Receipt of Timely Primary Care Services Following Post-Acute Skilled Nursing Facility Care.
Adam Simning, Jessica Orth, Thomas V Caprio and 3 others
PMID 33121870WHAT IT FOUND
60.6% of older adults discharged to the community after skilled nursing care saw a primary care provider within 7 days.
Patients without a timely visit were more likely to be alive and not in a facility for 30 days, but this was not proof.
Key findings
0160.6% of the 25,357 older adults discharged to the community after post-acute skilled nursing facility care had a primary care provider visit within 7 days.
02Patients without a timely primary care visit were more likely than those with a timely visit to have perfect 30-day home time (88.3% vs. 80.6%), had fewer hospital and skilled nursing facility readmissions, and had mortality that was not different.
03In adjusted analyses, lower odds of a timely primary care visit were associated with non-White race, rural county, Medicare-only status, no home health services, and discharge from a for-profit skilled nursing facility.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study did not have information on in-home assistance or social determinants of health. Some skilled nursing facility factors that could affect linkage to outpatient care were not measured, such as whether facility providers also see patients in the outpatient setting. Primary care services may have been misclassified. The sample was from New York State and may not represent post-acute skilled nursing facility patients in other regions or patients with Medicare Advantage plans. The study was not designed to examine the benefit of timely primary care linkage, so it cannot show that primary care visits caused better or worse outcomes. Standard errors were not clustered at the skilled nursing facility or county level.
Declared interests
The article is listed as supported by NIH extramural and non-U.S. government research funding. One author serves as an editor for Springer and a consultant for BCG Inc. and Intermountain Healthcare; otherwise no disclosures were reported.
The easy way to misread this
Do not conclude that patients should skip a 7-day primary care visit because those without a timely visit were more likely to be alive and not in a facility for 30 days. This was an observational study, and the authors state it was not designed to examine the benefit of timely primary care linkage.