For Medicare Heart Failure Patients, Hospital Readmission Risks Are Highest Immediately Following Nursing Home Discharge

Patients with heart failure were more likely to go back to the hospital within two days of being discharged to their homes from a skilled nursing facility, but after that two-day period the chance of readmission declined considerably, a recent AHRQ-funded study found. In the study, published in the Journal of the American Medical Directors Association, researchers examined records of 67,500 Medicare patients 65 years and older who were hospitalized with heart failure 30 days after discharge from a nursing home in 2012-2015. Of them, 16,333 (24 percent) were readmitted within 30 days of discharge from the facility. But the readmission rate was at least twice as high in the first two days after discharge as in subsequent days. The results are meaningful because 1 in 5 Medicare patients has heart failure. Researchers suggested that further work should examine if current hospital discharge practices could be applied to the transition from nursing home to home. Access the abstract.

2019 Apr;20(4):432-437. doi: 10.1016/j.jamda.2019.01.135.

Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart FailureHospitalization: A Retrospective Cohort Study.

Weerahandi H1, Li L2, Bao H2, Herrin J3, Dharmarajan K4, Ross JS5, Kim KL6, Jones S6, Horwitz LI6.

Author information

Abstract

OBJECTIVE:

Discharge to skilled nursing facilities (SNFs) is common in patients with heart failure (HF). It is unknown whether the transition from SNF to home is risky for these patients. Our objective was to study outcomes for the 30 days after discharge from SNF to home among Medicare patients hospitalized with HF who had subsequent SNF stays of 30 days or less.

DESIGN:

Retrospective cohort study.

SETTING AND PARTICIPANTS:

All Medicare fee-for-service beneficiaries 65 and older admitted during 2012-2015 with a HF diagnosis discharged to SNF then subsequently discharged home.

MEASURES:

Patients were followed for 30 days following SNF discharge. We categorized patients by SNF length of stay: 1 to 6 days, 7 to 13 days, and 14 to 30 days. For each group, we modeled time to a composite outcome of unplanned readmission or death after SNF discharge. Our model examined 0-2 days and 3-30 days post-SNF discharge.

RESULTS:

Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home. Overall, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge. The hazard rate of the composite outcome for each group was significantly increased on days 0 to 2 after SNF discharge compared to days 3 to 30, as reflected in their hazard rate ratios: for patients with SNF length of stay 1 to 6 days, 4.60 (4.23-5.00); SNF length of stay 7 to 13 days, 2.61 (2.45-2.78); SNF length of stay 14 to 30 days, 1.70 (1.62-1.78).

CONCLUSIONS/IMPLICATIONS:

The hazard rate of readmission after SNF discharge following HF hospitalization is highest during the first 2 days home. This risk attenuated with longer SNF length of stay. Interventions to improve postdischarge outcomes have primarily focused on hospital discharge. This evidence suggests that interventions to reduce readmissions may be more effective if they also incorporate the SNF-to-home transition.