVENTION: The Enhanced Care Program (ECP) involved the following 3 interventions in addition to standard care: (1) a team of nurse practitioners participating in the care of SNF patients; (2) a pharmacist-driven medication reconciliation at the time of transfer; and (3) educational in-services for SNF nursing staff. MEASUREMENT: Thirty-day readmission rate for ECP patients compared to patients not enrolled in ECP. RESULTS: The average unadjusted, 30-day readmission rate for ECP patients over the 18-month study period was 17.2% compared to 23.0% among patients not enrolled in ECP (P < 0.001). After adjustment for sociodemographic and clinical characteristics, ECP patients had 29% lower odds of being readmitted within 30 days (P < 0.001). These effects were robust to stratified analyses, analyses adjusted for clustering, and balancing of covariates using propensity weighting. CONCLUSIONS: A coordinated, interdisciplinary team caring for SNF patients can reduce 30-day hospital readmissions.
BACKGROUND: Increased acuity of skilled nursing facility (SNF) patients challenges the current system of care for these patients. OBJECTIVE: Evaluate the impact on 30-day readmissions of a program designed to enhance the care of patients discharged from an acute care facility to SNFs. DESIGN: An observational, retrospective cohort analysis of 30-day hospital readmissions for patients discharged to 8 SNFs between January 1, 2014, and June 30, 2015. SETTING: A collaboration between a large, acute care hospital in an urban setting, an interdisciplinary clinical team, 124 community physicians, and 8 SNFs. PATIENTS: All patients discharged from Cedars-Sinai Medical Center to 8 partner SNFs were eligible for participation. INTERVENTION: The Enhanced Care Program (ECP) involved the following 3 interventions in addition to standard care: (1) a team of nurse practitioners participating in the care of SNF patients; (2) a pharmacist-driven medication reconciliation at the time of transfer; and (3) educational in-services for SNF nursing staff. MEASUREMENT: Thirty-day readmission rate for ECP patients compared to patients not enrolled in ECP. RESULTS: The average unadjusted, 30-day readmission rate for ECP patients over the 18-month study period was 17.2% compared to 23.0% among patients not enrolled in ECP (P < 0.001). After adjustment for sociodemographic and clinical characteristics, ECP patients had 29% lower odds of being readmitted within 30 days (P < 0.001). These effects were robust to stratified analyses, analyses adjusted for clustering, and balancing of covariates using propensity weighting. CONCLUSIONS: A coordinated, interdisciplinary team caring for SNF patients can reduce 30-day hospital readmissions.
Authors: Ioana Popescu; Neeraj Sood; Sushant Joshi; Peter Huckfeldt; José Escarce; Teryl K Nuckols Journal: Med Care Date: 2019-10 Impact factor: 2.983
Authors: Samuel Kabue; John Greene; Patricia Kipnis; Brian Lawson; Gina Rinetti-Vargas; Vincent Liu; Gabriel Escobar Journal: Med Care Date: 2019-04 Impact factor: 2.983
Authors: Duygu Sezgin; Rónán O'Caoimh; Aaron Liew; Mark R O'Donovan; Maddelena Illario; Mohamed A Salem; Siobhán Kennelly; Ana María Carriazo; Luz Lopez-Samaniego; Cristina Arnal Carda; Rafael Rodriguez-Acuña; Marco Inzitari; Teija Hammar; Anne Hendry Journal: Eur Geriatr Med Date: 2020-08-04 Impact factor: 1.710