Completion of an Outpatient Visit After Skilled Nursing Facility Discharge and Readmission Risk

Objectives: Examine the association between completion of an outpatient visit with a physician or advanced practice provider (PCP) within 7 days of discharge from a short skilled nursing facility (SNF) stay and 30-day readmission and determine if functional status at discharge moderates visit effectiveness.

Design: Retrospective cohort study.

Setting: Large integrated health care system.

Participants: Adults 65 years and older, discharged home from a short SNF stay (n = 4073).

Intervention: None.

Measurements: Exposure is completion of an outpatient visit with a PCP within 7 days of discharge from an SNF. Primary outcome is readmission within 30 days of SNF discharge. Covariates included gender, risk score for readmission or early death, medical or surgical hospitalization, SNF facility, SNF length of stay, SNF stay in the previous 12 months, discharge to home or home health, and discharge functional independence measures (FIM).

Results: A total of 476 (11.6%) patients were readmitted within 30 days of SNF discharge. Patients who completed an outpatient visit with a PCP within 7 days of SNF discharge had a 23% higher risk of being readmitted compared to patients who did not complete any visit (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.01-1.50). Patients who had FIM scores ≥80 and completed a visit had an increased readmission risk (HR 1.37, 95% CI 1.04-1.79); the increased risk was not seen for those with worse functional impairment, FIM <80 (HR 1.11, 95% CI 0.85-1.46).

Conclusion: The finding of increased risk of readmission post SNF discharge with completion of an outpatient visit likely reflects inadequate adjustment for selection bias in this observational study, which strongly argues for the need to design prospective studies to test transitional care services post SNF discharge.