title: The association between skilled nursing facility care quality and 30-day readmission rates after hospitalization for heart failure.
abstract: The objective of the study was to assess the association between care quality of skilled nursing facilities (SNFs) and 30-day risk-adjusted readmission rate (RAR) for patients with acute decompensated heart failure (ADHF). A retrospective cohort study was conducted involving 603 discharges from a tertiary care hospital to 17 SNFs after hospitalization for ADHF. SNF quality was assessed based on the CMS 5-star quality rating and a survey of SNF characteristics and processes of care. In all, 20% of cases were readmitted within 30-days; 9.4% were for ADHF. The all-cause RARs for higher- and lower-quality SNFs were 18% (95% confidence interval [CI]=14%-23%) and 22% (95% CI=17%-26%), respectively, and the ADHF RARs were 8.8% (95% CI=6.0%-11.6%) and 10.2% (95% CI=7.0%-12.9%), respectively. There were no significant associations between ADHF RARs and individual processes of care or structural characteristics. Quality ratings of SNF or processes of care did not correlate with RAR.
authors.affiliation: Baystate Medical Center, Springfield, MA.
authors.forename: Owolabi
authors.initials: O
authors.lastname: Ogunneye
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.affiliation: Baystate Medical Center, Springfield, MA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Friderici
authors.affiliation: Baystate Medical Center, Springfield, MA Tufts University School of Medicine, Boston, MA.
authors.forename: Mara T
authors.initials: MT
authors.lastname: Slawsky
authors.affiliation: Baystate Medical Center, Springfield, MA.
authors.forename: Vijay T
authors.initials: VT
authors.lastname: Gadiraju
authors.affiliation: Baystate Medical Center, Springfield, MA Tufts University School of Medicine, Boston, MA Mihaela.stefan@bhs.org.
authors.forename: Mihaela S
authors.initials: MS
authors.lastname: Stefan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000592:standards / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000592:standards / Q000706:statistics & numerical data; D014481:United States
keywords: heart failure; nursing home; processes of care; quality rating; readmissions