Increasing hospital readmission and mortality rates for patients discharged to post-acute care facilities raises questions about the quality of processes for transitional care--or a "mismatch between patient needs and PAC resources," a new study concludes.
The study, published in the Journal of Post-Acute and Long-Term Care Medicine, found that nearly 23 percent of patients discharged to post-acute care facilities following acute hospitalization were readmitted at least once within 30 days. Nearly half of the readmissions occurred within two weeks of discharge, according to an announcement from the University of Colorado School of Medicine, which conducted the research.
The study noted that under current payment systems, "hospitals are incentivized to discharge these patients as early as possible, and in contrast to discharges home, hospitals are not currently penalized for readmissions from PAC facilities. PAC facilities may be substituting for prolonged hospital care in some cases."
The strongest risk factors for readmission were impaired function, needing intravenous medications in post-acute care, and for-profit PAC ownership. Readmitted patients also were more likely to have an invasive device such as a feeding tube or urinary catheter, and to need advanced care such as dialysis, according to the announcement.
Patients readmitted to acute care were twice as likely to die within 30 days of hospital discharge and nearly four times as likely to die within 100 days of discharge, the university noted. Researchers concluded better coordination could reduce readmissions and mortality.
Post-acute care providers are key to new care delivery models for value-based care, the American Hospital Association noted recently. With higher proportions of Medicare patients now being discharged to PACs, PAC providers are sharing risk with acute-care hospitals.
The AHA also advises that hospitals need to minimize care transitions by determining which care settings best suit each patient's needs, FierceHealthcare previously reported. Discharge planning tools that allow clinicians to prioritize health during the hospital stay can reduce the time spent in post-acute care, an AHA case study found.