Association Between Skilled Nursing Facility Quality Indicators and Hospital Readmissions

IMPORTANCE Hospital readmissions are common, costly, and potentially preventable. Little is known about the association between available skilled nursing facility (SNF) performance measures and the risk of hospital readmission. OBJECTIVE To measure the association between SNF performance measures and hospital readmissions among Medicare beneficiaries receiving postacute care at SNFs in the United States. DESIGN AND PARTICIPANTS Using national Medicare data on fee-for-service Medicare beneficiaries discharged to a SNF after an acute care hospitalization between September 1, 2009, and August 31, 2010, we examined the association between SNF performance on publicly available metrics (SNF staffing intensity, health deficiencies identified through site inspections, and the percentages of SNF patients with delirium, moderate to severe pain, and new or worsening pressure ulcers) and the risk of readmission or death 30 days after discharge to a SNF. Adjusted analyses controlled for patient case mix, SNF facility factors, and the discharging hospital. MAIN OUTCOMES AND MEASURES Readmission to an acute care hospital or death within 30 days of the index hospital discharge. RESULTS Of 1 530 824 patients discharged, 357 752 (23.3%; 99% CI, 23.3%-23.5%) were readmitted or died within 30 days; 72 472 died within 30 days (4.7%; 99% CI, 4.7%-4.8%), and 321 709 were readmitted (21.0%; 99% CI, 20.9%-21.1%). The unadjusted risk of readmission or death was lower at SNFs with better staffing ratings and better facility inspection ratings. [GRAPHICS] Adjustment for patient factors, SNF facility factors, and the discharging hospital attenuated these associations; we observed small differences in the adjusted risk of readmission or death according to SNF facility inspection ratings. Other measures did not predict clinically meaningful differences in the adjusted risk of readmission or death. CONCLUSIONS AND RELEVANCE Among fee-for-service Medicare beneficiaries discharged to a SNF after an acute care hospitalization, available performance measures were not consistently associated with differences in the adjusted risk of readmission or death. Copyright 2014 American Medical Association. All rights reserved.