Fragmented Readmissions From a Nursing Facility in Medicare Beneficiaries

Abstract

Over one-third of Medicare beneficiaries discharged to nursing facilities require readmission. When those readmissions are to a different hospital than the original admission, or "fragmented readmissions," they carry increased risks of mortality and subsequent readmissions. This study examines whether Medicare beneficiaries readmitted from a nursing facility are more likely to have a fragmented readmission than beneficiaries readmitted from home among a 2018 cohort of Medicare beneficiaries, and examined whether this association was affected by a diagnosis of Alzheimer's Disease (AD). In fully adjusted models, readmissions from a nursing facility were 19% more likely to be fragmented (AOR 1.19, 95% CI 1.16, 1.22); this association was not affected by a diagnosis of AD. These results suggest that readmission from nursing facilities may contribute to care fragmentation for older adults, underscoring it as a potentially modifiable pre-hospital risk factor for fragmented readmissions.

Keywords: care coordination; care fragmentation; hospitalizations; nursing homes; readmission.

Figure 1.

Discharges, readmissions, and fragmented readmissions by discharge destination, Medicare data, 2018. “Other” includes leaving against medical advice, law enforcement, and psychiatric facilities.

Figure 2.

Sample development, Medicare fee for service data, 2018.