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Effect of Hospital– SNF Referral Linkages on Rehospitalization
Author(s) -
Rahman Momotazur,
Foster Andrew D.,
Grabowski David C.,
Zinn Jacqueline S.,
Mor Vincent
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12112
Subject(s) - medicine , referral , minimum data set , residence , emergency medicine , hospital care , family medicine , health care , demography , nursing homes , nursing , sociology , economics , economic growth
Objective To determine whether the rate of rehospitalization is lower among patients discharged to skilled nursing facilities ( SNF s) with which a hospital has a strong linkage. Data Sources/Collection We used national Medicare enrollment, claims, and the Minimum Data Set to examine 2.8 million newly discharged patients to 15,063 SNF s from 2,477 general hospitals between 2004 and 2006. Study Design We examined the relationship between the proportion of discharges from a hospital and alternative SNF s on the rehospitalization of patients treated by that hospital– SNF pair using an instrumental variable approach. We used distances to alternative SNF s from residence of the patients of the originating hospital as the instrument. Principal Findings Our estimates suggest that if the proportion of a hospital's discharges to an SNF was to increase by 10 percentage points, the likelihood of patients treated by that hospital– SNF pair to be rehospitalized within 30 days would decline by 1.2 percentage points, largely driven by fewer rehospitalizations within a week of hospital discharge. Conclusions Stronger hospital– SNF linkages, independent of hospital ownership, were found to reduce rehospitalization rates. As hospitals are held accountable for patients' outcomes postdischarge under the Affordable Care Act, hospitals may steer their patients preferentially to fewer SNF s.