Vanderbilt University Medical Center in Nashville, Tenn., and Massachusetts Institute of Technology in Cambridge, Mass., have linked higher spending on post-acute care in skilled nursing facilities to lower patient survival rates in a recent study.
The nationwide study, "Uncovering Waste in U.S. Healthcare," analyzes inefficiencies in the healthcare system.
For the study, researchers tracked claims data from more than 1.5 million Medicare patients who needed immediate hospital care for emergencies like hip fracture, femur fracture and intracerebral hemorrhage. All patient outcome comparisons are within single zip codes and every U.S. residential zip code is represented.
The researchers found patients assigned to hospitals with high 90-day spending overall (compared to patient acuity) had no better survival than patients assigned to hospitals with low 90-day spending.
According to the study authors, it's unclear whether poor initial hospital care led to the need for care at a SNF, or if poor quality SNF care led to mortality for patients in this study.
Either way, John Graves, PhD, assistant professor of Health Policy and Medicine at Vanderbilt and study co-author, suggested the findings support making post-discharge SNF utilization a hospital quality measure.
"We can't really attribute our finding to one or the other. If it's the SNFs that are poor quality, that could explain why we're finding that that type of spending is inefficient, in the sense that we're spending more and getting worse outcomes," said Dr. Graves. "Or it could reflect poor quality on the inpatient side: the patients just aren't ready to go home because they got poor quality while they were in the hospital."
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