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Member Research & Reports

Member Research & Reports

Brown: JAMA Editorial Stresses Need to Realign Discharge Processes to encourage patient home care

Dr. Vincent Mor, professor of health services, policy & practice at the Brown University School of Public Health has published an editorial in the March edition of The Journal of the American Medical Association. The editorial stresses the need to realign the healthcare system so that elderly patients can be discharged to their homes more often, rather than to skilled nursing facilities.

Using evidence from prior studies, Dr. Mor points that out that available Medicare recipient data shows that more recipients use skilled nursing facilities (SNF) rather than home health care. He points out that while patients are given choices by hospital administrators prior to being discharged (home or SNF), as to where they want to go – there is little information about how informed the patient actually is when they are making that choice.

He points out that while social support is best predictor as to whether or not someone will choose home health care, the chaotic discharge process often makes it easier to place someone in a skilled nursing facility. Since hospitals are penalized for rehospitalizations that occur within 30 days, hospitals are more comfortable with sending patients to SNFs, that they often have worked with in the past, where they know qualified medical personnel are staffed.

Overall, Dr. Mor states that the relative ease in transferring a patient to a skilled nursing facility compared to coordinating the logistics involved for home care plays a big role as to why more patients are discharged to SNFs and that more research and investigation is needed in order to change this trend.

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