Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA.
J Am Med Dir Assoc. 2021 May;22(5):1060-1066. doi: 10.1016/j.jamda.2020.10.007. Epub 2020 Nov 24.
Older patients discharged to skilled nursing facilities (SNFs) for post-acute care are at high risk for hospital readmission. Yet, as in the community setting, some readmissions may be preventable with optimal transitional care. This study examined the proportion of 30-day hospital readmissions from SNFs that could be considered potentially preventable readmissions (PPRs) and evaluated the reasons for these readmissions.
Retrospective cohort study.
Post-acute practice of an integrated health care delivery system serving 11 SNFs in the US Midwest. Patients discharged from the hospital to an SNF and subsequently readmitted to the hospital within 30 days from January 1, 2009, through November 31, 2016.
A computerized algorithm evaluated the relationship between initial and repeat hospitalizations to determine whether the repeat hospitalization was a PPR. We assessed for changes in PPR rates across the system over the study period and evaluated the readmission categories to identify the most prevalent PPR categories.
Of 11,976 discharges to SNFs for post-acute care among 8041 patients over the study period, 16.6% resulted in rehospitalization within 30 days, and 64.8% of these rehospitalizations were considered PPRs. Annual proportion of PPRs ranged from 58.2% to 66.4% [mean (standard deviation) 0.65 (0.03); 95% confidence interval CI 0.63-0.67; P = .36], with no discernable trend. Nearly one-half (46.2%) of all 30-day readmissions were classified as potentially preventable medical readmissions related to recurrence or continuation of the reason for initial admission or to complications from the initial hospitalization.
For this cohort of patients discharged to SNFs, a computerized algorithm categorized a large proportion of 30-day hospital readmissions as potentially preventable, with nearly one-half of those linked to the reason for the initial hospitalization. These findings indicate the importance of improvement in postdischarge transitional care for patients discharged to SNFs.
入住康复护理机构（SNF）进行急性后护理的老年患者再次住院的风险很高。然而，与社区环境一样，一些再入院可能可以通过优化的过渡性护理来预防。本研究调查了从 SNF 出院后 30 天内再次住院的比例，这些再住院可被认为是潜在可预防的再住院（PPR），并评估了这些再住院的原因。
回顾性队列研究。
美国中西部 11 家 SNF 的综合医疗服务提供机构的急性后护理实践。患者从医院出院至 SNF，随后在 2009 年 1 月 1 日至 2016 年 11 月 31 日期间 30 天内再次住院。
计算机算法评估了初始和重复住院之间的关系，以确定重复住院是否为 PPR。我们评估了研究期间整个系统中 PPR 率的变化，并评估了再入院类别，以确定最常见的 PPR 类别。
在研究期间，8041 名患者中有 11976 名出院至 SNF 进行急性后护理，其中 16.6%在 30 天内再次住院，其中 64.8%的再住院被认为是 PPR。每年 PPR 的比例从 58.2%到 66.4%不等[平均值（标准差）为 0.65（0.03）；95%置信区间为 0.63-0.67；P=0.36]，没有明显的趋势。所有 30 天再入院中有近一半（46.2%）被归类为潜在可预防的医疗再入院，与初始入院的原因复发或持续相关，或与初始住院的并发症相关。
对于从 SNF 出院的这一组患者，计算机算法将很大一部分 30 天内的医院再入院归类为潜在可预防的，其中近一半与初始住院的原因有关。这些发现表明，为从 SNF 出院的患者改善出院后过渡性护理非常重要。
