Skilled Nursing Facility Discharges Associated With Fewer Readmissions for Healthcare-Associated Infections

Among Medicare patients admitted to the hospital with healthcare-associated infections (HAIs), those discharged to skilled nursing facilities (SNFs) were less likely to be readmitted for treatment for the same infection compared with those discharged to their homes or home health care, an AHRQ-funded study has found. The study, published in the Journal of the American Geriatrics Society, used AHRQ Healthcare Cost and Utilization Project (HCUP) data to review more than 700,000 hospital admissions involving HAIs in 2013 and 2014. About half of these patients were discharged to an SNF, with the rest being discharged to home or home health care. Patients discharged to an SNF had more accompanying illnesses, but were 38 percent less likely to be readmitted to the hospital for treatment of their initial infection. The authors called for research to identify strategies to improve home-based infection care. Access the abstract.

2019 Oct 23. doi: 10.1111/jgs.16208. [Epub ahead of print]

Role of Post-Acute Care in Readmissions for Preexisting Healthcare-Associated Infections.

Hoffman GJ1,2, Min LC2,3,4,5,6, Liu H1, Marciniak DJ7, Mody L3,6.

Author information

1: Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan.
2: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
3: Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan.
4: Veterans Affairs Center for Clinical Management and Research (CCMR), VA Medical Center, Ann Arbor, Michigan.
5: Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
6: Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
7: School of Medicine, University of Michigan, Ann Arbor, Michigan.

Abstract

OBJECTIVES:

Although preventable, healthcare-associated infections (HAIs) are commonly observed in post-acute care settings for at-risk older adults and are a leading cause of hospital readmissions. However, whether HAIs resulting in avoidable readmissions for preexisting HAIs (the same HAI as at the index admission) are more common for patients discharged to post-acute care as opposed to home is unknown. We examined the risk of preexisting HAI readmissions according to patient discharge disposition and comorbidity level.

DESIGN:

We used 2013-2014 national hospital discharge data to estimate the likelihood of readmissions for preexisting HAIs according to patients' discharge disposition and whether the likelihood varies according to patient comorbidity level, across four common types of HAIs (not including respiratory infections).

PARTICIPANTS:

A total of 702 304 hospital discharges for Medicare beneficiaries 65 years or older.

MEASUREMENTS:

Our outcome was a 30-day preexisting, or "linked," HAI readmission (readmission involving the same HAI diagnosis as at the index admission). Patient discharge disposition was skilled nursing facility (SNF), home health care, and home care without home health care ("home").

RESULTS:

Of 702 304 index admissions involving HAI treatment, 353 073 (50%) were discharged to a SNF, 179 490 (26%) to home health care, and 169 872 (24%) to home. Overall, 17 523 (2.5%) of preexisting HAIs resulted in linked HAI readmissions, which were more common for Clostridioides difficile infections (4.0%) and urinary tract infections (2.4%) than surgical site infections (1.1%; P < .001). Being discharged to a SNF compared to home or to home health care was associated with a 1.15 percentage point (95% confidence interval = -1.29 to -1.00), or 38%, lower risk of a linked HAI readmission. This risk difference was observed to increase with greater patient comorbidity.

CONCLUSIONS:

SNF discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. Further research to identify modifiable mechanisms that improve posthospital infection care at home is needed.