Abstract

Objective: Fragmentation of care between acute and post-acute care settings is one of the key drivers of hospital readmissions. Prior research has shown that higher concentration of discharges from a hospital to a particular post-acute care provider reduces hospital readmissions, signifying the importance of collaboration between acute and post-acute care providers. However, we have very little understanding how hospitals collaborate with post-acute care providers. This paper has two aims: 1) to characterize the nature and degree of hospitals’ efforts to collaborate with nursing facilities using qualitative interviews and 2) to assess how post-acute care and hospital readmission rates evolved for hospitals with different levels of collaborative effort.

Data Sources/Study Setting: Qualitative data were collected through 138 interviews with staff in 16 hospitals and 25 nursing facilities in eight markets across the US in 2015. Quantitative data include Medicare claims data for the 290,603 patients discharged from those 16 hospitals between 2008 and 2015.

Study Design/Data Collection: Semi-structured interviews with hospital and nursing facility staff were coded to create a measure of hospital efforts to collaborate with nursing facilities dichotomized into high versus low collaboration hospitals. We examined trends in the proportion of a hospital’s patients discharged to different post-acute care settings, quality of the nursing facilities where patients were admitted to and re-hospitalization rates between low and high collaboration hospitals. Interview data were also qualitatively analyzed to identify themes related to collaborative efforts.

Principal Findings: Hospital collaboration efforts were defined as: establishing nursing facility partners, transition management initiatives, and hospital staff visits at nursing facilities. High collaboration hospitals were more likely to send patients to nursing facilities (as opposed to home, home with home health, or other post-acute care settings), sent a higher share of patients to high quality nursing facilities, and reduced rehospitalizations from nursing facilities more and faster than low collaboration hospitals.

Conclusions: Hospitals which invested in collaborative relationships with nursing facilities benefitted from this by experiencing a steeper decline in hospital readmissions from nursing facilities than was observed for hospitals which had not made such investments. The nature of collaborative investments were in the form of specific programmatic initiatives undertaken jointly with nursing facility partners such as shared staff, shared access to electronic health information, and joint activities such as sharing assessments and care planning.