OBJECTIVES Successful discharge of nursing home (NH) residents to community has been reported in Nursing Home Compare (NHCompare) as a quality indicator, yet it is likely influenced by the availability of home- and community-based services (HCBS). Medicaid NH reimbursement rates and bed-hold policies have been shown to be related to quality of care, which may also affect successful discharge. This study explores the relationship of state Medicaid long-term care policies and successful discharge. DESIGN Longitudinal study of Medicaid policies and NHCompare successful discharge rates over 3 time periods, 2014-2015, 2015-2016, and 2016-2017, using generalized estimating equation models. SETTING AND PARTICIPANTS 11,694 unique NHs. MEASURES Risk-adjusted rates of successful discharge were downloaded from NHCompare. Truven's "Medicaid Expenditures for Long-term Services and Supports" reports provided states' expenditures on HCBS and NHs. Details of bed-hold policies in 2014 were obtained from the Medicaid and CHIP Payment and Access Commission. Data on NH and market characteristics were extracted from LTCFocUs.org and Area Health Resources File. RESULTS The national average-adjusted successful discharge rates were 49.7%, 56.8%, and 56.2% in 2014-2015, 2015-2016, and 2016-2017, respectively. In 2015, states spent between 30.6% (Mississippi) and 82.2% (Oregon) on HCBS, with an overall average of 53.1%. States reimbursed NHs, on average, $185.7 per resident day. Five percent increase in Medicaid spending for HCBS was statistically significantly associated with 0.47% higher successful discharge rates. Compared to NHs in states with reimbursement rates in the first quartile (≤$152), NHs in the second ($153-$178), third ($179-$212), and fourth (≥$213) quartiles were associated with 2.33%, 1.86%, and 1.15% higher successful discharge rates (all P < .01). Results were stronger in states without bed-hold policies. CONCLUSIONS/IMPLICATIONS This study provides promising evidence to state governments that shifting expenditures from institutions to communities as well as more generous reimbursements to NHs may improve quality of care in NHs.

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医疗补助长期照护政策及疗养院成功出院率

目标 疗养院比较 (NHCompare) 已将疗养院 (NH) 居民成功出院作为质量指标报告给社区，但这可能会受到家庭和社区服务 (HCBS) 可用性的影响。医疗补助 NH 报销率和卧床政策已被证明与护理质量有关，这也可能影响成功出院。本研究探讨了州医疗补助长期护理政策与成功出院的关系。设计 使用广义估计方程模型对 2014-2015、2015-2016 和 2016-2017 3 个时间段内的医疗补助政策和 NHCompare 成功出院率进行纵向研究。设置和参与者 11,694 个独特的 NH。措施 从 NHCompare 下载风险调整后的成功出院率。特鲁文的“ 与报销率在第一个四分位数 (≤ $152) 的州的 NHs 相比，第二个 ($153-$178)、第三个 ($179-$212) 和第四个 (≥$213) 四分位数的 NHs 与 2.33%、1.86%、成功出院率提高 1.15%（所有 P < .01）。在没有卧床政策的州，结果更强。结论/意义 这项研究为州政府提供了有希望的证据，表明将支出从机构转移到社区以及向 NH 提供更慷慨的报销可能会提高 NH 的护理质量。