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.

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

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 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.

An evaluation of a Geriatric Substance Abuse Recovery Program in post-acute care of a skilled nursing facility

2017 ◽  
Vol 44 (1) ◽  
pp. 28-39 ◽  
Author(s):  
Verena R Cimarolli ◽  
Orah Burack ◽  
Gregory Poole-Dayan ◽  
Irene Liu ◽  
Sherry P Samaroo ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Acute Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Substance Abuse Recovery ◽  
Recovery Program ◽  
Post Acute Care

scholarly journals Frailty and Functional Status improvement after Skilled Nursing Facility based Post-Acute Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 821-822
Author(s):  
Sandra Shi ◽  
Brianne Olivieri-Mui ◽  
Ellen McCarthy ◽  
Dae Hyun Kim
Keyword(s):  
Functional Status ◽  
Acute Care ◽  
Frailty Index ◽  
Functional Decline ◽  
Skilled Nursing Facility ◽  
Deficit Accumulation ◽  
Nursing Facility ◽  
Data Set ◽  
Skilled Nursing ◽  
Post Acute Care

Abstract People admitted to a skilled nursing facility (SNF) for post-acute care undergo comprehensive evaluation and rehabilitation, potentially enabling prediction of future functional recovery. We identified the first SNF admission per beneficiary (n=250,159) between 07/01/2014 – 06/30/2016 in a 5% Medicare sample, using the Minimum Data Set (MDS) and the Outcome and Assessment Information Set (OASIS). Episodes were excluded for non-community discharge (n=43,397) or no OASIS admission assessment within 14 days of SNF discharge (n=77,989). A deficit accumulation Frailty Index (FI) was measured on admission MDS assessment and categorized into robust (MDS-FI<0.15), pre-frailty (MDS-FI0.15-0.24), mild frailty (MDS-FI0.25-0.34), and moderate or worse frailty (MDS-FI≥0.35). Outcomes were functional decline obtained from OASIS, readmission, or death after initiation of home care. Functional status was measured by activities of daily living from OASIS assessments. A total of 135,310 SNF episodes were matched to OASIS episodes. Of these, there were 6,472 (4.8%) robust patients, 38,923 (28.8%) pre-frail, 63,727 (47.1%) mildly frail and 26,053 (19.3%) moderately frail or worse. In a logistic regression after adjustment for OASIS admission function, compared to robust status, frailty was associated with hospital readmission or death within 30 days of OASIS admission, (mild frailty OR1.33 [95%CI 1.23-1.45] and moderate or worse OR1.81 [95%CI 1.66-1.97]). Frailty was also associated with functional decline at OASIS discharge, after adjustment for OASIS admission function (mild frailty OR1.50 [95%CI 1.38-1.63] and moderate or worse OR2.30 [95%CI 2.11-2.50]). Among those discharged from SNF with home services, a SNF-based MDS-FI is associated with increased likelihood of poor community outcomes.

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