OBJECTIVE To determine if implementation of Project Re-Engineered Discharge (RED), designed for hospitals but adapted for skilled nursing facilities (SNFs), reduces hospital readmissions after SNF discharge to the community in residents admitted to the SNF following an index hospitalization. DESIGN A pragmatic trial. SETTING AND PARTICIPANTS SNFs in southeastern Massachusetts, and residents discharged to the community. METHODS We compared SNFs that deployed an adapted RED intervention to a matched control group from the same region. The primary outcome was hospital readmission within 30 days after SNF discharge, among residents who had been admitted to the SNF following an index hospitalization and then discharged home. January 2016 through March 2017 was the baseline period; April 2017 through June 2018 was the follow-up period (after implementation of the intervention). We used a difference-in-differences analysis to compare the intervention SNFs to the control group, using generalized estimating equation regression and controlling for facility characteristics. RESULTS After implementation of RED, readmission rates were lower across all 4 measures in the intervention group; control facilities' readmission rates remained stable or increased. The relative decrease was 0.9% for the primary outcome of hospital readmission within 30 days after SNF discharge and 1.7% for readmission within 30 days of the index hospitalization discharge date (P ≤ .001 for both comparisons). CONCLUSIONS AND IMPLICATIONS We found that a systematic discharge process developed for the hospital can be adapted to the SNF environment and can reduce readmissions back to the hospital, perhaps through improved self-management skills and better engagement with community services. This work is particularly timely because of Medicare's new Value-Based Purchasing Program, in which nursing homes can receive incentive payments if their hospital readmission rates are low relative to their peers. To verify its scalability and broad potential, RED should be validated across a broader diversity of SNFs nationally.

中文翻译：

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通过熟练的护理设施出院干预减少医院再入院：一项务实的试验

目的 确定为医院设计但适用于专业护理设施 (SNF) 的重新设计出院 (RED) 项目的实施是否可以减少 SNF 出院到社区的居民在指数住院后的再入院率。设计一个务实的试验。设置和参与者 马萨诸塞州东南部的 SNF 和居民出院到社区。方法 我们将部署适应 RED 干预的 SNF 与来自同一地区的匹配对照组进行比较。主要结果是 SNF 出院后 30 天内再次入院，这些居民在首次住院后入院 SNF，然后出院回家。2016 年 1 月至 2017 年 3 月为基准期；2017 年 4 月至 2018 年 6 月为随访期（干预实施后）。我们使用差异中的差异分析来比较干预 SNF 与对照组，使用广义估计方程回归并控制设施特征。结果 实施 RED 后，干预组所有 4 项措施的再入院率均较低；控制设施的再入院率保持稳定或上升。SNF 出院后 30 天内再入院的主要结局相对下降 0.9%，指数住院出院后 30 天内再入院的相对下降为 1.7%（两项比较 P ≤ .001）。结论和启示 我们发现，为医院开发的系统出院流程可以适应 SNF 环境，并可以通过提高自我管理技能和更好地参与社区服务来减少再入院。由于医疗保险新的基于价值的采购计划，这项工作特别及时，如果养老院的再入院率相对于同龄人较低，则可以在该计划中获得奖励金。为了验证其可扩展性和广泛的潜力，RED 应在全国范围内更广泛的 SNF 中进行验证。如果养老院的再入院率低于同龄人，养老院可以获得奖励金。为了验证其可扩展性和广泛的潜力，RED 应在全国范围内更广泛的 SNF 中进行验证。如果养老院的再入院率低于同龄人，养老院可以获得奖励金。为了验证其可扩展性和广泛的潜力，RED 应在全国范围内更广泛的 SNF 中进行验证。