Journal article
Accountable Care Organization Attribution and Post-Acute Skilled Nursing Facility Outcomes for People Living With Dementia
Journal of the American Medical Directors Association, Vol.25(1), pp.53-57.e2
01/2024
DOI: 10.1016/j.jamda.2023.10.031
PMCID: PMC11613903
PMID: 38081322
Abstract
Under the Accountable Care Organization (ACO) model, reductions in healthcare spending have been achieved by targeting post-acute care, particularly in skilled nursing facilities (SNFs). People with Alzheimer disease and related dementias (ADRD) are frequently discharged to SNF for post-acute care and may be at particular risk for unintended consequences of SNF cost reduction efforts. We examined SNF length of stay (LOS) and outcomes among ACO-attributed and non-ACO-attributed ADRD patients.
Observational serial cross-sectional study.
Twenty percent national random sample of fee-for-service Medicare beneficiaries (2013-2017) to identify beneficiaries with a diagnosis of ADRD and with a hospitalization followed by SNF admission (n = 263,676).
Our primary covariate of interest was ACO (n = 66,842) and non-ACO (n = 196,834) attribution. Hospital readmission and death were measured for 3 time periods (<30, 31-90, and 91-180 days) following hospital discharge. We used 2-stage least squares regression to predict LOS as a function of ACO attribution, and patient and facility characteristics.
ACO-attributed ADRD patients have shorter SNF LOS than their non-ACO counterparts (31.7 vs 32.8 days; P < .001). Hospital readmission rates for ACO vs non-ACO differed at ≤30 days (13.9% vs 14.6%; P < .001) but were similar at 31-90 days and 91-180 days. No significant difference was observed in mortality post-hospital discharge for ACO vs non-ACO at ≤30 days; however, slightly higher mortality was observed at 31-90 days (8.4% vs 8.8%; P = .002) and 91-180 days (7.6% vs 7.9%; P = .011). No significant association was found between LOS and readmission, with small effects on mortality favoring ACOs in fully adjusted models.
Being an ACO-attributed patient is associated with shorter SNF LOS but is not associated with changes in readmission or mortality after controlling for other factors. Policies that shorten LOS may not have adverse effects on outcomes for people living with dementia.
Details
- Title: Subtitle
- Accountable Care Organization Attribution and Post-Acute Skilled Nursing Facility Outcomes for People Living With Dementia
- Creators
- Julie P W BynumAna MontoyaEmily J Lawton - University of IowaJason B Gibbons - Johns Hopkins UniversityMousumi BanerjeeJennifer MeddingsEdward C Norton
- Resource Type
- Journal article
- Publication Details
- Journal of the American Medical Directors Association, Vol.25(1), pp.53-57.e2
- DOI
- 10.1016/j.jamda.2023.10.031
- PMID
- 38081322
- PMCID
- PMC11613903
- NLM abbreviation
- J Am Med Dir Assoc
- eISSN
- 1538-9375
- Grant note
- DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality, award: R01 HS024698
- Language
- English
- Electronic publication date
- 12/08/2023
- Date published
- 01/2024
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984528123602771
Metrics
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