Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Skilled Nursing Facility Discharge Among Medicare Beneficiaries

Addie Middleton, Brian Downer, Allen Haas, Yu Li Lin, James E. Graham, Kenneth Ottenbacher

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: The objectives of this study were to determine the association between patients' functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable hospital readmissions, and to examine common reasons for potentially preventable readmissions. Design: Retrospective cohort study. Setting: SNFs and acute care hospitals submitting claims to Medicare. Participants: National cohort of Medicare fee-for-service beneficiaries discharged from SNF care between July 15, 2013, and July 15, 2014 (n = 693,808). Average age was 81.4 (SD 8.1) years, 67.1% were women, and 86.3% were non-Hispanic white. Measurements: Functional items from the Minimum Data Set 3.0 were categorized into self-care, mobility, and cognition domains. We used specifications for the SNF potentially preventable 30-day postdischarge readmission quality metric to identify potentially preventable readmissions. Results: The overall observed rate of 30-day potentially preventable readmissions following SNF discharge was 5.7% (n = 39,318). All 3 functional domains were independently associated with potentially preventable readmissions in the multivariable models. Odds ratios for the most dependent category versus the least dependent category from multilevel models adjusted for patients' sociodemographic and clinical characteristics were as follows: mobility, 1.54 (95% confidence interval [CI] 1.49-1.59); self-care, 1.50 (95% CI 1.44-1.55); and cognition, 1.12 (95% CI 1.04-1.20). The 5 most common conditions were congestive heart failure (n = 7654, 19.5%), septicemia (n = 7412, 18.9%), urinary tract infection/kidney infection (n = 4297, 10.9%), bacterial pneumonia (n = 3663, 9.3%), and renal failure (n = 3587, 9.1%). Across all 3 functional domains, septicemia was the most common condition among the most dependent patients and congestive heart failure among the least dependent. Conclusions: Patients with functional limitations at SNF discharge are at increased risk of hospital readmissions considered potentially preventable. Future research is needed to determine whether improving functional status reduces risk of potentially preventable readmissions among this vulnerable population.

Original languageEnglish (US)
JournalJournal of the American Medical Directors Association
DOIs
StateAccepted/In press - Jan 1 2018

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Skilled Nursing Facilities
Medicare
Patient Readmission
Confidence Intervals
Self Care
Nursing Care
Cognition
Sepsis
Heart Failure
Bacterial Pneumonia
Fee-for-Service Plans
Vulnerable Populations
Urinary Tract Infections
Renal Insufficiency
Cohort Studies
Retrospective Studies
Odds Ratio
Kidney
Infection

Keywords

  • Chronic conditions
  • Cognition
  • Infection
  • Mobility
  • Self-care

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy

Cite this

@article{403ad069a2ca46ae9fa48f91c6a1e7fd,
title = "Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Skilled Nursing Facility Discharge Among Medicare Beneficiaries",
abstract = "Objectives: The objectives of this study were to determine the association between patients' functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable hospital readmissions, and to examine common reasons for potentially preventable readmissions. Design: Retrospective cohort study. Setting: SNFs and acute care hospitals submitting claims to Medicare. Participants: National cohort of Medicare fee-for-service beneficiaries discharged from SNF care between July 15, 2013, and July 15, 2014 (n = 693,808). Average age was 81.4 (SD 8.1) years, 67.1{\%} were women, and 86.3{\%} were non-Hispanic white. Measurements: Functional items from the Minimum Data Set 3.0 were categorized into self-care, mobility, and cognition domains. We used specifications for the SNF potentially preventable 30-day postdischarge readmission quality metric to identify potentially preventable readmissions. Results: The overall observed rate of 30-day potentially preventable readmissions following SNF discharge was 5.7{\%} (n = 39,318). All 3 functional domains were independently associated with potentially preventable readmissions in the multivariable models. Odds ratios for the most dependent category versus the least dependent category from multilevel models adjusted for patients' sociodemographic and clinical characteristics were as follows: mobility, 1.54 (95{\%} confidence interval [CI] 1.49-1.59); self-care, 1.50 (95{\%} CI 1.44-1.55); and cognition, 1.12 (95{\%} CI 1.04-1.20). The 5 most common conditions were congestive heart failure (n = 7654, 19.5{\%}), septicemia (n = 7412, 18.9{\%}), urinary tract infection/kidney infection (n = 4297, 10.9{\%}), bacterial pneumonia (n = 3663, 9.3{\%}), and renal failure (n = 3587, 9.1{\%}). Across all 3 functional domains, septicemia was the most common condition among the most dependent patients and congestive heart failure among the least dependent. Conclusions: Patients with functional limitations at SNF discharge are at increased risk of hospital readmissions considered potentially preventable. Future research is needed to determine whether improving functional status reduces risk of potentially preventable readmissions among this vulnerable population.",
keywords = "Chronic conditions, Cognition, Infection, Mobility, Self-care",
author = "Addie Middleton and Brian Downer and Allen Haas and Lin, {Yu Li} and Graham, {James E.} and Kenneth Ottenbacher",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jamda.2017.12.003",
language = "English (US)",
journal = "Journal of the American Medical Directors Association",
issn = "1525-8610",
publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Skilled Nursing Facility Discharge Among Medicare Beneficiaries

AU - Middleton, Addie

AU - Downer, Brian

AU - Haas, Allen

AU - Lin, Yu Li

AU - Graham, James E.

AU - Ottenbacher, Kenneth

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: The objectives of this study were to determine the association between patients' functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable hospital readmissions, and to examine common reasons for potentially preventable readmissions. Design: Retrospective cohort study. Setting: SNFs and acute care hospitals submitting claims to Medicare. Participants: National cohort of Medicare fee-for-service beneficiaries discharged from SNF care between July 15, 2013, and July 15, 2014 (n = 693,808). Average age was 81.4 (SD 8.1) years, 67.1% were women, and 86.3% were non-Hispanic white. Measurements: Functional items from the Minimum Data Set 3.0 were categorized into self-care, mobility, and cognition domains. We used specifications for the SNF potentially preventable 30-day postdischarge readmission quality metric to identify potentially preventable readmissions. Results: The overall observed rate of 30-day potentially preventable readmissions following SNF discharge was 5.7% (n = 39,318). All 3 functional domains were independently associated with potentially preventable readmissions in the multivariable models. Odds ratios for the most dependent category versus the least dependent category from multilevel models adjusted for patients' sociodemographic and clinical characteristics were as follows: mobility, 1.54 (95% confidence interval [CI] 1.49-1.59); self-care, 1.50 (95% CI 1.44-1.55); and cognition, 1.12 (95% CI 1.04-1.20). The 5 most common conditions were congestive heart failure (n = 7654, 19.5%), septicemia (n = 7412, 18.9%), urinary tract infection/kidney infection (n = 4297, 10.9%), bacterial pneumonia (n = 3663, 9.3%), and renal failure (n = 3587, 9.1%). Across all 3 functional domains, septicemia was the most common condition among the most dependent patients and congestive heart failure among the least dependent. Conclusions: Patients with functional limitations at SNF discharge are at increased risk of hospital readmissions considered potentially preventable. Future research is needed to determine whether improving functional status reduces risk of potentially preventable readmissions among this vulnerable population.

AB - Objectives: The objectives of this study were to determine the association between patients' functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable hospital readmissions, and to examine common reasons for potentially preventable readmissions. Design: Retrospective cohort study. Setting: SNFs and acute care hospitals submitting claims to Medicare. Participants: National cohort of Medicare fee-for-service beneficiaries discharged from SNF care between July 15, 2013, and July 15, 2014 (n = 693,808). Average age was 81.4 (SD 8.1) years, 67.1% were women, and 86.3% were non-Hispanic white. Measurements: Functional items from the Minimum Data Set 3.0 were categorized into self-care, mobility, and cognition domains. We used specifications for the SNF potentially preventable 30-day postdischarge readmission quality metric to identify potentially preventable readmissions. Results: The overall observed rate of 30-day potentially preventable readmissions following SNF discharge was 5.7% (n = 39,318). All 3 functional domains were independently associated with potentially preventable readmissions in the multivariable models. Odds ratios for the most dependent category versus the least dependent category from multilevel models adjusted for patients' sociodemographic and clinical characteristics were as follows: mobility, 1.54 (95% confidence interval [CI] 1.49-1.59); self-care, 1.50 (95% CI 1.44-1.55); and cognition, 1.12 (95% CI 1.04-1.20). The 5 most common conditions were congestive heart failure (n = 7654, 19.5%), septicemia (n = 7412, 18.9%), urinary tract infection/kidney infection (n = 4297, 10.9%), bacterial pneumonia (n = 3663, 9.3%), and renal failure (n = 3587, 9.1%). Across all 3 functional domains, septicemia was the most common condition among the most dependent patients and congestive heart failure among the least dependent. Conclusions: Patients with functional limitations at SNF discharge are at increased risk of hospital readmissions considered potentially preventable. Future research is needed to determine whether improving functional status reduces risk of potentially preventable readmissions among this vulnerable population.

KW - Chronic conditions

KW - Cognition

KW - Infection

KW - Mobility

KW - Self-care

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DO - 10.1016/j.jamda.2017.12.003

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