At Gateway Transitional Care Center, we’ve found that administrators and clinicians can work together to stratify residents’ risk for re-hospitalization. Below, we’ve provided some data to aid in understanding the current statistics associated with hospital readmission from skilled nursing facilities (SNF).

Hospital Readmission Rates: Why They Matter

Hospital readmission rates are regarded as a valid quality measure for SNFs:

  • CMS data show top ¾ rate < 17%
  • Bottom ¼ > 23%
  • Authors conclude the relationship between readmissions and quality of facility is not an artifact
  • High rates may damage hospital-SNF relations
  • Hospitals penalized by CMS for readmissions
  • Increased burden on U.S. healthcare ($9.41 million in Idaho alone)
  • 20% of Medicare beneficiaries discharged to SNF
  • One in four patients discharged to a SNF is readmitted within 30 days
  • Two-thirds of these readmissions may be preventable

Note: Risk stratification can occur during both admission and discharge.

Hospital Scoring Validation

  • Kim et al. validated use of the tool in 2016
  • Risk stratification
  • All cause readmission 30.9%
  • Low risk (0-4) 15.4%
  • Intermediate risk (5-6) 28.1%
  • High risk (>7) 40.9%
  • Those at high risk tend to be those who are younger (mean age 72.8), likely to be on dialysis and discharged to subspecialty service

 

Discharge Risk: Function Out-Predicts Co-Morbidities

  • Main tool of use: Functional Independence Measure
  • Motor subscale out-predicted cognitive subscale
  • Motor subscale
  • Eating, grooming, bathing, upper and lower body dressing, toileting, bowel/bladder management, bed to chair transfer, toilet transfer, shower transfer, locomotion, stairs

Prediction At Discharge Using FIM Categories

  • Patients dependent in any category of mobility — 50% increased odds (OR= 1.50)
  • Patients dependent for self-care — 36% increased odds (OR = 1.36)
  • Patients dependent for cognition — 19% increased odds (OR= 1.19)
  • All compared to 8.5% for those independent in ⅔ categories

Additional Performance Measures Useful for Prediction

  • 10 Meter Walk Test
  • Functional Reach Test
  • Six-Minute Walk Test

Using the above data, we can assess and stratify patient risk for hospital readmission, as well as predict discharge safety using valid outcome measures based on the current best evidence. By providing evidence for risk, facilities may decrease rates of hospital readmission and justify the need for ongoing services to better meet patients’ needs.

By Ian M. Campbell, SPT, Gateway Transitional Care Center, Pocatello, ID