Impact of skilled nursing facility discharge on inpatient oncology quality outcomes.

Abstract

Background: Hospitalist co-management of inpatient oncology patients can improve length of stay (LOS), discharge time and readmission rates. Identifying additional clinical factors affecting LOS and readmissions will guide further oncology hospitalist practice improvement.

Methods: Hospitalizations on the Smilow Cancer Hospital medical oncology service with discharge to home under self-care (n = 622), home with services (n = 462) or skilled nursing facility (SNF; n = 152) from 07/01/2021-07/31/2022 were included. Outcomes included LOS, time of discharge and 30-day readmission rate. Multivariable mixed linear (LOS, time of discharge) or Poisson (30-day readmission rates) models were adjusted for demographics, cancer type, severity of illness index, housestaff team and fiscal quarter and included a random intercept for patient. Analyses were two-sided with a priori significance of < 0.05.

Results: Patients discharged to SNF had a longer LOS (8.25 days (7.13 days, 9.55 days)) compared to patients discharged to home under self-care (3.04 days (2.76 days, 3.36 days)) or with services (4.48 days (4.03 days, 4.97 days)) (p < .0001). 30-day readmission rates for patients discharged to SNF (43.99%) were 10 percentage points higher than those discharged home either under self-care (32.86%) or with services (33.48%) (p = .14). These differences persisted in patients regardless of severity of illness index. Of the 152 patients discharged to SNF, 31 (20.3%) were readmitted specifically back to the medical oncology service within 60 days with 16 (51.6%) cycling back to SNF which resulted in 11 second readmissions.

Conclusions and relevance: For oncology patients requiring discharge to SNF, mindful and upfront discharge planning may improve care quality and efficiency.