title: Effect of hospital-SNF referral linkages on rehospitalization.
abstract: OBJECTIVE
  To determine whether the rate of rehospitalization is lower among patients discharged to skilled nursing facilities (SNFs) with which a hospital has a strong linkage.
  We used national Medicare enrollment, claims, and the Minimum Data Set to examine 2.8 million newly discharged patients to 15,063 SNFs from 2,477 general hospitals between 2004 and 2006.
  
  
  METHODS
  We examined the relationship between the proportion of discharges from a hospital and alternative SNFs on the rehospitalization of patients treated by that hospital-SNF pair using an instrumental variable approach. We used distances to alternative SNFs from residence of the patients of the originating hospital as the instrument.
  
  
  RESULTS
  Our estimates suggest that if the proportion of a hospital's discharges to an SNF was to increase by 10 percentage points, the likelihood of patients treated by that hospital-SNF pair to be rehospitalized within 30 days would decline by 1.2 percentage points, largely driven by fewer rehospitalizations within a week of hospital discharge.
  
  
  CONCLUSIONS
  Stronger hospital-SNF linkages, independent of hospital ownership, were found to reduce rehospitalization rates. As hospitals are held accountable for patients' outcomes postdischarge under the Affordable Care Act, hospitals may steer their patients preferentially to fewer SNFs.
authors.affiliation: Department of Health Services Policy and Practice, Brown University, Providence, RI.
authors.forename: Momotazur
authors.initials: M
authors.lastname: Rahman
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Foster
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Zinn
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007373:Interinstitutional Relations; D007902:Length of Stay; D008297:Male; D016344:Medicare Part A / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States
keywords: Health economics; health care organizations and systems; instrumental variables