Hospital Readmission History is a Valid Measure of Skilled Nursing Quality

That's why on its Nursing Home Compare website, the federal government recently included an SNF's historical track record of 30-day hospital readmissions in its ratings of care quality.

A rigorous statistical analysis in the journal Health Services Research backs the idea that readmission history is a valid quality measure. Though the measure may seem intuitive, said lead author Momotazur Rahman, an assistant professor in the Brown University School of Public Health, its significance could have been diluted by confounding factors. An SNF can have a low hospital readmission rate for either of two competing reasons: It treats healthier patients or it provides better quality of care.

The new study compares hospital readmission among patients discharged to SNFs with different levels of historical readmission rates. What the authors found is that a historical readmission rate is a strong predictor of future readmissions after disentangling key confounding factors.

"We do think that it reflects quality, at least in terms of likelihood of re-hospitalization," Rahman said.

To make their findings, the team gathered and analyzed four years (2009 to 2013) of Medicare data on SNF admissions and resulting hospital readmissions. The researchers used those to calculate the historical readmission rate of more than 14,000 SNFs serving millions of patients. The rates varied significantly: the best quartile's rates were below 17 percent, and the worst quartile's rates were above 23 percent. Then they compared the effect of treatment in a low-readmission SNFs vs. high-readmission SNFs on new SNF patients in 2013.

What accounted for the different readmission rates? And how well did they predict new readmissions? The particular confounding factor that worried experts, including Rahman and his co-authors, was called "patient selection." Like the best hospitals sometimes receive the most serious patients, what if the entire reason some SNFs send a lot of patients back to the hospital within 30 days is because they received very sick patients in the first place?

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