The Hospital Readmissions Reduction Program's Impact on Readmissions From Skilled Nursing Facilities
The Hospital Readmissions Reduction Program's Impact on Readmissions From Skilled Nursing Facilities
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DOI：
10.1097/jhm-d-18-00035
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发表时间：
2019-05-01
影响因子：
1.8
通讯作者：
Whitman, Marilyn, V
中科院分区：
文献类型：
--
作者：
Smith, Todd Brenton;English, Thomas MacAndrew;Whitman, Marilyn, V
长期以来，再次入院一直是患者康复和护理效果的指标。本研究考察了减少医院再入院计划(HRRP)对来自熟练护理机构(SNF)的医院再入院的影响，以及SNF预测较低再住院率的特征。2011年至2015年，美国14,666名SNF的调整后30天再入院率使用线性回归和广义估计方程进行了检验，以确定HRRP任务与SNF再入院率的关系。调查结果显示，随着时间的推移，调整后的30天再住院率呈显著下降趋势，从2011年到2015年下降了1.4%。此外，较低的再住院率与SNF的特征有关，包括医院设施中的位置、农村指定、较高的注册护士与护士比率以及非营利性地位。我们发现与HRRP相关的与SNF相关的再入院人数大幅减少，这可能限制了《保护获得医疗保险法案》的影响。政策制定者在起草未来针对SNF再次住院的立法之前，可能会考虑这些系统和结构上的差异。此外，没有SNF的急性护理机构运营商可以考虑在其设施中增加一家和/或考虑与SNF合作，以确保在这些SNF中实施高质量的计划，以减少急性护理机构30天的再入院。
Hospital readmissions have long served as an indicator of patient recovery and the effectiveness of care. The present study examines the Hospital Readmissions Reduction Program's (HRRP's) impact on hospital readmissions from skilled nursing facilities (SNFs) and the characteristics of SNFs that were predictive of lower readmission rates. Adjusted 30-day readmission rates among 14,666 SNFs in the United States from 2011 through 2015 were examined using linear regression with generalized estimating equations to determine the relationship of the HRRP mandate to readmission rates from SNFs. Findings indicate a significant downward trend in adjusted 30-day readmission rates over time, decreasing 1.4% from 2011 to 2015. Furthermore, lower readmission rates were associated with SNF characteristics including location in a hospital facility, rural designation, higher registered nurse-to-nurse ratios, and not-for-profit status. We found a substantial decrease in SNF-related readmissions associated with HRRP, which may limit the impact of the Protecting Access to Medicare Act. Policy-makers may consider these systemic and structural differences before drafting future legislation targeting hospital readmission from SNFs. In addition, acute care facility operators who do not have an SNF may consider adding one to their facility and/or consider partnering with SNFs to ensure that high-quality programs in these SNFs are in place to reduce 30-day readmissions to the acute care facilities.