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Referrals To Post-Acute Care Related To Higher Readmission Rates

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referrals to post

There may be a relationship between metrics, like the length of stay and admission rates, and the use of post-acute care.

To make sure that patients are taken of properly after surgery, they are usually referred by hospitals to facilities such as skilled nursing homes or inpatient rehabilitation centers or to receive home care. This type is called post-acute care, and is now seen to account for spending for medical care.

Spending for post-acute care actually varies across the United States, which kind of suggests that some areas use these types of services too frequently, and some areas use them too sparingly. A recent report by the Institute of Medicine found that the variation in medical care spending actually is based on the differences in the cost of post-acute care. Little is known though about why there are variations.

A new study done by researchers from the University of California, Los Angeles (UCLA) published in the journal Medical Care has discovered that the percentage in which hospitals refer patients to inpatient facilities actually ranges from 3 to 40 percent (of patients). In the same light, in terms of referrals to home health care, the range is from 3 to 58 percent of patients. This big range of values prompted the researchers to check whether this big variation might be attributed to the overall quality of care provided by the hospitals.


There was no correlation between how often hospitals used post-acute care and the number of recorded postoperative deaths or complications. However, the researchers discovered that there was a relationship between metrics like the length of stay and admission rates, and the use of post-acute care. Hospitals that tended to refer patients to inpatient facilities had shorter lengths of stay, as well as higher readmission rates.

Dr. Greg Sacks, lead investigator of the study, and a resident in general at UCLA says that the findings might suggest that a number of hospitals might be using post-acute care as a substitute for inpatient care. This might lead to patients being discharged from the hospital prematurely, which then results in higher readmission rates, he adds.

Hospital Readmission

Data from 112,620 patients that were treated at 217 hospitals in a total of 39 states was analyzed. The researchers used data from the national surgery registry and Medicare claims, as well as from annual surveys of the American Hospital Association from 2005 to 2008.

Additionally, hospitals that referred patients to inpatient facilities were more likely to readmit the same patients within 30 days (at 24.1 percent) as compared to the hospitals who referred patients to inpatient facilities least often (at 21.2 percent). Hospitals with the shortest average length of stay were also the ones that used inpatient facilities more frequently, at 24 percent versus 19.5 percent.

The research suggests that health care payment policies that make financial incentives for hospitals to release patients earlier than needed could be the reason why hospitals are making such decisions regarding post-acute care.

Our findings suggest that there is an urgent need to study the appropriate use of post-acute care to develop guidelines to assist postoperative discharge planning. The new evidence and guidelines based on that evidence would help ensure that patients receive the post-discharge care they need, while avoiding additional care they do not need, as stated in the report.