title: Potentially Avoidable Readmissions of Patients Discharged to Post-Acute Care: Perspectives of Hospital and Skilled Nursing Facility Staff.
abstract: BACKGROUND
  Hospital readmissions from skilled nursing facilities (SNFs) are common. Previous research has not examined how assessments of avoidable readmissions differ between hospital and SNF perspectives.
  
  
  OBJECTIVE
  To determine the percentage of readmissions from post-acute care that are considered potentially avoidable from hospital and SNF perspectives.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  One academic medical center and 23 SNFs.
  
  
  METHODS
  We included patients from a quality improvement trial aimed at reducing hospital readmissions among patients discharged to SNFs. We included Medicare patients who were discharged to one of 23 regional SNFs between January 2013 and January 2015, and readmitted to the hospital within 30 days.
  
  
  METHODS
  Hospital-based physicians and SNF-based staff performed structured root-cause analyses (RCA) on a sample of readmissions from a participating SNF to the index hospital. RCAs reported avoidability and factors contributing to readmissions.
  
  
  RESULTS
  The 30-day unplanned readmission rate to the index hospital from SNFs was 14.5% (262 hospital readmissions of 1,808 discharges). Of the readmissions, 120 had RCA from both the hospital and SNF. The percentage of readmissions rated as potentially avoidable was 30.0% and 13.3% according to hospital and SNF staff, respectively. Hospital and SNF ratings of potential avoidability agreed for 73.3% (88 of the 120 readmissions), but readmission factors varied between settings. Diagnostic problems and improved management of changes in conditions were the most common avoidable readmission factors by hospitals and SNFs, respectively.
  
  
  CONCLUSIONS
  A substantial percentage of hospital readmissions from SNFs are rated as potentially avoidable. The ratings and factors underlying avoidability differ between hospital and SNF staff. These data support the need for joint accountability and collaboration for future readmission reduction efforts between hospitals and their SNF partners.
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
authors.affiliation: Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Ouslander
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Mixon
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee.|Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Bell
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee.|Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: J Mary Lou
authors.initials: JM
authors.lastname: Jacobsen
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Avantika A
authors.initials: AA
authors.lastname: Saraf
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Daniel
authors.initials: D
authors.lastname: Markley
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Sponsler
authors.affiliation: Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.
authors.forename: Jill
authors.initials: J
authors.lastname: Shutes
authors.affiliation: Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Long
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee.|Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee.|Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee.|Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee.|Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement; D060891:Root Cause Analysis; D012866:Skilled Nursing Facilities; D014481:United States
keywords: hospital readmissions; skilled nursing facility; transitions of care