title: Is higher volume of postacute care patients associated with a lower rehospitalization rate in skilled nursing facilities?
abstract: This study determined whether higher patient volume of skilled nursing facility (SNF) care was associated with a lower hospital transfer rate. Using the nursing home Minimum Data Set and the Online Survey, Certification, and Reporting file, we assembled a national cohort of Medicare SNF postacute care admissions between January and September of 2008. Multivariable analyses based on Cox proportional hazards models found that patients admitted to high-volume SNFs (annual number of admissions in the top tertile group) showed an approximately 15% reduced risk for 30-day rehospitalization and an approximately 25% reduced risk for 90-day rehospitalization, compared with patients admitted to low-volume SNFs (annual number of admissions in the bottom tertile group, or <45). Similar patterns of volume-outcome associations were found for hospital-based and freestanding facilities separately. The inverse volume-outcome association in postacute SNF care may reflect a "practice makes perfect" effect, a "selective referral" effect, or both.
authors.affiliation: University of Iowa, Iowa City, IA 52242, USA. yue-li@uiowa.edu
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Xueya
authors.initials: X
authors.lastname: Cai
authors.forename: Jun
authors.initials: J
authors.lastname: Yin
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000639:trends*; D016016:Proportional Hazards Models; D012046:Rehabilitation; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States