title: The Contribution of Skilled Nursing Facilities to Hospitals' Readmission Rate.
abstract: To examine the relative influence of hospital and skilled nursing facilities (SNFs) on 30-day rehospitalization.
  
  
  
  Elderly Medicare beneficiaries newly admitted to a SNF following hospitalization.
  
  
  
  We ranked hospitals and SNFs into quartiles based on previous years' adjusted rehospitalization rates (ARRs) and examined how rehospitalizations from a given hospital vary depending upon the admitting SNF ARR quartile. We examined whether the availability of SNFs with low rehospitalization rates influenced hospitals' SNF readmission rates and whether changes in a hospital's ARR over 3 years is associated with changes in the SNFs to which they discharge.
  
  
  
  Hospital readmission rates from SNFs varied 5 percentage points between patients discharged to SNFs in the lowest and the highest rehospitalization quartiles. Low rehospitalization rate hospitals sent a larger fraction of their patients to the lowest rehospitalization SNFs available in the area. A 10 percent increase in hospital's share of discharges to the lowest rehospitalization quartile SNFs is associated with a 1 percentage point reduction in hospital's ARR.
  
  
  
  The SNF rehospitalization rate has greater influence on patients' risk of rehospitalization than the discharging hospital. Identifying high-performing SNFs may be a powerful strategy for hospitals to reduce rehospitalizations.
authors.affiliation: Department of Health Services Policy and Practice, Brown University, Providence, RI.
authors.forename: Momotazur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Department of Health Services Policy and Practice, Brown University, Providence, RI.
authors.forename: John
authors.initials: J
authors.lastname: McHugh
authors.affiliation: Department of Health Services Policy and Practice, Brown University, Providence, RI.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Gozalo
authors.affiliation: NaviHealth, Nashville, TN.
authors.forename: Dana Clay
authors.initials: DC
authors.lastname: Ackerly
authors.affiliation: Department of Health Services Policy and Practice, Brown University, Providence, RI.|Providence Veterans Administration Medical Center, Health Services Research Program, Providence, RI.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States
keywords: 30-day rehospitalization rate; hospital discharge; skilled nursing facilities