Community Discharge Among Post-Acute Nursing Home Residents: An Association With Patient Safety Culture?

Abstract

Objectives: We examined whether better patient safety culture (PSC) in skilled nursing facilities was associated with higher likelihood of successful community discharge for post-acute care residents.

Design: Cross-sectional study.

Setting and participants: Medicare beneficiaries who were newly admitted for post-acute care (N = 53,929) to skilled nursing facilities participating in PSC survey (N = 818).

Methods: Facility-level PSC scores were obtained from a national, random survey conducted in 2017. Survey data was linked to Minimum Dataset 3.0, Medicare Provider Analysis and Review, Master Beneficiary Summary File, Nursing Home Compare File, Payroll-Based Journal, and Areal Health Resources File. Successful discharge to community was the outcome of interest. Facility-level PSC scores were the key covariate. We controlled for individual-level, facility-level, and area-level characteristics. Separate logistic regression models for each of the 12 PSC domains and for the overall score were fit.

Results: Post-acute care residents who were successfully discharged to community were more likely to be female (63.7%), white (87.1%), Medicare-only (88.1%), cognitively intact (87.8%), and admitted following a surgery (40.9%) The multivariable analyses showed that teamwork (odds ratio 1.09, P = .02) and supervisor expectations and actions promoting resident safety (odds ratio 1.11, P = .01) were significantly associated with the increased likelihood of successful community discharge.

Conclusions and implications: This is the first study to analyze the relationship between patient safety culture and successful discharge among post-acute care residents. Our results suggest that nursing home leaders may want to focus their quality and safety improvement efforts on specific PSC domains (eg, teamwork) as means for improving community discharge for post-acute care residents.

Keywords: Post-acute care; nursing home; patient safety culture; successful discharge.