BACKGROUND: COVID-19 represents a grave risk to residents in skilled nursing facilities (SNFs).

OBJECTIVE: To determine whether establishment of an appropriate-use committee was associated with a reduction in SNF utilization.

DESIGNS, SETTING, AND PARTICIPANTS: Retrospective cohort study at NorthShore University HealthSystem, a multihospital integrated health system in northern Illinois. Participants were patients hospitalized from March 19, 2019, to July 16, 2020.

INTERVENTION: Creation of a multidisciplinary committee to assess appropriateness of discharge to SNF following hospitalization.

MAIN OUTCOME AND MEASURES: Primary outcome was total discharges to SNFs. Secondary outcomes were new discharges to SNFs, readmissions, length of stay (LOS), and COVID-19 incidence following discharge.

RESULTS: Matched populations pre and post intervention were each 4424 patients. Post intervention, there was a relative reduction in total SNF discharges of 49.7% (odds ratio [OR], 0.42; 95% CI, 0.38-0.47) and in new SNF discharges of 66.9% (OR, 0.29; 95% CI, 0.25-0.34). Differences in readmissions and LOS were not statistically significant. For patients discharged to a SNF, 2.99% (95% CI, 1.59%-4.39%) developed COVID-19 within 30 days, compared with 0.26% (95% CI, 0.29%-0.93%) of patients discharged to other settings (P < .001).

CONCLUSION: Implementing a review committee to assess for appropriateness of SNF use after a hospitalization during the COVID-19 pandemic is highly effective. There was no negative impact on safety or efficiency of hospital care, and reduced SNF use likely prevented several cases of COVID-19. This model could serve as a template for other hospitals to reduce the risks of COVID-19 in SNFs and as part of a value-based care strategy.

背景： COVID-19 对专业护理机构 (SNF) 的居民构成严重风险。

目的：确定适当使用委员会的建立是否与 SNF 使用的减少有关。

设计、设置和参与者：北岸大学卫生系统的回顾性队列研究，北岸大学卫生系统是伊利诺伊州北部的一个多医院综合卫生系统。参与者是2019年3月19日至2020年7月16日住院的患者。

干预：创建一个多学科委员会来评估住院后 SNF 出院的适当性。

主要结果和测量：主要结果是 SNF 的总排放量。次要结果是新的 SNF 出院、再入院、住院时间 (LOS) 和出院后的 COVID-19 发病率。

结果：干预前后的匹配人群各为 4424 名患者。干预后，总 SNF 排放相对减少 49.7%（优势比 [OR]，0.42；95% CI，0.38-0.47），新 SNF 排放相对减少 66.9%（OR，0.29；95% CI，0.25 -0.34）。再入院率和 LOS 的差异无统计学意义。对于出院至 SNF 的患者，2.99%（95% CI，1.59%-4.39%）在 30 天内发展为 COVID-19，而出院至其他环境的患者为 0.26%（95% CI，0.29%-0.93%）（P < .001)。

结论：成立一个审查委员会来评估 COVID-19 大流行期间住院后 SNF 使用的适当性是非常有效的。对医院护理的安全性或效率没有负面影响，减少 SNF 的使用可能防止了几例 COVID-19。该模型可以作为其他医院的模板，以降低 SNF 中 COVID-19 的风险，并作为基于价值的护理策略的一部分。