Outcomes of Patients With Cancer Discharged to a Skilled Nursing Facility After Acute Care Hospitalization

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  • 1 Division of Hospital Medicine, University of Colorado Denver;
  • 2 University of Colorado Cancer Center;
  • 3 Division of Health Care Policy & Research, and
  • 4 Division of General Internal Medicine, University of Colorado Denver, Aurora, Colorado.
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Background: After discharge from an acute care hospitalization, patients with cancer may choose to pursue rehabilitative care in a skilled nursing facility (SNF). The objective of this study was to examine receipt of anticancer therapy, death, readmission, and hospice use among patients with cancer who discharge to an SNF compared with those who are functionally able to discharge to home or home with home healthcare in the 6 months after an acute care hospitalization. Methods: A population-based cohort study was conducted using the SEER-Medicare database of patients with stage II–IV colorectal, pancreatic, bladder, or lung cancer who had an acute care hospitalization between 2010 and 2013. A total of 58,770 cases were identified and patient groups of interest were compared descriptively using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Logistic regression was used to compare patient groups, adjusting for covariates. Results: Of patients discharged to an SNF, 21%, 17%, and 2% went on to receive chemotherapy, radiotherapy, and targeted chemotherapy, respectively, compared with 54%, 28%, and 6%, respectively, among patients discharged home. Fifty-six percent of patients discharged to an SNF died within 6 months of their hospitalization compared with 36% discharged home. Thirty-day readmission rates were 29% and 28% for patients discharged to an SNF and home, respectively, and 12% of patients in hospice received <3 days of hospice care before death regardless of their discharge location. Conclusions: Patients with cancer who discharge to an SNF are significantly less likely to receive subsequent oncologic treatment of any kind and have higher mortality compared with patients who discharge to home after an acute care hospitalization. Further research is needed to understand and address patient goals of care before discharge to an SNF.

Submitted July 23, 2019; accepted for publication January 10, 2020.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This project is supported by the Palliative Care Research Cooperative Group funded by the National Institute of Nursing Research (U24NR014637) and the Population Health Shared Resources, University of Colorado Cancer Center (P30CA046934).

Correspondence: Sarguni Singh, MD, University of Colorado Denver, Division of Hospital Medicine, Leprino Building, 4th Floor, 12401 East 17th Avenue, Mailstop F-782, Aurora, CO 80045. Email: sarguni.singh@ucdenver.edu

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