Elizabeth M. White (
Cyrus M. Kosar is a doctoral candidate in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health.
Health Aff (Millwood). 2020 Aug;39(8):1312-1320. doi: 10.1377/hlthaff.2019.01502.
Hospitals and skilled nursing facilities (SNFs) face increasing pressure to improve care coordination and reduce unnecessary readmissions. One strategy to accomplish this is to share physicians and advanced practice clinicians, so that the same providers see patients in both settings. Using 2008-16 Medicare claims, we found that as SNFs moved increasingly toward using SNF specialists, there was a steady decline in the number of facilities sharing medical providers and in the proportion of SNF primary care delivered by provider practices with both hospital and SNF clinicians (hospital-SNF practices). In SNF fixed effects analyses, we found that SNFs that increased primary care visits by hospital-SNF practices had slightly fewer readmissions, shorter lengths-of-stay, and increased successful community discharges. These findings suggest that SNFs that share medical providers with hospitals may see some benefit from that linkage, although the magnitude of the benefit may be small.
医院和熟练护理设施（SNF）面临着提高护理协调和减少不必要的再入院的压力。实现这一目标的一种策略是共享医生和高级实践临床医生，以便同一提供者可以在这两种环境中看到患者。使用 2008-2016 年的 Medicare 索赔，我们发现，随着 SNF 越来越倾向于使用 SNF 专家，共享医疗提供者的设施数量和由同时具有医院和 SNF 临床医生的提供者实践提供的 SNF 初级保健的比例稳步下降（医院-SNF 实践）。在 SNF 固定效应分析中，我们发现增加医院-SNF 实践初级保健就诊次数的 SNF 再入院人数略有减少，住院时间缩短，成功出院到社区的人数增加。这些发现表明，与医院共享医疗提供者的 SNF 可能会从这种联系中获得一些好处，尽管好处的幅度可能很小。
