1 Brown University, Providence, RI, USA.
2 Uppsala University, Uppsala, Sweden.
J Appl Gerontol. 2019 Apr;38(4):479-498. doi: 10.1177/0733464817752084. Epub 2018 Jan 7.
We explored post-Affordable Care Act hospital and skilled nursing facility (SNF) perspectives in discharge and admission practices.
Interviews were conducted with 138 administrative personnel in 16 hospitals and 25 SNFs in eight U.S. markets and qualitatively analyzed.
Hospitals may use prior referral rates and patients' geographic proximity to SNFs to guide discharges. SNFs with higher hospital referral rates often use licensed nurses to screen patients to admit more preferred patients. While SNFs with lower hospital referral rates use marketing strategies to increase admissions, these patients are often less preferred due to lower reimbursement or complex care needs.
An unintended consequence of increased hospital-SNF integration may be greater disparity. SNFs with high hospital referral rates may admit well-reimbursed or less medically complex patients than SNFs with lower referral rates. Without policy remediation, SNFs with lower referral rates may thus care for more medically complex long-term care patients.
我们探讨了《平价医疗法案》（Affordable Care Act）之后医院和疗养院（SNF）在出院和入院方面的做法。
对美国八个市场的 16 家医院和 25 家疗养院的 138 名行政人员进行了访谈，并进行了定性分析。
医院可能会根据之前的转诊率和患者与疗养院的地理位置来指导出院。转诊率较高的疗养院通常会使用注册护士对患者进行筛查，以接收更多首选患者。而转诊率较低的疗养院则会使用营销策略来增加入院人数，但这些患者往往由于报销较低或护理需求复杂而不受欢迎。
医院与疗养院融合程度增加可能会导致更大的差距。转诊率较高的疗养院可能会接收报销情况较好或医疗护理需求不那么复杂的患者，而转诊率较低的疗养院则会接收更多的报销情况较差或医疗护理需求复杂的患者。如果没有政策补救，转诊率较低的疗养院可能会因此接收更多医疗护理需求复杂的长期护理患者。
