title: Structure, process, and outcomes in skilled nursing facilities: understanding what happens to surgical patients when they cannot go home. A systematic review.
abstract: BACKGROUND
  The surgical population is aging, and greater numbers of surgical patients are being discharged to skilled nursing facilities. Post-acute care is a poorly understood but very important aspect of our healthcare system.
  
  
  METHODS
  This systematic review examines the current body of literature surrounding the structural, process of care, and outcomes measurements for patients in skilled nursing facilities. English language articles published between 1998 and 2011 that purposed to examine nursing facility structure, process of care, and/or outcomes were included.
  
  
  CONCLUSIONS
  Abstracts (2129) were screened and 102 articles were reviewed in full. Twenty-nine articles were included in the qualitative synthesis. The role of the care setting and care delivery in contributing to outcomes has not been well studied, and no strong conclusions can be made. This area of care currently represents a "black box" to practicing surgeons. An understanding of these factors maybe instrumental to determining future directions for research to maximize positive outcomes for these patients.
authors.affiliation: Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington. Electronic address: timoh@uw.edu.
authors.forename: Timo W
authors.initials: TW
authors.lastname: Hakkarainen
authors.affiliation: Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ayoung-Chee
authors.affiliation: Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Rafael
authors.initials: R
authors.lastname: Alfonso
authors.affiliation: Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
authors.affiliation: Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D012866:Skilled Nursing Facilities; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000534:rehabilitation*