Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Seton Medical Center, Austin, TX.
J Arthroplasty. 2019 Jun;34(6):1066-1071. doi: 10.1016/j.arth.2019.02.032. Epub 2019 Mar 1.
With the advent of bundled payment models, identifying high-performing skilled nursing facilities (SNFs) has become increasingly important. The goal of this study is to develop a rating system to rank SNFs within our health system and to use this system to improve the SNF discharge process at our institution.
All SNF-discharged primary total joint arthroplasty cases in 2017 at a multi-hospital academic health system were queried. Discharge patterns were assessed using heat map analysis. Regression analyses in conjunction with structured discussions with subject matter experts were used to identify measures of SNF efficiency and care quality. A revised rating system was developed and used to identify high-performing facilities within our health system. Opportunities to re-direct patients to higher performing facilities were identified.
A revised rating system for SNFs was constructed based on risk-adjusted SNF length of stay, 30-day re-admission rate, and 30-day emergency department visit rate. As 82% of patients were discharged to SNFs in close proximity to their home, high-performing SNFs (according to the revised rating system) were identified by geographic region. Mapping of the discharge process revealed multiple opportunities where patients could be re-directed to a higher performing SNF in their area. Using conservative estimates (25% of discharges re-directed), this is expected to achieve a cost saving of $2,600,000 over a 5-year period, mainly through reductions in SNF length of stay.
This study describes the development of a revised rating system for SNFs which, when implemented, is expected to achieve substantial cost savings over a 5-year period.
随着捆绑式支付模式的出现，确定表现出色的熟练护理设施（SNF）变得越来越重要。本研究的目的是开发一种评级系统，对我们医疗系统内的 SNF 进行排名，并使用该系统改进我们机构的 SNF 出院流程。
在一个多医院学术医疗系统中，查询了 2017 年所有 SNF 出院的原发性全关节置换病例。使用热图分析评估出院模式。结合回归分析和与主题专家的结构化讨论，确定 SNF 效率和护理质量的衡量标准。开发了一个修订后的评级系统，并用于识别我们医疗系统内表现出色的设施。确定了将患者重新分配到表现更好的设施的机会。
根据风险调整后的 SNF 住院时间、30 天再入院率和 30 天急诊就诊率，构建了 SNF 的修订评级系统。由于 82%的患者出院到离家较近的 SNF，因此根据修订后的评级系统确定了表现良好的 SNF（按地理区域划分）。出院流程的映射显示了多个可以将患者重新定向到其所在地区表现更好的 SNF 的机会。使用保守估计（25%的出院患者重新定向），预计在 5 年内将节省 260 万美元的成本，主要通过减少 SNF 的住院时间来实现。
本研究描述了一种修订后的 SNF 评级系统的开发，实施后预计在 5 年内将实现大量成本节约。
