{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T10:48:21Z","timestamp":1780397301451,"version":"3.54.1"},"reference-count":70,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS023345"],"award-info":[{"award-number":["R01HS023345"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["INQUIRY"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:p>Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role in lowering readmissions. Although having a hospital-based skilled nursing facility (HBSNF) in a hospital could help in improving care for patients needing short-term skilled nursing or rehabilitation services, little is known about HBSNFs\u2019 association with hospitals\u2019 readmission rates. This study seeks to examine the association between HBSNFs and hospitals\u2019 readmission rates. Data sources included 2007-2012 American Hospital Association Annual Survey, Area Health Resources Files, the Centers for Medicare and Medicaid Services (CMS) Medicare cost reports, and CMS Hospital Compare. The dependent variables were 30-day risk-adjusted readmission rates for acute myocardial infarction (AMI), congestive heart failure, and pneumonia. The independent variable was the presence of HBSNF in a hospital (1 = yes, 0 = no). Control variables included organizational and market factors that could affect hospitals\u2019 readmission rates. Data were analyzed using generalized estimating equation (GEE) models with state and year fixed effects and standard errors corrected for clustering of hospitals over time. Propensity score weights were used to control for potential selection bias of hospitals having a skilled nursing facility (SNF). GEE models showed that the presence of HBSNFs was associated with lower readmission rates for AMI and pneumonia. Moreover, higher SNFs to hospitals ratio in the county were associated with lower readmission rates. These findings can inform policy makers and hospital administrators in evaluating HBSNFs as a potential strategy to lower hospitals\u2019 readmission rates.<\/jats:p>","DOI":"10.1177\/0046958018817994","type":"journal-article","created":{"date-parts":[[2019,3,21]],"date-time":"2019-03-21T00:01:37Z","timestamp":1553126497000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Reduction in Hospitals\u2019 Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities"],"prefix":"10.1177","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3562-4561","authenticated-orcid":false,"given":"Shivani","family":"Gupta","sequence":"first","affiliation":[{"name":"The University of Southern Mississippi, Hattiesburg, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferhat D.","family":"Zengul","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganisher K.","family":"Davlyatov","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5005-0909","authenticated-orcid":false,"given":"Robert","family":"Weech-Maldonado","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,3,20]]},"reference":[{"issue":"1","key":"e_1_3_2_2_2","first-page":"31","article-title":"Improving care transitions means more than reducing hospital readmissions","volume":"73","author":"Cykert S.","year":"2012","unstructured":"Cykert S. Improving care transitions means more than reducing hospital readmissions. N C Med J. 2012;73(1):31-33.","journal-title":"N C Med J"},{"key":"e_1_3_2_3_2","unstructured":"Medicare Hospital Compare. https:\/\/www.medicare.gov\/hospitalcompare\/Data\/30-day-measures.html. Published 2012. Accessed December 6 2018."},{"key":"e_1_3_2_4_2","unstructured":"MedPAC. Report to the Congress: Medicare Payment Policy. http:\/\/www.medpac.gov\/docs\/default-source\/reports\/Mar07_EntireReport.pdf. Published March 2007. Accessed December 6 2018."},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.101860"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001786-200501000-00006"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-8-201110180-00008"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0803563"},{"key":"e_1_3_2_9_2","unstructured":"Dummit LA. Medicare\u2019s bundling pilot: Including post-acute care services. Issue Brief No. 841 National Health Policy Forum The George Washington University Washington DC; March 28 2011."},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2010.02.015"},{"key":"e_1_3_2_11_2","first-page":"1","volume-title":"Congressional Research Service Report for Congress","author":"Stone J","unstructured":"Stone J, Hoffman GJ. Medicare hospital readmissions: Issues, policy options and PPACA. Congressional Research Service Report for Congress, September 21, 2010; 1-37."},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.0394."},{"issue":"2","key":"e_1_3_2_13_2","first-page":"1","article-title":"Reducing hospital readmissions","volume":"23","author":"Minott J.","year":"2008","unstructured":"Minott J. Reducing hospital readmissions. Academy Health. Published November 2008;23(2):1-10. Accessed on December 6, 2018.","journal-title":"Academy Health"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gns082"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/03601277.2013.767615."},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2012.06077.x"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.8.1074"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.17.1822"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2008.01.001"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12328."},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2016.08.004"},{"issue":"8","key":"e_1_3_2_22_2","first-page":"60","article-title":"Hospital based SNFs: An alternative to empty beds","volume":"41","author":"Deangelis P","year":"1987","unstructured":"Deangelis PJr. Hospital based SNFs: An alternative to empty beds. Healthc Financ Manage. 1987;41(8):60-62, 64, 66 passim.","journal-title":"Healthc Financ Manage"},{"key":"e_1_3_2_23_2","volume-title":"Restructuring hospital capacity: The hospital-based skilled nursing facility.","author":"Whitman J","year":"1986","unstructured":"Whitman J, DeAngelis P, Knapp M. Restructuring hospital capacity: The hospital-based skilled nursing facility. Chicago,Ill: Hospital Research and Educational Trust; 1986."},{"key":"e_1_3_2_24_2","volume-title":"Discharge destination and cost of care in an acute care unit versus a hospital-based skilled nursing unit","author":"Smith CA","year":"1996","unstructured":"Smith CA. Discharge destination and cost of care in an acute care unit versus a hospital-based skilled nursing unit. Doctoral dissertation: University of New Mexico; 1996."},{"key":"e_1_3_2_25_2","volume-title":"The State Long-Term Health Care Sector: Characteristics, Utilization and Government Funding: 2011 Update","author":"American Health Care Association","year":"2011","unstructured":"American Health Care Association. The State Long-Term Health Care Sector: Characteristics, Utilization and Government Funding: 2011 Update. Reimbursement and Research Department American Health Care Association, Washington, DC. Published 2011. Accessed 24 February, 2014."},{"issue":"10","key":"e_1_3_2_26_2","first-page":"289","article-title":"The subacute care patient: Hospital responses to the challenge","volume":"23","author":"McDowell TN","year":"1990","unstructured":"McDowell TNJr. The subacute care patient: Hospital responses to the challenge. J Health Hosp Law. 1990;23(10):289-294.","journal-title":"J Health Hosp Law"},{"issue":"101","key":"e_1_3_2_27_2","first-page":"1","article-title":"Skilled nursing facilities and post-acute care","volume":"1","author":"Murad Y.","year":"2011","unstructured":"Murad Y. Skilled nursing facilities and post-acute care. J Gerontol Geriatr Res. 2011;1(101):1-4.","journal-title":"J Gerontol Geriatr Res"},{"key":"e_1_3_2_28_2","unstructured":"MedPAC. Report to the Congress: Medicare Payment Policy. http:\/\/www.medpac.gov\/docs\/default-source\/reports\/mar14_entirereport.pdf. Published March 2014. Accessed November 28 2018."},{"key":"e_1_3_2_29_2","volume-title":"A study of hospitals\u2019 changes in length of stay and number of discharges as a result of changes in financial incentives related to medicare exempt status for hospital-based skilled nursing care","author":"Joseph JA.","year":"1998","unstructured":"Joseph JA. A study of hospitals\u2019 changes in length of stay and number of discharges as a result of changes in financial incentives related to medicare exempt status for hospital-based skilled nursing care [dissertation]. Pittsburgh, PA: University of Pittsburgh; 1998."},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2005.00434.x."},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/1077558706290944."},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12001"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2016.08.004"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1561"},{"issue":"160","key":"e_1_3_2_35_2","first-page":"51660","article-title":"Hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals\u2019 FTE resident caps for graduate medical education payment: Final rules","volume":"76","author":"Medicare Program","year":"2011","unstructured":"Medicare Program. Hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals\u2019 FTE resident caps for graduate medical education payment: Final rules. Federal Register. 2011;76(160):51660-51676.","journal-title":"Federal Register"},{"key":"e_1_3_2_36_2","volume-title":"Organization and environment: Managing differentiation and integration","author":"Lawrence PR","year":"1967","unstructured":"Lawrence PR, Lorsch JW. Organization and environment: Managing differentiation and integration. Boston, MA: Irwin; 1967."},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1177\/003803857200600101"},{"key":"e_1_3_2_38_2","volume-title":"American Anti-Management Theories of Organization: A critique of paradigm proliferation","author":"Donaldson L","year":"1995","unstructured":"Donaldson L. American Anti-Management Theories of Organization: A critique of paradigm proliferation. Vol. 25. Cambridge: Cambridge University Press; 1995."},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004010-199001540-00003"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1086\/467352"},{"issue":"3","key":"e_1_3_2_41_2","first-page":"303","article-title":"Hospitals\u2019 vertical integration into skilled nursing: A rational approach to controlling transaction costs","volume":"35","author":"Lehrman S","year":"1998","unstructured":"Lehrman S, Shore KK. Hospitals\u2019 vertical integration into skilled nursing: A rational approach to controlling transaction costs. Inquiry. 1998;35(3):303-314.","journal-title":"Inquiry"},{"issue":"6","key":"e_1_3_2_42_2","first-page":"43","article-title":"Remaking health care in America","volume":"70","author":"Shortell SM","year":"1996","unstructured":"Shortell SM, Gillies RR, Anderson DA, Erickson KM, Mitchell JB. Remaking health care in America. Hosp Health Netw. 1996;70(6):43-44.","journal-title":"Hosp Health Netw"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1097\/01974520-199607000-00002"},{"key":"e_1_3_2_44_2","volume-title":"A description of the vertical integration of acute and post-acute care and its impact on patients with stroke in California, 1997 to 1998","author":"Zingmond DS","year":"2002","unstructured":"Zingmond DS. A description of the vertical integration of acute and post-acute care and its impact on patients with stroke in California, 1997 to 1998 [Dissertation]. Los Angeles, CA: University of California, Los Angeles. UCLA; 2002."},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004010-200210000-00002"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1177\/014920639101700108"},{"key":"e_1_3_2_47_2","volume-title":"Organization theory and design","author":"Daft R.","year":"1983","unstructured":"Daft R. Organization theory and design. New York, NY: West; 1983."},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12112"},{"issue":"5","key":"e_1_3_2_49_2","first-page":"486","article-title":"Case mix and surrogate indicators of quality of care over time in freestanding and hospital-based nursing homes in Colorado","volume":"98","author":"Shaughnessy P","year":"1983","unstructured":"Shaughnessy P, Schlenker R, Brown K, Yslas I. Case mix and surrogate indicators of quality of care over time in freestanding and hospital-based nursing homes in Colorado. Public Health Rep. 1983;98(5):486-492.","journal-title":"Public Health Rep"},{"issue":"11","key":"e_1_3_2_50_2","first-page":"29","article-title":"Subacute\u2019s place in the capitated scene","volume":"21","author":"Bailis S","year":"1995","unstructured":"Bailis S, Shannon J. Subacute\u2019s place in the capitated scene. Provider. 1995;21(11):29-30.","journal-title":"Provider"},{"key":"e_1_3_2_51_2","first-page":"631","article-title":"Postacute care in the 1990s","volume":"81","author":"Tuch H","year":"1994","unstructured":"Tuch H, Hiep P, Robinson BE. Postacute care in the 1990s. J Fla Med Assoc. 1994;81:631-634.","journal-title":"J Fla Med Assoc"},{"key":"e_1_3_2_52_2","unstructured":"American Hospital Association. AHA Annual Survey Database Fiscal Year 2010. http:\/\/www.ahadata.com\/academics-researchers\/. Published 2018. Accessed December 6 2018."},{"key":"e_1_3_2_53_2","unstructured":"HRSA US Department of Health and Human Services: Health Resources and Services Administration. National County-Level Health Resource Information Database: Overview. https:\/\/data.hrsa.gov\/topics\/health-workforce\/ahrf. Published 2011. Accessed December 6 2018."},{"key":"e_1_3_2_54_2","unstructured":"Centers for Medicare & Medicaid Services. Research Data and Systems. https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Downloadable-Public-Use-Files\/Cost-Reports\/. Published 2014. Accessed November 28. 2018."},{"key":"e_1_3_2_55_2","unstructured":"Medicare.gov Hospital Compare. 30-day unplanned readmission and death measures. https:\/\/www.medicare.gov\/hospitalcompare\/Data\/30-day-measures.html. Published 2012. Accessed December 6 2018."},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(98)00098-1"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.00042"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.950964"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.123"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.78.6.680"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1067\/mno.2002.126696"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0047-2727(02)00216-5"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004010-200107000-00009"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281675"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.0613"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182763284"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.5430\/jha.v3n4p109"},{"key":"e_1_3_2_68_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2013.12.004"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.72"},{"key":"e_1_3_2_70_2","unstructured":"Centers for Medicare & Medicaid Services. Readmissions Reduction Program. http:\/\/www.cms.gov\/Medicare\/Medicare-Fee-for-Service-Payment\/AcuteInpatientPPS\/Readmissions-Reduction-Program.html. Published 2014. Accessed November 28 2018."},{"key":"e_1_3_2_71_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2012.08.009"}],"container-title":["INQUIRY: The Journal of Health Care Organization, Provision, and Financing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0046958018817994","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0046958018817994","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0046958018817994","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:05:30Z","timestamp":1777460730000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0046958018817994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":70,"alternative-id":["10.1177\/0046958018817994"],"URL":"https:\/\/doi.org\/10.1177\/0046958018817994","relation":{},"ISSN":["0046-9580","1945-7243"],"issn-type":[{"value":"0046-9580","type":"print"},{"value":"1945-7243","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1]]},"article-number":"0046958018817994"}}