Background: Previous studies have documented discriminatory refusals from post-acute care facilities related to opioid use disorder or opioid agonist therapy, however the impact of inability to secure skilled nursing facility (SNF) placement for patients with any substance use disorder (SUD) has not been fully explored. The objective of this study is to measure the odds [...]

Background: Hospitalists increasingly confront patient care and policy dilemmas due to financial incentives created by bundled payments, single payments that “bundle” acute and post-acute care for specific diagnoses. The most common and most successful bundled payment has been for total joint replacement, where cost savings have been achieved through discharging patients to home rather than [...]

Background: Discharge to post-acute care settings (PACs), such as skilled nursing facilities (SNFs), requires significant, complex discharge planning which often needs to be started early during hospitalization to be complete by time of discharge. This study sought to identify and model factors which predict a given patient’s likelihood of requiring PAC after discharge, using routinely [...]

Background: The age-friendly hospital implements an evidence-based “4M” framework (what matters most, medication reconciliation, mentation and mobility) to minimize harm among older adults. Clinical outcomes of patients who receive bundled 4M’s care delivery remains a knowledge gap. We determined if the incremental benefit of more M’s was associated with reduced discharges to post-acute care facilities. [...]

Background: Timely discharge of medically-ready patients from acute care hospitalization can reduce strain on hospital resources and limit patient exposure to iatrogenic harm [1-2]. The smooth transition of these patients to post-acute care has been critical during the COVID-19 pandemic to increase acute care bed availability and reduce the potential of hospital-based viral transmission [3]. [...]

Background: Alternative payment models have been proposed for lower extremity joint replacement surgeries to deliver well-coordinated and high quality care. It is speculated that while these payment models may lead to more cost effective care, institutions may “cherry pick” less costly and less complex patients to minimize financial risks. In this study, we aim to [...]

Background: Hospitalized older adults are increasingly referred to skilled nursing facilities (SNFs) for post-acute care following hospitalization. However, whether hospitalized older adults are enabled to make high-quality decisions about different post-acute care options is unclear. This is important because a high-quality decision aligned with patient values and expectations may lead to a better match of [...]

Background: Hospital admissions are the majority contributor to the cost in caring for diabetes, accounting for about 40% of the costs. As most hospital reimbursements are based upon diagnosis-related groups, hospitals have strong financial incentives for quicker discharges to control length of stay and costs. This can limit the time available to develop a comprehensive [...]

Background: Following a hospitalization, older adults, their caregivers, and clinicians caring for them face a complex decision regarding post-acute care (PAC). The purpose of PAC, delivered by a skilled nursing facility (SNF) or home health (HH), is to support the recovery of patients after hospital discharge. However, the transition to PAC is a vulnerable time [...]

Background: The strongest risk factor for readmission to the hospital and failure to successfully return to the community after hospital discharge is impaired physical function. Although published experience with wearable devices in post-acute care settings is scant, measurement of steps in other care settings has been shown to be feasible and directly linked with post-discharge [...]