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Patients discharged to skilled nursing facilities (SNFs) often have had complicated hospitalizations that involved specialist care, but we know little about how access to subspecialist follow-up care affects outcomes. Researchers performed a retrospective cohort study using U.S. Medicare fee-for-service claims and the Nursing Home Minimum Data Set for 1 million beneficiaries (age, ≥65) who were seen by medical subspecialists during their hospital stays and were discharged to 15,000 SNFs between 2012 and 2014.
In this sample, 85% of patients were non-Hispanic white, and 15% identified as Black, indigenous, or people of color. In adjusted analysis, patients who identified as Black, indigenous, or people of color were modestly — but statistically significantly — less likely to receive outpatient specialty care follow-up during their SNF stays than were non-Hispanic white patients (odds ratio, 0.96; 95% confidence interval, 0.94–0.99). This lack of follow-up was associated with a significant difference in 30-day emergency department visits (27.4% vs. 25.9%).
Krickus C et al. Disparities in access to specialty care and emergency department use after hospital discharge to a skilled nursing facility. J Hosp Med 2023 Feb; 18:111. (https://doi.org/10.1002/jhm.13006)
Comment
Disparities based on race are well established in healthcare facilities, and SNFs are no exception. SNFs are not reimbursed to transport patients and often assume other costs associated with outpatient appointments (e.g., lab/diagnostic testing); these barriers might disproportionately affect patients who identify as Black, indigenous, or people of color. If more recent data can confirm these results, policy and practice interventions (e.g., greater use of telemedicine in SNFs) should be used to improve SNF outcomes for all patients.