There is significant variation between hospitals regarding referrals for post-acute care. While some hospitals refer fewer than 3 percent of their patients to inpatient facilities, others refer up to 40 percent, according to the report. Similarly, researchers found some hospitals prescribe home healthcare for 3 percent of patients, while others may refer as many as 58 percent.
The researchers analyzed data for 112,620 patients treated at 217 hospitals in 39 states. They evaluated information from a national surgery registry and Medicare claims, as well as from American Hospital Association annual surveys from 2005 through 2008.
The study did not identify an association between how often hospitals used post-acute care and the number of postoperative deaths or complications. Rather, it uncovered an association between use of post-acute care and indirect indicators of hospital quality, including length of stay and readmission rates.
Hospitals that referred patients to inpatient facilities most often were more likely to readmit patients within 30 days (24.1 percent) compared with those who referred patients to inpatient facilities less frequently (21.2 percent).
Hospitals with the shortest average length of stay most frequently referred patients to inpatient post-acute care facilities (24 percent versus 19.5 percent), according to the report. The study also found teaching hospitals referred patients to home healthcare 21 percent of the time, compared with 18 percent of patients at non-teaching hospitals.
“These findings suggest that some hospitals may be using post-acute care as a substitute for inpatient care,” said Greg Sacks, MD, PhD, the study’s lead investigator, a resident in general surgery resident at UCLA and a Robert Wood Johnson/Veterans Affairs Clinical Scholar. “This might lead to patients being discharged from the hospital prematurely, which then results in higher readmission rates.”
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