(P69) Interventions to Reduce 30-day Rehospitalization Rates in SNFs: Systematic Review

Introduction/

Objective: Many people who are admitted to a hospital for acute reasons are transferred to a skilled nursing facility (SNF) for continuity of care. Meanwhile, 25% of these patients face readmission to the hospital within 30 days of discharge. This has led to financial loss, lower quality of life for patients, and safety concerns. The Protecting Access to Medicare Act of 2014 sought to address this problem by including penalties for SNFs with high rates of unplanned hospital readmissions, which was implemented into practice in 2019. Despite SNFs facing financial penalties for higher-than-expected hospital readmissions, some are still unable to address high 30-day rehospitalization rates in their facility. In the face of the new financial and public-reporting incentives, stronger evidence to inform SNF efforts to reduce readmission is needed.

Design/Methodology: We conducted a systematic review to identify interventions and current strategies utilized by facilities to reduce rehospitalization from SNFs. The PRISMA reporting guideline was utilized for this systematic review to optimize transparency and minimize the risk of bias. We used the following databases to select primary peer-reviewed articles published between 1/01/2010 to 12/31/2022: Academic Search Premier, Cochrane Library, Embase, ERIC, LitCovid, MedEdPortal, MedRxiv, Medline, Scopus, and Web of Science. The search was reviewed by two independent reviewers, and conflicts were resolved by a third reviewer, to ensure that the list of articles selected includes all the relevant studies. Databases were searched using a combination of controlled vocabulary and free text terms for rehospitalization and SNFs.

Results: A total of 2579 articles were identified for title and abstract search. Studies were included if they comprised original quantitative research and described an intervention of any design. Studies were excluded if they were not available in English, were the incorrect study design (e.g., commentaries, letters to the editor, or conference abstract), duplicates, secondary analyses, or no original data reported. A total of 25 studies met the eligibility criteria and comprised the study sample. With the exception of two studies (UK and Australia), all were conducted in the USA. The sample size of the studies ranged from 49 to 3951 patients. Five studies focused on heart failure specific populations whereas the remainder comprised general SNF patients. Interventions primarily consisted of collaborative care models, telemedicine, medication reconciliation, educational in-services, decision support tools, transitions of care, advanced care planning, and adaptations of Project RED and INTERACT quality improvement tools. Overall 21 out of 25 studies (84%) observed a statistically significant reduction in re-hospitalization rates following the intervention.

Conclusion/

Discussion: Interventions to reduce the 30-day hospital readmission rates hold promise for wide-scale implementation. In particular, interventions focused on specific patient populations (e.g., heart failure patients), collaborative interventions with hospital care teams, and quality care models appear to be effective. Interventions involving medication reconciliation approaches only did not reduce rehospitalization rates. Further evaluation of the barriers and facilitators of the intervention strategies will help to identify mitigating factors related to intervention success and failure.