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Tytuł:
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The Five-Star Skilled Nursing Facility Rating System and Care of Disadvantaged Populations.
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Autorzy:
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Zuckerman RB; Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia.
Wu S; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Chen LM; Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia.; Department of Internal Medicine, Institute for Healthcare Policy and Innovation, University of Michigan Health System, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Joynt Maddox KE; Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia.; Cardiovascular Division, Department of Medicine, School of Medicine, Washington University, St. Louis, Missouri.
Sheingold SH; Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia.
Epstein AM; Department of Health Policy and Management, T.H. Chan School of Public Health, Harvard University, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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Źródło:
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Journal of the American Geriatrics Society [J Am Geriatr Soc] 2019 Jan; Vol. 67 (1), pp. 108-114. Date of Electronic Publication: 2018 Oct 19.
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Typ publikacji:
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Journal Article; Observational Study
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Język:
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English
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Imprint Name(s):
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Publication: Malden, MA : Blackwell Science
Original Publication: New York [etc.]
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MeSH Terms:
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Patient Discharge/*statistics & numerical data
Quality of Health Care/*statistics & numerical data
Skilled Nursing Facilities/*statistics & numerical data
Subacute Care/*statistics & numerical data
Vulnerable Populations/*statistics & numerical data
Aged ; Aged, 80 and over ; Female ; Healthcare Disparities/statistics & numerical data ; Humans ; Logistic Models ; Male ; Medicare ; Patient Discharge/standards ; Quality Assurance, Health Care ; Retrospective Studies ; Skilled Nursing Facilities/standards ; Subacute Care/standards ; United States
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Grant Information:
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T32 HS000029 United States HS AHRQ HHS
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Contributed Indexing:
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Keywords: medicare; postacute care; quality measurement; skilled nursing facility
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Entry Date(s):
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Date Created: 20181020 Date Completed: 20191125 Latest Revision: 20191125
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Update Code:
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20240105
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DOI:
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10.1111/jgs.15629
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PMID:
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30339726
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Objectives: To examine characteristics and locations of high- and low-quality skilled nursing facilities (SNFs) and whether certain vulnerable individuals were differentially discharged to facilities with lower quality ratings.
Design: Retrospective observational study.
Setting: Medicare-certified SNFs providing postacute care.
Participants: SNF stays (N=1,195,166) of Medicare beneficiaries aged 65 and older admitted to 14,033 SNFs within 2 days of hospital discharge.
Measurements: We used Medicare claims from October 2013 to September 2014 and SNF 5-star ratings published on Nursing Home Compare. We describe the characteristics and populations of facilities according to quality, and the location of low (1 star) and high (5 stars) quality facilities. We used logistic regression models to estimate odds of admission to a low-quality facility after hospital discharge according to race, ethnicity, dual Medicare-Medicaid enrollment, functional status, discharge from a safety-net or low-quality hospital, and residence in a county with more low-quality SNFs.
Results: More than one-fifth (22.2%) of the facilities had a 5-star (high quality) rating, and 15.9% had a one-star (low quality) rating. Low-quality facilities were more likely to be in the south (44%), for profit (85%), and larger (>70 beds (86%)). Dual enrollment was the strongest predictor of admission to a 1-star facility (odds ratio (OR) = 1.53, 95% confidence interval (CI) = 1.51-1.55), although racial or ethnic minority status (black: OR = 1.25, 95% CI = 1.22-1.28; Hispanic: OR = 1.10, 95% CI = 1.06-1.14) and geographic prevalence of facilities (for a 10% increase in 1-star beds located in the county of individual's residence: OR = 1.27, 95% CI = 1.26-1.27) were also significant predictors.
Conclusion: Vulnerable groups are more likely to be discharged to lower-quality facilities for postacute care. Policy-makers should monitor disparities in SNF quality. J Am Geriatr Soc 67:108-114, 2019.
(© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.)
