title: Outcomes of Patients Discharged to Skilled Nursing Facilities After Acute Care Hospitalizations.
abstract: OBJECTIVE
  To evaluate previously independent older patients discharged to skilled nursing facilities (SNFs) and identify risk factors for failure to return home and death and development of a predictive tool to determine likelihood of adverse outcome.
  
  
  BACKGROUND
  Little is known about the likelihood of return to home, and higher than expected mortality rates in SNFs have recently been described, which may represent an opportunity for quality improvement.
  
  
  METHODS
  Retrospective cohort of older hospitalized patients discharged to SNFs during 2007 to 2009 in 5 states using Centers for Medicare & Medicaid Services linked minimum data set data from SNFs. We assessed mortality, hospital readmission, discharge to home, and logistic regression models for predicting risk of each outcome.
  
  
  RESULTS
  Of 416,997 patients, 3.8% died during the initial SNF stay, 28.6% required readmission, and 60.5% were ultimately discharged home. Readmission to a hospital was the strongest predictor of death in the years after SNF admission (unadjusted hazard ratio, 28.2; 95% confidence interval, 27.2-29.3; P < 0.001). Among all patients discharged to SNFs, 7.8% eventually died in an SNF and overall 1-year mortality was 26.1%. Risk factors associated with mortality and failure to return home were increasing age, male sex, increasing comorbidities, decreased cognitive function, decreased functional status, parenteral nutrition, and pressure ulcers.
  
  
  CONCLUSIONS
  A large proportion of older patients discharging to SNFs never return home. A better understanding of the natural history of patients sent to SNFs after hospitalization and risk factors for failure to return to home, readmission, and death should help identify opportunities for interventions to improved outcome.
authors.affiliation: Department of Surgery Surgical Outcomes Research Center, the Comparative Effectiveness Research Translation Network, and the Harborview Injury Prevention Research Center, University of Washington, Seattle, WA.
authors.forename: Timo W
authors.initials: TW
authors.lastname: Hakkarainen
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Willis
authors.forename: Giana H
authors.initials: GH
authors.lastname: Davidson
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D003661:Decision Support Techniques; D005260:Female; D006760:Hospitalization; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D014481:United States