Urban-Rural Differences in Skilled Nursing Facility Rehospitalization Rates.

OBJECTIVES: To examine the association of rurality with skilled nursing facility (SNF) all-cause 30-day risk-adjusted rehospitalization rates.

DESIGN: Cross-sectional study combining Center for Medicare and Medicaid Services Nursing Home Compare (CMS-NHC) website for 30-day risk-adjusted rehospitalization rates for 2014-2015 with SNF organizational and community variables.

PARTICIPANTS: 12,261 non-hospital based skilled nursing facilities in the US.

MEASUREMENTS: We estimated a multiple linear regression model of percentage all-cause unplanned risk-adjusted rehospitalization rate within 30 days after a hospital discharge and admission to the SNF averaged over the third and fourth quarters of 2014 and the first and second quarters of 2015. The model uses robust standard errors.

RESULTS: After controlling for community- and SNF-level resources, the risk-adjusted rehospitalization rates for SNFs are lowest in rural areas and large rural towns followed by SNFs in suburban and then urban areas.

CONCLUSION: The rural culture that includes a strong sense of connectedness among residents may contribute to lower SNF rehospitalization rates. Our results suggest that rural SNFs may avoid future reimbursement penalties and decreased admissions from patients discharged from hospitals because of their lower rehospitalizaton rates. However, because this is the first study to address this topic, additional research is needed.