Study: Hospital to nursing home discharges need focus

The juncture where patients are discharged from hospitals to skilled nursing facilities for rehabilitation is pinpointed by a new study as a place where greater focus could prolong lives and reduce costs.

Vanderbilt University Medical Center and Massachusetts Institute of Technology analyzed claims data from more than 1.5 million Medicare patients across every zip code in the country who needed emergency hospital care for injuries such as hip or femur fractures or intercerebral hemorrhage stroke.

The authors found a higher mortality rate within a year of discharge in patients who were sent to a skilled nursing facility before going home.

That's where the results get muddled. John Graves, co-author and assistant professor of health policy and medicine at Vanderbilt, said the results are inconclusive about whether the mortality rate is directly linked to care received at the nursing facility, the seriousness of illness or care at the hospital.

"If you want to look for waste in the system then it has to do with the transition between inpatient and post-acute care," Graves said.

The report indicates it's important to look at the quality of treatment that money buys rather than the quantity of treatment, Graves said. Better outcomes, or in this case survival at the one-year mark, is more linked to specialized care rather than quantity or duration of treatment.

A key finding is that patients who are sent to a "high intensity hospital," such as an academic or specialized hospital, had better chances of survival at the one-year mark.

Patients who are sent to hospitals with higher rates of discharging to skilled nursing facilities compared to other hospitals had worse outcomes. The severity of disease was also a factor.

"It's a tough message for nursing homes but this gets at really tough issues," said Dr. Clay Ackerly, chief clinical officer of naviHealth, a Brentwood-based company that works with health plans and health systems to monitor and arrange care for patients after they are discharged from hospital stays.

Hospitals and nursing homes are increasingly working together, but Ackerly said the report "eloquently describes" the challenge of deciding when to discharge to a nursing home and underscoring that nursing home quality is key.

"Several key messages are making sure their quality is as high as possible and making the investments possible to give the high quality care," Ackerly said.

There is value to sending patients who need additional care to nursing homes if the care is coordinated with the hospital and if the receiving facility is qualified to care for the patient, he said.

Tennessee is among the worst in the country, 43rd, for the number of skilled nursing facilities with four- or five-star ratings from the U.S. Centers for Medicare and Medicaid Services, according to a new study on senior health from United Health Foundation.

Reach Holly Fletcher at 615-259-8287 and on Twitter @hollyfletcher.