Abstract TMP69: Association Between Skilled Nursing Facility Quality Indicators and Hospital Readmissions After Stroke

Abstract

Background: Reducing readmission within 30 days of hospital discharge is a national priority. Care in high-quality skilled nursing facilities (SNFs) could lower readmission rates, but its impact on stroke readmissions at the community level has not been assessed. We evaluated the relationships of SNF quality metrics with readmissions within 30 days of stroke discharge Methods: We used 2010-2012 data from the CMS Nursing Home Compare 5-star quality rating system of 4 metrics (health inspections, quality performance, and registered nurse and total staffing hours/resident/day; each rated from 1 to 4 stars). Hospital 30-day risk-standardized readmission rates after ischemic stroke were obtained from CMS Hospital Compare. Hospital and SNF zip codes were used to aggregate data to the healthcare community level (defined by NCHS Health Service Areas). We fit mixed models, weighted by community-specific total hospital discharges, to evaluate the relationship between community-specific SNF quality ratings and readmissions. Results: There were 1,813 healthcare communities with a total of 1,170,817 residents across 11,989 SNFs and 2,603 unique hospitals. Within a community, there was a median of 4 SNFs per hospital. Among 482,124 discharges for stroke during the study period, the median community-specific hospital 30-day readmission rate was 13.3% (IQR 1.62). An increase of 1 star for each of the 4 metrics in the SNF quality composite was associated with a 0.42% decrease in the stroke readmission rate (figure). Among the individual metrics, only the registered nurse and total nurse staffing measures were associated with lower stroke readmissions. Conclusions: Hospitals located in healthcare communities with higher-performing SNFs had lower 30-day readmission rates after stroke. Efforts to increase SNF nurse staffing levels may represent an opportunity to decrease 30-day readmissions after stroke.