Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania, United States of America.
Department of Surgery, Division of Outcomes Research and Quality, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, United States of America.
PLoS One. 2019 Apr 16;14(4):e0215245. doi: 10.1371/journal.pone.0215245. eCollection 2019.
Postacute care (PAC) is a major driver of the rising health care costs in the United States (US). There is limited evidence on the causal effect of skilled nursing facility (SNF) use on readmission after an inpatient colectomy.
We performed a retrospective analysis of data from the Pennsylvania Health Care Cost Containment Council (PHC4) on 38,635 patients who underwent an inpatient colectomy between 2011 and 2014 in a Pennsylvania hospital. Using propensity scores, we matched patients who were discharged to a SNF to those who were discharged elsewhere. We compared the probability of readmissions within 30 days for the two groups of matched patients in a regression framework. For the subset of patients who were readmitted within 30 days, we assessed whether patients discharged to SNF were readmitted earlier than those discharged to other entities.
The use of a SNF after a colectomy significantly raises the patients' chance of readmissions within 30 days, even after controlling for their demographic characteristics and illness severity. Based on our estimates, being discharged to a SNF raises the chance of a readmission by 7.7 percentage points. For patients who were admitted within 30 days, we find no association between discharge to a SNF and the timing of readmission.
Sending less severe patients to facilities other than a SNF following inpatient colectomy may help hospitals reduce 30-day readmission rates.
美国（US）的急性后期护理（PAC）是医疗保健费用不断上涨的主要原因。关于使用熟练护理设施（SNF）对住院结肠切除术患者再入院的因果效应，证据有限。
我们对宾夕法尼亚州医疗保健成本控制委员会（PHC4）的数据进行了回顾性分析，涉及 2011 年至 2014 年期间在宾夕法尼亚州一家医院接受住院结肠切除术的 38635 名患者。利用倾向评分，我们将出院到 SNF 的患者与出院到其他地方的患者进行匹配。我们在回归框架中比较了两组匹配患者在 30 天内再次入院的概率。对于在 30 天内再次入院的患者子集，我们评估了出院到 SNF 的患者是否比出院到其他机构的患者更早再次入院。
结肠切除术后使用 SNF 显著增加了患者在 30 天内再次入院的机会，即使在控制了他们的人口统计学特征和疾病严重程度后也是如此。根据我们的估计，将患者送往 SNF 会使再次入院的机会增加 7.7 个百分点。对于在 30 天内入院的患者，我们发现将患者送往 SNF 与再次入院的时间之间没有关联。
在住院结肠切除术后，将病情较轻的患者送往 SNF 以外的其他设施，可能有助于医院降低 30 天再入院率。
