Good performance on SNF quality measures does not prevent deaths or readmissions, study finds

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Specially trained RNs could help reduce avoidable hospitalizations, results suggest.
Specially trained RNs could help reduce avoidable hospitalizations, results suggest.

A skilled nursing facility that scores well on quality measures is not necessarily reducing residents' risk of death or readmission within 30 days of arriving from a hospital, according to findings in the latest issue of the American Medical Association journal JAMA.

At SNFs that score well on facility inspections ratings, Medicare beneficiaries do have a “slightly lower” risk of hospital readmission or death within 30 days of arrival, the investigators determined. However, other quality measures were not associated in “clinically meaningful” ways with reduced risk, they found.

In addition to facility inspections ratings, the investigators considered staffing ratings and the percentage of residents with delirium, moderate to severe pain, and new or worsening pressure ulcers. They adjusted for factors such as facility characteristics of the SNF and the discharging hospital. Without this adjustment, better performance on quality measures was associated more strongly with reduced risk of death or readmission.

The study authors — led by the University of Pennsylvania's Mark D. Neuman, MD, M.Sc. — analyzed Medicare data and publicly available quality metrics for individual SNFs. Among more than 1.5 million beneficiaries discharged to a SNF between 2009 and 2010, the overall rate of readmission or death within 30 days was about 23%, they calculated.

Quality ratings are important for “transparency and accountability” but focusing on them is not likely to result in “large-scale reductions in readmissions,” the study authors wrote.

It might not be fair to suggest that predicting readmission or death risk is even a goal of current SNF quality measures, stated experts from the Kaiser Permanente Center for Effectiveness and Safety Research in an accompanying JAMA editorial.

“The information required for consumers to choose among nursing homes or hospitals may be different than the information required to improve clinical outcomes,” wrote Elizabeth A. McGlynn, Ph.D., and John L. Adams, Ph.D., in the editorial. “Measures that work for one purpose and not another are still valuable.”