Comparison of Patient Characteristics Rehospitalized During SNF Stay, Post SNF Discharge and Referred to Hospice at Post-Acute Care

The Affordable Care Act of 2010 requires the Department of Health and Human Services to establish a rehospitalization reduction program.  CMS (Centers for Medicare and Medicaid Services) implemented a program that considers rehospitalization an indicator of poor quality care.  Readmission during post-acute care at skilled nursing facility (SNF) or post SNF discharge negatively impacts the resources and effectiveness of health care. 

We performed a retrospective study on 387 patients, who were discharged from January 1, 2015 to November 30, 2015 at a skilled nursing rehabilitation center.  Patients were categorized into four groups:

• Group A: 38 (9.8%) patients rehospitalized during rehabilitation in SNF stay,
• Group B: 32 (8.3%) patients referred to hospice during or after SNF rehabilitation,
• Group C&D: 317 (81.9%) patients discharged to home, assisted living, board and care, long term care facility,
• Group C: 37 (9.6%) patients rehospitalized within 30 days post SNF discharge,
• Group D: 280 (72.4%) patients discharge dispositions were D1. Home 205 (53%), D2. Assisted Living 34 (8.8%), D3. Board and Care 13 (3.4%), and D4. Long Term Care Facility 28 (7.2%).

The following characteristics were analyzed: age, gender, body mass index (BMI), St. Louis University Mental Status (SLUMS), Allen Cognitive Placement Levels (ACL), the initial functional independent measure (FIM1) on admission, the last functional independent measure (FIM2) prior to discharge, the length of stay (LOS), and number of days prior to rehospitalization post SNF discharge.

Overall, patients rehospitalized during SNF stay were younger (76.6 years-old), better nourished (BMI 26.2), mild demented (SLUMS 16.8), more ill, with lower functional level (ACL 3.8) and had shorter length of stay (9.9 days). The rehospitalized patients post SNF discharge generally 1) had LOS longer than 17 days (43%, p<0.001), 2) required minimal assist in ADL upon discharge (p=0.002), 3) had increased admission rate from assisted living (16%) and board and care (8%) (p<0.001), 4) were older (80.4 years-old), and mild demented (SLUMS 17.5), and 5) were more likely (51.4%) rehospitalized within 10 days after discharged from SNF (p<0.001).  Discharging process and home health services should focus on and consider a higher priority to patients with higher risks for rehospitalization.  Also, the timing of the follow-up appointment with primary care physician post-SNF discharge should be as early as possible in order to reduce avoidable rehospitalization.

Hospice patients were oldest (86.9 years-old), malnourished (BMI 19.5), had lower initial functional level (ACL 2.2), required moderate assist in ADL upon discharge, and more severely demented (SLUMS 7.1).  The rehospitalization rates of patients with moderate impairment in functional level (27.8%) of group C and group D were lower than patients with minimal impairment in functional level (30.6%), which probably correlated with proper hospice referral of debilitated patients to group B.  The parameters of hospice referred patients can assist health care providers to introduce hospice services appropriately, focus on patients’ quality of life, and subsequently reduce the rehospitalization rate during SNF stay and post SNF discharge.