Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA.
Université de Paris, Paris, France.
Health Serv Res. 2021 Oct;56(5):839-846. doi: 10.1111/1475-6773.13654. Epub 2021 Mar 29.
To examine whether stronger referral relationships between hospitals and skilled nursing facilities (SNF) are associated with lower-risk patients being admitted to SNF.
DATA SOURCES/COLLECTION: We used MedPAR data to estimate referral relationship strength and nursing home survey data (OSCAR and CASPER) to determine the risk of patient admissions at nearly 14 000 SNFs from 2008 to 2014.
We examined the association of hospital referral concentration with the percentage of higher-risk patients admitted to non-hospital-based (freestanding) SNFs using an instrumental variables approach. We used the distance between patients and SNFs and hospitals and SNFs as the instrument.
DATA COLLECTION/EXTRACTION METHODS: We used previously collected MedPAR and OSCAR/CASPER survey data.
We find greater observed referral concentration among freestanding SNFs is associated with lower percentages of patients with pressure sores (coefficient, -2.64; 95% CI, [-2.82 to -2.46]), catheters (-0.55; [-0.74 to -0.36]), and physical restraints (-0.16; [-0.29 to -0.03]) at admission to a skilled nursing facility.
We find evidence that freestanding SNFs with stronger hospital referral relationships may be admitting less risky patients, possibly contributing to disparities across SNFs.
研究医院与熟练护理机构（SNF）之间的转诊关系是否更为紧密与 SNF 收治低危患者有关。
数据来源/采集：我们使用 MedPAR 数据来评估转诊关系的紧密程度，同时使用疗养院调查数据（OSCAR 和 CASPER）来确定 2008 年至 2014 年间近 14000 家 SNF 收治患者的风险。
我们采用工具变量法，考察医院转诊集中程度与非医院附属（独立）SNF 收治高危患者比例之间的关系。我们将患者与 SNF 以及患者与医院和 SNF 之间的距离作为工具变量。
数据收集/提取方法：我们使用了之前收集的 MedPAR 和 OSCAR/CASPER 调查数据。
我们发现，独立 SNF 之间的转诊集中程度越高，入住 SNF 时压疮（系数为-2.64；95%置信区间，[-2.82 至-2.46]）、导尿管（-0.55；[-0.74 至-0.36]）和身体约束（-0.16；[-0.29 至-0.03]）的患者比例越低。
我们有证据表明，与医院转诊关系更为紧密的独立 SNF 可能收治风险较低的患者，这可能导致 SNF 之间存在差异。
