Format

Send to

Choose Destination
J Am Med Dir Assoc. 2018 Jan;19(1):70-76.e1. doi: 10.1016/j.jamda.2017.08.007. Epub 2017 Oct 15.

Facility-Level Factors and Outcomes After Skilled Nursing Facility Admission for Trauma and Surgical Patients.

Author information

1
Department of Surgery, University of Washington, Seattle, WA; Surgical Outcomes Research Center, University of Washington, Seattle, WA. Electronic address: lucaswt@uw.edu.
2
Department of Surgery, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA.
3
Department of Surgery, University of Washington, Seattle, WA; Surgical Outcomes Research Center, University of Washington, Seattle, WA.
4
Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA.
5
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.

Abstract

OBJECTIVE:

Patients discharged to skilled nursing facilities (SNFs) have worse outcomes than those discharged to home, but whether this is due to differences in facility-level factors in addition to patient characteristics is not known. We aimed to determine whether SNF-level factors including nurse staffing and patient density are associated with outcomes after acute hospitalization for trauma or surgery.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS:

Retrospective study of patients discharged to Medicare-certified SNFs after trauma or major surgery from 2007 to 2009. We measured the ratio of beds per nurse and the proportion of trauma and surgery patients at each facility (density). Outcomes were 1-year mortality, hospital readmission, and failure to discharge home at first discharge disposition.

RESULTS:

For 389,133 patients (mean age 78 years, 63% female) admitted to 3707 SNFs, mortality was 26%, hospital readmission 26%, and failure to discharge home 44%. After adjusting for patient-level factors, SNFs with fewer beds per nurse had lower odds of mortality [odds ratio (OR): trauma 0.84; (95% confidence interval: 0.77-0.91), surgery 0.80 (0.75-0.86)], readmission [OR: trauma 0.81 (0.74-0.88), surgery 0.71 (0.65-0.76)], and failure to discharge home [OR: trauma 0.82 [0.74-0.91], surgery 0.66 [0.60-0.72]). SNFs with greater density of specialty patients (>4.3% surgery, >14.1% trauma) had lower odds of readmission [OR: trauma 0.59 (0.53-0.66), surgery 0.62 (0.58-0.67)] and failure to discharge home [OR: trauma 0.48 (0.43-0.55), surgery 0.45 (0.42-0.49)].

CONCLUSIONS:

There are modifiable SNF-level factors that influence long-term outcomes and may be targets for intervention. Staffing standardization and SNF specialization may reduce variation of quality in post-acute care.

KEYWORDS:

Skilled nursing facility; nursing; outcomes; postacute care; surgery; trauma

PMID:
29042263
PMCID:
PMC5742547
[Available on 2019-01-01]
DOI:
10.1016/j.jamda.2017.08.007

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center