Division of General Medicine, University of Michigan, North Campus Research Complex, Ann Arbor, MI.
The Pennsylvania State University, University Park, PA.
Med Care. 2018 Aug;56(8):679-685. doi: 10.1097/MLR.0000000000000941.
There is widespread interest in reducing use of postacute care (ie, care after hospital discharge) following major surgery, provided that such reductions do not worsen quality outcomes such as readmission rates.
To describe the association between changes in skilled nursing facility (SNF) use and changes in readmission rates after surgery.
This was a observational study.
Fee-for-service Medicare beneficiaries undergoing coronary artery bypass grafting (CABG) or total hip replacement (THR) from 2008 to 2013.
Primary exposure was risk-adjusted SNF use initiated 0-2 days after hospital discharge, and the primary outcome was risk-adjusted readmission rates from 3 to 30 days after discharge.
Among 176,994 patients who underwent CABG at 804 hospitals and 233,955 patients who underwent THR at 1220 hospitals, hospital-level SNF utilization increased after CABG (16.4%-19.0%, P=0.001) and THR (40.8%-45.5%, P<0.001), from 2008 to 2013. Hospital readmission rates decreased for CABG (14.7%-12.7%, P<0.001) but did not change for THR (4.9%-4.8%, P=0.55), from 2008 to 2013. However, there was wide variation in hospital-level change in readmission rates. After adjusting for hospital characteristics and baseline readmission rates, there was no statistically significant association between change in SNF use and change in readmission rates (0.017 and 0.011 percentage point increase in SNF use for every one percentage point increase in readmission rates for CABG and THR respectively, P=0.58 and 0.32).
Changes in use of postacute care after THR and CABG have not been associated with changes in readmission rates.
广泛关注的是减少主要手术后的急性后护理（即出院后的护理）的使用，前提是这种减少不会恶化质量结果，如再入院率。
描述术后熟练护理设施（SNF）使用变化与再入院率变化之间的关系。
这是一项观察性研究。
2008 年至 2013 年期间接受冠状动脉旁路移植术（CABG）或全髋关节置换术（THR）的按服务收费医疗保险受益人。
主要暴露因素是出院后 0-2 天开始的风险调整 SNF 使用，主要结果是出院后 3-30 天的风险调整再入院率。
在 804 家医院接受 CABG 的 176994 名患者和在 1220 家医院接受 THR 的 233955 名患者中，CABG（16.4%-19.0%，P=0.001）和 THR（40.8%-45.5%，P<0.001）的医院 SNF 使用量从 2008 年到 2013 年有所增加，从 2008 年到 2013 年，CABG 的医院再入院率下降（14.7%-12.7%，P<0.001），而 THR 则没有变化（4.9%-4.8%，P=0.55）。然而，医院水平的再入院率变化存在很大差异。调整医院特征和基线再入院率后，SNF 使用变化与再入院率变化之间没有统计学显著关联（CABG 和 THR 每增加 1%的再入院率，SNF 使用增加 0.017 和 0.011 个百分点，P=0.58 和 0.32）。
THR 和 CABG 后急性后护理使用的变化与再入院率的变化无关。
