Posthospital Nursing Home Utilization and Quality Indicators Among Medicare Beneficiaries in Puerto Rico: Comparison With the United States.
Maricruz Rivera-Hernandez, Amilcar Matos-Moreno, Nasim B Ferdows and 1 others
PMID 33306998WHAT IT FOUND
Puerto Rico Medicare patients newly admitted to skilled nursing facilities were more often discharged back to the community but had higher 30-day rehospitalization than US patients.
They were also lower acuity and admitted to lower-rated facilities.
Key findings
01Puerto Rico patients were more likely to be successfully discharged to the community than all US patients or US Hispanic patients, but had higher 30-day rehospitalization rates.
02Puerto Ricans had less functional impairment at admission, were about 50 percentage points more likely to be discharged from the hospital with a musculoskeletal or connective tissue diagnosis category, and were over 15 percentage points more likely to be classified as requiring low nursing care.
03Puerto Ricans were admitted to facilities with fewer beds, over four times the admissions per bed, and lower overall star ratings, 2.5 in Puerto Rico versus 3.4 in the US.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 2% of hospital discharges in Puerto Rico went to skilled nursing facilities, compared with about 20% in the US, so the study may not represent older adults who are discharged home, die before admission, or receive other care. The researchers could not adjust for family or caregiver support, patient preferences, or other social risk factors that can affect discharge and readmission. The data did not identify Hispanic subgroups in the US, so comparisons with US Hispanic patients may be imprecise. The study compared records across groups, so it cannot show why rehospitalization or discharge differences happened. The findings may not generalize to other post-acute care quality measures.
Declared interests
No conflict of interest was reported. The supplied publication types indicate NIH extramural research support.
The easy way to misread this
Do not read the higher community discharge rate as evidence that Puerto Rico skilled nursing facilities provide better care. The same patients had higher 30-day rehospitalization and were admitted to lower-rated facilities, and the study cannot show why.