title: Skilled nursing facility referral and hospital readmission rates after heart failure or myocardial infarction.
abstract: BACKGROUND
  Substantial hospital-level variation in the risk of readmission after hospitalization for heart failure (HF) or acute myocardial infarction (AMI) has been reported. Prior studies have documented considerable state-level variation in rates of discharge to skilled nursing facilities (SNFs), but evaluation of hospital-level variation in SNF rates and its relationship to hospital-level readmission rates is limited.
  
  
  METHODS
  Hospital-level 30-day all-cause risk-standardized readmission rates (RSRRs) were calculated using claims data for fee-for-service Medicare patients hospitalized with a principal diagnosis of HF or AMI from 2006-2008. Medicare claims were used to calculate rates of discharge to SNF following HF-specific or AMI-specific admissions in hospitals with ≥25 HF or AMI patients, respectively. Weighted regression was used to quantify the relationship between RSRRs and SNF rates for each condition.
  
  
  RESULTS
  Mean RSRR following HF admission among 4101 hospitals was 24.7%, and mean RSRR after AMI admission among 2453 hospitals was 19.9%. Hospital-level SNF rates ranged from 0% to 83.8% for HF and from 0% to 77.8% for AMI. No significant relationship between RSRR after HF and SNF rate was found in adjusted regression models (P=.15). RSRR after AMI increased by 0.03 percentage point for each 1 absolute percentage point increase in SNF rate in adjusted regression models (P=.001). Overall, HF and AMI SNF rates explained <1% and 4% of the variation for their respective RSRRs.
  
  
  CONCLUSIONS
  SNF rates after HF or AMI hospitalization vary considerably across hospitals, but explain little of the variation in 30-day all-cause readmission rates for these conditions.
authors.affiliation: Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, USA. jersey.chen@yale.edu
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: Melissa D A
authors.initials: MD
authors.lastname: Carlson
authors.forename: Zhenqiu
authors.initials: Z
authors.lastname: Lin
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Susannah M
authors.initials: SM
authors.lastname: Bernheim
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Drye
authors.forename: Shari M
authors.initials: SM
authors.lastname: Ling
authors.forename: Lein F
authors.initials: LF
authors.lastname: Han
authors.forename: Michael T
authors.initials: MT
authors.lastname: Rapp
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology