Health Care Costs and Utilization Predictions by the Skilled Nursing Facility Readmission Risk Instrument |
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| Institution: | 1. Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA;2. Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA;3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA;4. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA;1. Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany;2. AGAPLESION Bethesda Clinic, Geriatric Research Ulm University, Geriatric Centre Ulm/Alb-Donau, Ulm, Germany;3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA;4. Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany;5. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;1. Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China;2. Department of Computer Science, The University of Hong Kong, Hong Kong, China;3. The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China;4. School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada |
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| Abstract: | ObjectivesHealth care providers at hospitals and skilled nursing facilities (SNFs) are increasingly expected to optimize care of post-acute patients to reduce hospital readmissions and contain costs. To achieve these goals, providers need to understand their patients’ risk of hospital readmission and how this risk is associated with health care costs. A previously developed risk prediction model identifies patients’ probability of 30-day hospital readmission at the time of discharge to an SNF. With a computerized algorithm, we translated this model as the Skilled Nursing Facility Readmission Risk (SNFRR) instrument. Our objective was to evaluate the relationship between 30-day health care costs and hospital readmissions according to the level of risk calculated by this model.DesignThis retrospective cohort study used SNFRR scores to evaluate patient data.Setting and ParticipantsThe patients were discharged from Mayo Clinic Rochester hospitals to 11 area SNFs.MethodsWe compared the outcomes of all-cause 30-day standardized direct medical costs and hospital readmissions between risk quartiles based on the distribution of SNFRR scores for patients discharged to SNFs for post-acute care from April 1 through November 30, 2017.ResultsMean 30-day all-cause standardized costs were positively associated with SNFRR score quartiles and ranged from $9199 in the fourth quartile (probability of readmission, 0.27-0.66) to $2679 in the first quartile (probability of readmission, 0.07-0.13) (P ≤ .05). Patients in the fourth SNFRR score quartile had 5.68 times the odds of 30-day hospital readmission compared with those in the first quartile.Conclusions and ImplicationsThe SNFRR instrument accurately predicted standardized direct health care costs for patients on discharge to an SNF and their risk for 30-day hospital readmission. Therefore, it could be used to help categorize patients for preemptive interventions. Further studies are needed to confirm its validity in other institutions and geographic areas. |
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| Keywords: | Health care costs post-acute readmission risk skilled nursing facility |
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