Abstract TP309: Creating a Crystal Ball: Predicting Successful Rehabilitation for Optimal Discharge Placement

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David Ermak ◽  
Raymond Reichwein ◽  
Alicia Richardson ◽  
Kathy Morrison ◽  
Travis Lehman
Keyword(s):  
Acute Care ◽  
Care Delivery ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Stroke Patients ◽  
Skilled Nursing ◽  
Bundled Payment ◽  
Successful Rehabilitation ◽  
Care Improvement ◽  
Post Acute Care

Introduction: In 2014, the Centers for Medicare and Medicaid Services (CMS) launched the Bundled Payment for Care Improvement (BPCI) program. Our institution is contracted for a 90 day stroke bundle, making us responsible for all Medicare stroke patient costs. Quarterly review of 2015 financial data (DRG 64 & 65) revealed a significant spend occurs in the post-acute care phase. Methods: Detailed analysis and sequencing revealed that of the 40% of patients discharged to an Inpatient Rehab Facility (IRF) 31% were unsuccessful in rehabilitation and instead transitioned to a Skilled Nursing Facility (SNF). Had SNF been initially selected, a cost avoidance of $292,650 would have been appreciated. Conclusion: Involvement in the BPCI program has provided insight into the post-acute care of stroke patients. With the advent of BPCI, institutions will be increasingly held fiscally responsible for post-acute care delivery. Ongoing retrospective chart review and collaboration with Physical Medicine and Rehabilitation colleagues is underway to identify key indicators that would project successful rehabilitation. Analysis will include comparison between those who were successfully discharged home after an IRF stay to those that needed a SNF after an IRF stay. This would provide inpatient teams with strategies for predicting the optimal discharge location for stroke patients.

scholarly journals Racial Disparities in 30-Day Outcomes Following Index Admission for COVID-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Vivek Nimgaonkar ◽  
Jeffrey C. Thompson ◽  
Lauren Pantalone ◽  
Tessa Cook ◽  
Despina Kontos ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Acute Care ◽  
Odds Ratio ◽  
Skilled Nursing Facility ◽  
Index Admission ◽  
Composite Outcome ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Black Patients ◽  
Post Acute Care

We investigated racial disparities in a 30-day composite outcome of readmission and death among patients admitted across a 5-hospital health system following an index COVID-19 admission. A dataset of 1,174 patients admitted between March 1, 2020 and August 21, 2020 for COVID-19 was retrospectively analyzed for odds of readmission among Black patients compared to all other patients, with sequential adjustment for demographics, index admission characteristics, type of post-acute care, and comorbidities. Tabulated results demonstrated a significantly greater odds of 30-day readmission or death among Black patients (18.0% of Black patients vs. 11.3% of all other patients; Univariate Odds Ratio: 1.71, p = 0.002). Sequential adjustment via logistic regression revealed that the odds of 30-day readmission or death were significantly greater among Black patients after adjustment for demographics, index admission characteristics, and type of post-acute care, but not comorbidities. Stratification by type of post-acute care received on discharge revealed that the same disparity in odds of 30-day readmission or death existed among patients discharged home without home services, but not those discharged to home with home services or to a skilled nursing facility or acute rehab facility. Collectively, the findings suggest that weighing comorbidity burdens in post-acute care decisions may be relevant in addressing racial disparities in 30-day outcomes following discharge from an index COVID-19 admission.

scholarly journals Transitional Care Outcomes in Veterans Receiving Post‐Acute Care in a Skilled Nursing Facility

2019 ◽  
Vol 67 (9) ◽  
pp. 1820-1826 ◽  
Author(s):  
Robert E. Burke ◽  
Anne Canamucio ◽  
Thomas J. Glorioso ◽  
Anna E. Barón ◽  
Kira L. Ryskina
Keyword(s):  
Acute Care ◽  
Transitional Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Care Outcomes ◽  
Post Acute Care

scholarly journals TRANSITIONAL CARE OUTCOMES IN VETERANS RECEIVING POST-ACUTE CARE IN A SKILLED NURSING FACILITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S732-S732
Author(s):  
Robert Burke ◽  
Anne Canamucio ◽  
Thomas Glorioso ◽  
Anna Baron ◽  
Kira Ryskina
Keyword(s):  
Acute Care ◽  
Transitional Care ◽  
Adverse Outcome ◽  
Skilled Nursing Facility ◽  
Adverse Outcomes ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Episodes Of Care ◽  
Va Hospitals ◽  
Post Acute Care

Abstract More than 200,000 Veterans transition between hospital and skilled nursing facility (SNF) annually. Capturing outcomes of these transitions has been challenging because older adult Veterans receive care at VA and non-VA hospitals, and four different kinds of SNFs: VA-owned and -operated Community Living Centers (CLCs), VA-contracted community nursing homes (CNHs), State Veterans Homes (SVHs), and non-VA community SNFs. We used a novel data source which concatenates VA, Medicare, and Medicaid data into longitudinal episodes of care for Veterans, to calculate the rate of adverse outcomes associated with the transition from hospital to SNF in all enrolled Veterans age 65 and older undergoing this transition 2012-2014. The composite primary outcome included Emergency Department (ED) visits, rehospitalizations, and mortality (not in the context of hospice) within 7 days of hospital discharge to SNF. We used multivariable logistic regression to adjust for Veteran and hospital characteristics and hospital random effects. In the 388,339 Veterans discharged from 1502 hospitals in our sample, we found more than 4 in 5 Veteran transitions (81.7%) occurred entirely outside the VA system. The overall 7-day outcome rate was 10.7%. After adjustment, VA hospitals had lower adverse outcome rates than non-VA hospitals (OR 0.80, 95% CI 0.74-0.86). VA hospital-CLC transitions had the lowest adverse outcome rates; in comparison, non-VA hospital-CNH (OR 2.51, 95% CI 2.09-3.02) and non-VA hospital-CLC (OR 2.25, 95% CI 1.81-2.79) had the highest rates. These findings raise important questions about the VA’s role as a major provider and payer of post-acute care in SNF.

Abstract 124: Post-acute Care Disposition To Home Or Acute Rehabilitation Helps Determine Favorable Clinical Outcome In The SENTIS Trial.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Samir R Belagaje ◽  
Kay Zander ◽  
Lisa Thackeray ◽  
Rishi Gupta
Keyword(s):  
Acute Stroke ◽  
Acute Care ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Favorable Outcome ◽  
Stroke Severity ◽  
Skilled Nursing ◽  
Stroke Treatment ◽  
Discharge Disposition ◽  
Post Acute Care

Intro: A person with stroke has improved outcomes with post-acute care in an inpatient rehabilitation facility (IRF) or at home compared to those who are discharged to a skilled nursing facility (SNF). However, this research was conducted in an era before acute stroke treatment was fully developed and implemented. In this analysis of a recently completed acute intervention trial, we hypothesize that subjects with similar severity of strokes will have better 90 day outcomes if they are discharged to a IRF or home compared to a SNF. Methods: Using the data from SENTIS, a prospective, multi-center single-blind, randomized trial of use of NeuroFlo technology compared to standard acute stroke therapy, patient demographics, day 4 National Institutes of Health Stroke Scores (NIHSS), and 90 day modified Rankin scores (mRS) was obtained. Severity of stroke was classfied in 3 groups based on NIHSS: less than 8, 8-13, 14+. Disposition following acute hospital care was classified as home, IRF and SNF. A favorable outcome was defined as 90 day mRS ≤ 2. For each stroke severity class, the effect of each disposition on a favorable outcome was calculated. Results: A total of 292 patients were analyzed with a mean age of 65±14 with presenting NIHSS of < 8 in 94/297(31.6%), NIHSS 8-13 in 118/297(39.7%) and 14+ in 85/297(28.6%) of patients. Regardless of day 4 NIHSS, only 2 out of 28 (7.1%) patients who were discharged to SNF achieved a 90 day mRS ≤2, compared to 60/153 (39.2%) in the IRF group (OR 8.02 95%CI[1.83-35.11], p=0.0057). Table 1 shows the distribution of outcomes by post-acute care disposition and day 4 NIHSS. Conclusions: The day 4 NIHSS had an inverse relationship with the likelihood of a favorable outome. Subjects who were discharged home or to an IRF were significantly more likely to have a favorable outcome compared to those who were discharged to a SNF. This analysis supports prior data stating that discharge disposition plays a role in determining outcomes.

scholarly journals Potentially Avoidable Readmissions of Patients Discharged to Post-Acute Care: Perspectives of Hospital and Skilled Nursing Facility Staff

2016 ◽  
Vol 65 (2) ◽  
pp. 269-276 ◽  
Author(s):  
Eduard E. Vasilevskis ◽  
Joseph G. Ouslander ◽  
Amanda S. Mixon ◽  
Susan P. Bell ◽  
J. Mary Lou Jacobsen ◽  
...  
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Avoidable Readmissions ◽  
Facility Staff ◽  
Post Acute Care

Medicare Bundled Payments for Post-Acute Care: Characteristics and Baseline Performance of Participating Skilled Nursing Facilities

2018 ◽  
Vol 77 (2) ◽  
pp. 155-164 ◽  
Author(s):  
Xi Cen ◽  
Helena Temkin-Greener ◽  
Yue Li
Keyword(s):  
Acute Care ◽  
Market Competition ◽  
Cost Of Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Bundled Payments ◽  
Baseline Performance ◽  
Care Improvement ◽  
Post Acute Care

Medicare bundled payment models have focused on post-acute care as a key component of improving the efficiency and quality of health care. This study investigated the characteristics and baseline performance of skilled nursing facilities (SNFs) that participated in Medicare Bundled Payments for Care Improvement Initiative Model 3. As of July 2016, 657 SNFs participated in 7,932 episodes in risk-bearing phase. Our retrospective analyses found that larger facilities, higher occupancy rate, chain affiliation, better five-star overall rating, and higher market competition for SNF care were associated with increased likelihood of enrolling in clinical episodes in Model 3, whereas not-for-profit ownership, higher adjusted staffing levels, higher percentage of Medicaid residents, and rural location were associated with reduced likelihood of participation in Bundled Payments for Care Improvement. Policy makers should consider approaches to encourage participation of post-acute care providers in this voluntary program and evaluate its impact on patient selection, cost of care, and health outcomes.

scholarly journals Machine-Learning Modeling to Predict Hospital Readmission Following Discharge to Post-Acute Care Settings

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 34-35
Author(s):  
Elizabeth Howard ◽  
John N Morris ◽  
Erez Schachter
Keyword(s):  
High Risk ◽  
Acute Care ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Care Delivery ◽  
Functional Limitations ◽  
Skilled Nursing Facility ◽  
Risk Groups ◽  
Total Sample ◽  
Post Acute Care

Abstract Increased attention to post-acute care (PAC) settings and available services to meet patients’ needs following acute hospital discharge is needed as these settings are being utilized increasingly in models of care delivery. The primary purpose was to generate a model to identify the most predictive factors relevant to hospital readmission within 90 days following discharge to one of three types of PAC sites: home with home care services (HC), skilled nursing facility (SNF), in-patient rehabilitation facility (IRF). Specific aims were to (1) examine number and characteristics of older adults discharged to the 3 PAC sites; (2) compare 90 day hospital readmission rate across sites and acuity level; and (3) examine assessment items across population and subgroups to identify variables most predictive of hospital readmission. 2015 assessment data from 3,592,995 Medicare beneficiaries were analyzed representing 1,536,908 from SNFs, 306,878 from IRFs, and 1,749,209 receiving HC services. Total sample 90-day readmission was 25.8 % . Patients discharged to IRF had lowest readmission rate (23.34%), and those receiving HC services had highest readmission rate (29.34%). Creation of risk subgroups however, revealed alternative outcomes. Among all patients in the low, intermediate and high risk groups, the lowest readmission rates occurred among SNF patients. Factor analysis of assessment variables indicated bladder and bowel incontinence and functional limitations were the most distinguishing factors between the very low and very high risk subgroups.

Use of an Exercise Technology in Post-Acute Care of a Skilled Nursing Facility: A Feasibility Study

2017 ◽  
Vol 18 (11) ◽  
pp. 991.e1-991.e4 ◽  
Author(s):  
Verena R. Cimarolli ◽  
Joann P. Reinhardt ◽  
Jillian Minahan ◽  
Orah Burack ◽  
Channing Thomas ◽  
...  
Keyword(s):  
Acute Care ◽  
Feasibility Study ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Post Acute Care

scholarly journals THE IMPACT OF MEDICARE ADVANTAGE ON SKILLED NURSING FACILITY FINANCIAL PERFORMANCE, STAFFING, AND QUALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S547-S547
Author(s):  
John R Bowblis ◽  
Sean Huang
Keyword(s):  
Financial Performance ◽  
Acute Care ◽  
Medicare Beneficiary ◽  
Skilled Nursing Facility ◽  
Nursing Facilities ◽  
Medicare Advantage ◽  
Data Set ◽  
Skilled Nursing ◽  
The Impact ◽  
Post Acute Care

Abstract Since the mid-2000s, skilled nursing facilities (SNFs) face an increasing percentage of post-acute care patients enrolled in Medicare Advantage (MA), yet our understanding the of how this affects SNFs is limited. Managed care may provide better coordination and continuous care that enhances SNF quality, but MA plans can also negotiate lower payments, providing SNFs with fewer financial resources to invest in staffing and quality. We use data from 2011-2015 from Medicare Beneficiary Summary File, Minimum Data Set, Certification and Survey Provider Enhanced Reporting, and Medicare Cost Reports to estimate linear fixed effect panel regressions with instrumental variables. We find that SNFs with greater MA share of post-acute care admissions have worse financial performance, lower nursing staff levels, and worse quality as measured by deficiency scores. Our finding favors the hypothesis that MA creates downward financial pressure and strong MA presence in local markets can potentially to spillover to non-MA residents.

scholarly journals Impact of Self-Care and Mobility on One or More Post-Acute Care Transitions

2020 ◽  
Vol 32 (10) ◽  
pp. 1325-1334
Author(s):  
Chih-Ying Li ◽  
Amol Karmarkar ◽  
Yong-Fang Kuo ◽  
Allen Haas ◽  
Kenneth J. Ottenbacher
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Functional Score ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Rehabilitation Facility ◽  
Rehabilitation Facilities ◽  
Inpatient Rehabilitation Facility ◽  
Post Acute Care

Objective: To investigate the association between functional status and post-acute care (PAC) transition(s). Methods: Secondary analysis of 2013–2014 Medicare data for individuals aged ≥66 years with stroke, lower extremity joint replacements, and hip/femur fracture discharged to one of three PAC settings (inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies). Functional scores were co-calibrated into a 0–100 scale across settings. Multilevel logistic regression was used to test the partition of variance (%) and the probability of PAC transition attributed to the functional score in the initial PAC setting. Results: Patients discharged to inpatient rehabilitation facilities with higher function were less likely to use additional PAC. Function level in an inpatient rehabilitation facility explained more of the variance in PAC transitions than function level while in a skilled nursing facility. Discussion: The function level affected PAC transitions more for those discharged to an inpatient rehabilitation facility than to a skilled nursing facility.

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