This study determined whether higher patient volume of skilled nursing facility (SNF) care was associated with a lower hospital transfer rate. Using the nursing home Minimum Data Set and the Online Survey, Certification, and Reporting file, we assembled a national cohort of Medicare SNF postacute care admissions between January and September of 2008. Multivariable analyses based on Cox proportional hazards models found that patients admitted to high-volume SNFs (annual number of admissions in the top tertile group) showed an approximately 15% reduced risk for 30-day rehospitalization and an approximately 25% reduced risk for 90-day rehospitalization, compared with patients admitted to low-volume SNFs (annual number of admissions in the bottom tertile group, or <45). Similar patterns of volume–outcome associations were found for hospital-based and freestanding facilities separately. The inverse volume–outcome association in postacute SNF care may reflect a “practice makes perfect” effect, a “selective referral” effect, or both.
Abt Associates Inc. (2004). Quality measures for national public reporting: User’s manual (Vol. 1.2, p. 48). Cambridge, MA: U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, & National Nursing Home Quality Measures.
BirkmeyerJ. D.FinlaysonE. V.BirkmeyerC. M. (2001). Volume standards for high-risk surgical procedures: Potential benefits of the leapfrog initiative. Surgery, 130, 415-422.
4.
BoockvarK.FishmanE.KyriacouC. K.MoniasA.GaviS.CortesT. (2004). Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. Archives of Internal Medicine, 164, 545-550.
5.
BuchananJ. L.MurkofskyR. L.O’MalleyA. J.KaronS. L.ZimmermanD.CaudryD. J.MarcantonioE. R. (2006). Nursing home capabilities and decisions to hospitalize: A survey of medical directors and directors of nursing. Journal of the American Geriatrics Society, 54, 458-465.
6.
CovinskyK. E.PalmerR. M.FortinskyR. H.CounsellS. R.StewartA. L.KresevicD.LandefeldC. S. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society, 51, 451-458.
7.
Donelan-McCallN.EilertsenT. B.FishR.KramerA. (2006). Small patient population and low frequency event effects on the stability of SNF quality measures. Washington, DC: Medicare Payment Advisory Commision.
8.
General Accounting Office. (2002). Public reporting of quality indicators has merit, but national implementation is premature (Publication No. GAO-03-187). Retrieved from http://www.gao.gov/new.items/d03187.pdf
9.
GlanceL. G.LiY.OslerT. M.DickA.MukamelD. B. (2006). Impact of patient volume on the mortality rate of adult intensive care unit patients. Critical Care Medicine, 34, 1925-1934.
10.
GorbienM. J.BishopJ.BeersM. H.NormanD.OsterweilD.RubensteinL. Z. (1992). Iatrogenic illness in hospitalized elderly people. Journal of the American Geriatrics Society, 40, 1031-1042.
11.
GrabowskiD. C.FengZ.IntratorO.MorV. (2010). Medicaid bed-hold policy and Medicare skilled nursing facility rehospitalizations. Health Services Research, 45, 1963-1980.
12.
GrabowskiD. C.StewartK. A.BroderickS. M.CootsL. A. (2008). Predictors of nursing home hospitalization: A review of the literature. Medical Care Research and Review, 65, 3-39.
13.
GruneirA.LapaneK. L.MillerS. C.MorV. (2007). Long-term care market competition and nursing home dementia special care units. Medical Care, 45, 739-745.
14.
HalmE. A.LeeC.ChassinM. R. (2002). Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Annals of Internal Medicine, 137, 511-520.
15.
HuttE.EcordM.EilertsenT. B.FredericksonE.KramerA. M. (2002). Precipitants of emergency room visits and acute hospitalization in short-stay medicare nursing home residents. Journal of the American Geriatrics Society, 50, 223-229.
16.
IntratorO.GrabowskiD. C.ZinnJ.SchleinitzM.FengZ.MillerS.MorV. (2007). Hospitalization of nursing home residents: The effects of states’ Medicaid payment and bed-hold policies. Health Services Research, 42, 1651-1671.
17.
IntratorO.ZinnJ.MorV. (2004). Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. Journal of the American Geriatrics Society, 52, 1730-1736.
18.
JencksS. F.WilliamsM. V.ColemanE. A. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine, 360, 1418-1428.
19.
JonesA. L.DwyerL. L.BercovitzA. R.StrahanG. W. (2009). The national nursing home survey: 2004 overview. Vital Health Statistics,13(167), 1-155.
20.
KonetzkaR. T.SpectorW.LimcangcoM. R. (2008). Reducing hospitalizations from long-term care settings. Medical Care Research and Review, 65, 40-66.
21.
LawtonM. P.CastenR.ParmeleeP. A.Van HaitsmaK.CornJ.KlebanM. H. (1998). Psychometric characteristics of the minimum data set II: Validity. Journal of the American Geriatrics Society, 46, 736-744.
22.
LiY.CaiX.MukamelD. B.GlanceL. G. (2010). The volume-outcome relationship in nursing home care: An examination of functional decline among long-term care residents. Medical Care, 48, 52-57.
23.
LiY.HarringtonC.SpectorW. D.MukamelD. B. (2010). State regulatory enforcement and nursing home termination from the Medicare and Medicaid programs. Health Services Research, 45(6, Pt. 1), 1796-1814.
24.
LiuK.BlackK. J. (2003). Hospital-based and freestanding skilled nursing facilities: Any cause for differential Medicare payments?Inquiry, 40, 94-104.
25.
LiuK.GarrettB.WissokerD.MaxwellS.KramerA.EilertsenT.BuchananJ. (2007). Options for improving Medicare payment for skilled nursing facilities. Retrieved from http://www.urban.org/url.cfm?ID=411526
26.
LuftH. S.BunkerJ. P.EnthovenA. C. (1979). Should operations be regionalized? The empirical relation between surgical volume and mortality. New England Journal of Medicine, 301, 1364-1369.
27.
LuftH. S.GarnickD. W.MarkD. H.PeltzmanD. J.PhibbsC. S.LichtenbergE.McPheeS. J. (1990). Does quality influence choice of hospital?Journal of the American Medical Association, 263, 2899-2906.
28.
LuftH. S.HuntS. S.MaerkiS. C. (1987). The volume-outcome relationship: Practice-makes-perfect or selective-referral patterns?Health Services Research, 22, 157-182.
29.
Medicare Payment Advisory Commission. (2009a). A data book: Health care spending and the Medicare program. Washington, DC: Author.
30.
Medicare Payment Advisory Commission. (2009b). Report to the Congress: Medicare payment policy. Washington, DC: Author.
31.
MilcentC. (2005). Hospital ownership, reimbursement systems and mortality rates. Health Economics, 14, 1151-1168.
32.
MorV.AngelelliJ.JonesR.RoyJ.MooreT.MorrisJ. (2003). Inter-rater reliability of nursing home quality indicators in the U.S. BMC Health Services Research, 3(1), 20.
33.
MorV.IntratorO.FengZ.GrabowskiD. C. (2010). The revolving door of rehospitalization from skilled nursing facilities. Health Affairs (Millwood), 29, 57-64.
34.
MukamelD. B.GlanceL. G.LiY.WeimerD. L.SpectorW. D.ZinnJ. S.MosquedaL. (2008). Does risk adjustment of the CMS quality measures for nursing homes matter?Medical Care, 46, 532-541.
35.
MukamelD. B.WeimerD. L.MushlinA. I. (2007). Interpreting market share changes as evidence for effectiveness of quality report cards. Medical Care, 45, 1227-1232.
36.
MukamelD. B.WeimerD. L.ZwanzigerJ.GorthyS. F.MushlinA. I. (2004). Quality report cards, selection of cardiac surgeons, and racial disparities: A study of the publication of the New York State Cardiac Surgery reports. Inquiry, 41, 435-446.
37.
OuslanderJ. G.LambG.PerloeM.GivensJ. H.KlugeL.RutlandT.SalibaD. (2010). Potentially avoidable hospitalizations of nursing home residents: Frequency, causes, and costs. Journal of the American Geriatrics Society, 58, 627-635. (See editorial comments by Drs. WymanJean F.HazzardWilliam R., pp 760-761.)
38.
OuslanderJ. G.WeinbergA. D.PhillipsV. (2000). Inappropriate hospitalization of nursing facility residents: A symptom of a sick system of care for frail older people. Journal of the American Geriatrics Society, 48, 230-231.
39.
SalibaD.KingtonR.BuchananJ.BellR.WangM.LeeM.RubensteinL. (2000). Appropriateness of the decision to transfer nursing facility residents to the hospital. Journal of the American Geriatrics Society, 48, 154-163.
40.
StearnsS. C.DaltonK.HolmesG. M.SeagraveS. M. (2006). Using propensity stratification to compare patient outcomes in hospital-based versus freestanding skilled-nursing facilities. Medical Care Research and Review, 63, 599-622.
41.
TeresiJ. A.HolmesD.BloomH. G.MonacoC.RosenS. (1991). Factors differentiating hospital transfers from long-term care facilities with high and low transfer rates. The Gerontologist, 31, 795-806.
42.
ThiemannD. R.CoreshJ.OetgenW. J.PoweN. R. (1999). The association between hospital volume and survival after acute myocardial infarction in elderly patients. New England Journal of Medicine, 340, 1640-1648.
43.
WernerR.StuartE.PolskyD. (2010). Public reporting drove quality gains at nursing homes. Health Affairs (Millwood), 29, 1706-1713.
44.
ZhanC.MillerM. R.WongH.MeyerG. S. (2004). The effects of HMO penetration on preventable hospitalizations. Health Services Research, 39, 345-361.
