Andrew Kramer

Theresa Eilertsen

Glenn Goodrich

Sung-joon Min

University of Colorado at Denver

and Health Sciences Center

13611 East Colfax Avenue

Suite 100

Aurora, CO 80045-5701

MedPAC

601 New Jersey Avenue, NW

Suite 9000

Washington, DC 20001

(202) 220-3700

Fax: (202) 220-3759

www.medpac.gov

•

•

The views expressed in this report

are those of the authors.

No endorsement by MedPAC

is intended or should be inferred.

Understanding Temporal

Changes in and Factors

Associated with SNF Rates

A study conducted by staff from the University of Colorado

at Denver and Health Sciences Center for the

Medicare Payment Advisory Commission

June 2007 • No. 07–5

of Community Discharge

and Rehospitalization
Understanding Temporal 

Changes in and Factors 

Associated with SNF Rates 

of Community Discharge 

and Rehospitalization

Purchase Order E4016381 

Final Report 

Submitted to: 

Sarah Thomas, MS 

Deputy Director 

The Medicare Payment Advisory 

Commission

Prepared by: 

Andrew Kramer, MD 

Theresa Eilertsen, BS 

Glenn Goodrich, MS 

Sung-joon Min, PhD 

Division of Health Care Policy and Research 

University of Colorado at Denver and 

 Health Sciences Center (UCDHSC) 

13611 East Colfax Avenue, Suite 100 

Aurora, CO 80045-5701 

June 12, 2007
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 1 

1 Introduction 

In 2004, Medicare beneficiaries experienced approximately 2.5 million admissions to post-acute 

skilled care in nearly 15,000 Medicare-certified skilled nursing facilities (SNFs), requiring Medicare 

expenditures of $16 billion(1-3). Prior research conducted by the UCDHSC found that risk-adjusted 

facility rehospitalization rates for Medicare SNF residents in the first 100 days after SNF admission 

increased from 11.8% to 17.0% between calendar year 2000 and 2004(4). These rates were based on 

hospitalizations for five conditions - heart failure, respiratory infection, urinary tract infection, 

sepsis, and electrolyte imbalance - which have been considered among the leading causes of 

potentially avoidable hospitalizations(5-7). Although not all hospitalizations for these conditions are 

preventable, the previously reported rising risk-adjusted rate points to a significant trend occurring 

in post-acute care. 

This trend raises questions about the resident, facility, and community factors that are associated 

with rehospitalization rates in SNFs and whether these explain the temporal changes in rates. To 

what extent are these increasing rehospitalization rates related to changes in the facilities that were 

in business in the year 2000 in comparison to those in business in the year 2004? Is prior acute 

hospital length of stay associated with SNF rehospitalization, suggesting that declining hospital 

length of stay may contribute to rising rehospitalization rates? How much geographic variation 

exists in rehospitalization rates for these causes? Are nurse staffing levels associated with 

rehospitalization rates, as found in previous studies(8;9)? How are facility characteristics (e.g., 

hospital-based vs. freestanding, ownership) associated with rehospitalization rates? To what extent 

are community characteristics (e.g., managed care penetration, hospital beds per capita) related to 

rehospitalization rates? And ultimately, does the association between rehospitalization and time 

persist after controlling for all these factors? These research questions are the basis for the present 

research on rehospitalization. 

In prior work, we also found a decrease in risk-adjusted facility community discharge rates 

occurring within 30 days of admission from 27.6% to 23.9% between calendar year 2000 and 2004(4). 

Risk-adjusted 100-day community discharge decreased only marginally between 2000 and 2004 

suggesting a temporal trend of SNF patients returning to the community after longer SNF stays, but 

no change in the rate at which Medicare SNF patients ultimately returned home. Community 

discharge has clear implications for resident quality of life and cost of care, and is frequently used to 

measure rehabilitation success(10-18). The previously reported trend of fewer SNF discharges within 

30 days is potentially important in post-acute care warranting further investigation. 

Similar questions arise about the resident, facility, and community factors that are associated with 

community discharge and whether these factors explain the temporal changes in rates. To what 

extent are these decreasing 30-day discharge rates related to changes in the facilities that were in 

business in the year 2000 in comparison to those in business in the year 2004? Is prior acute hospital 

length of stay associated with SNF discharge, suggesting that declining hospital length of stay may 

contribute to decreasing discharge rates? How much geographic variation exists in community 

discharge rates? Are nurse staffing levels associated with 30-day discharge rates, as found in 

previous research(18)? How are facility characteristics (e.g. hospital-based vs. freestanding, 

ownership) associated with discharge rates? To what extent are community characteristics (e.g., 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 2 

managed care penetration, SNF beds per capita) related to discharge rates? And ultimately, does the 

association between 30-day community discharge and time persist after controlling for all these 

factors? These research questions are the basis for the present research on community discharge. 

The major objective of the current study is to understand both the factors associated with and the 

reasons for temporal changes in rates of community discharge and rehospitalization. A related 

objective is to examine the relationship between these two post-acute care performance measures 

and the publicly reported post-acute care quality measures (QMs)(19). We hypothesize that good 

quality based on these performance measures (i.e., low rehospitalization rate or high community 

discharge rate) will be associated with poor quality on the QMs (higher rates of delirium, pain, and 

pressure sore). The reason we expect this association is that the QMs are based largely on the 14-day 

MDS and only about 50% of SNF admissions remain in the facility long enough to have a 14-day 

MDS due to death, rehospitalization, or discharge(20;21). Facilities with the lowest rehospitalization 

rates are likely to have the worst (highest) QM scores - negative association - because more of their 

residents who experience decline are treated in the facility rather than being rehospitalized. 

Conversely, facilities with the highest community discharge rates discharge their healthiest patients 

and would be expected to have the worst (highest) QM scores - a positive association - because the 

sickest patients remain in the facility. 

2 Methods 

2.1 Data sources and sample 

The national DataPRO SNF Stay File, containing information on Medicare-covered SNF stays linked 

with the preceding qualifying hospitalization and any rehospitalization was used in all analyses. 

This file contains information from Medicare claims, the MDS, and the Online Survey Certification 

and Reporting (OSCAR) system; file documentation is available elsewhere(4;22). Additional data 

sources were used to supplement the DataPRO SNF Stay File for these analyses. OSCAR-reported 

staffing levels for 2000 through 2004, the Area Resource File market characteristics for 2000 through 

2002, and the Nursing Home Quality Initiative (NHQI) post-acute care quality measures (QMs) for 

2004 were also utilized. The OSCAR staffing data editing rules proposed by Abt Associates(23) were 

applied. These sources were combined at the facility level to create a single analytic file. Analysis of 

the stability and variability of the risk-adjusted rates indicated that a minimum sample of 25 or more 

stays (excluding deaths) over one year was required for estimates to be sufficiently stable(4). The 

analytic file was therefore restricted to only those SNFs with at least 25 stays (excluding deaths) with 

known outcome for any year between 2000 and 2004, averaging approximately 13,000 facilities per 

year. 

2.2 Measures 

 2.2.1 Facility characteristics

Resident characteristics were aggregated to the facility level to obtain facility case mix measures. 

The specific resident characteristics aggregated were the set of measures used previously for 

resident-level risk adjustment(4). These included presence of advance directives, the Barthel Index (a 

measure of functional independence, ranging from 0 most dependent to 90 most independent), the 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 3 

Cognitive Performance Scale (a measure of cognitive impairment, ranging from 0 least impaired to 6 

most impaired), selected MDS items, a weighted comorbidity index(4), selected comorbid conditions 

(primary or secondary diagnoses from the qualifying hospitalization), and length of stay of the 

qualifying hospitalization. OSCAR-reported staffing levels for RN, licensed nursing (defined as 

RNs, LPNs, DONs, and nurses with administrative duties), and CNA hours per resident-day were 

also examined. Measures of facility characteristics included hospital-based/freestanding, 

urban/rural, chain membership, ownership, state, and region. Market characteristics included 

hospital, SNF, NF, and HHA providers, admissions, and beds were captured, as well as Medicare 

managed care penetration rate. Facility scores for the three NHQI post-acute care QMs (delirium, 

pain, and pressure sores) were also obtained for 2004. 

2.2.2 Outcome measures 

Two outcome measures were investigated: observed rate of community discharge and observed 

rate of rehospitalization for any of the following five conditions: heart failure, electrolyte imbalance, 

respiratory infection, sepsis, and UTI. Both measures were assessed at 30 days and 100 days after 

SNF admission, and excluded residents who died in the SNF before 30 days or 100 days, 

respectively. 

Community discharge was defined as direct discharge from the SNF to home or assisted living. 

However, if a resident was discharged to community but then hospitalized within one day, the stay 

was reclassified as a rehospitalization and not a community discharge. 

The rehospitalization measure was limited to hospitalizations with an ICD-9-CM code for heart 

failure, electrolyte imbalance, respiratory infection, sepsis, or UTI - conditions for which 

rehospitalization may be potentially avoidable. Rehospitalization was defined as an admission to an 

acute care or critical access hospital. Any such hospitalization that occurred within one day of SNF 

discharge (regardless of discharge location) was also considered a rehospitalization.

 2.3 Univariate analyses

 2.3.1 Changes in outcomes over time

For each of the four outcomes (community discharge and rehospitalization within 30 and within 100 

days of SNF admission), simple descriptive statistics were computed by year at the facility level and 

at the resident level. For the subset of facilities that were present (i.e., had at least 25 stays) at all 

time points, repeated measures ANOVA was used to assess the differences in outcomes over time. 

Facility-level descriptive statistics were also computed for each outcome across year by facility type, 

state, region, and various market characteristics. Because of the previous findings that were 

confirmed by these results, it was decided to focus the remainder of the analysis on comparison of 

2000 and 2004 for community discharge within 30 days and for rehospitalization within 100 days. 

2.3.2 Which facilities experienced the largest changes 

For the subset of facilities present at both time points, within-facility differences between 2000 and 

2004 were calculated for both outcomes (community discharge within 30 days and rehospitalization 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 4 

within 100 days). Facilities that changed by more than 5% (increase or decrease) were compared to 

facilities that did not experience that large a change. Additionally, facilities that increased by 5% or 

more on community discharge and decreased by 5% or more on rehospitalization (“good” changes 

in both measures) were compared to facilities that decreased by 5% or more on community 

discharge and increased by 5% or more on rehospitalization (“bad” changes in both measures). 

 2.3.3 Differences between facilities present at different time points

Initial results suggested that facilities that were present for the entire analysis period (2000 through 

2004) had different outcome rates than facilities that were present only at 2000 or only at 2004. 

“Presence” required at least 25 observations (excluding deaths) for which the outcome was known 

(i.e., not missing). A facility might be “not present” if it had fewer than 25 stays or if it was not in 

business at all. For facilities present in 2000 but not in 2004, approximately 75% had no SNF 

admissions in 2004 (presumably out of business), and approximately 25% had fewer than 25 stays in 

2004. Observed outcome rates and facility characteristics were compared between facilities present 

in only 2000, present in only 2004, and present at both time points. Additional unadjusted 

comparisons were made with the group of facilities present at 2000 regardless of status at 2004, and 

with the group of facilities present at 2004 regardless of status at 2000. 

2.4 Multivariate analyses 

 2.4.1 Influence of staffing, facility characteristics, acute length of stay, geographic 

region, and community characteristics 

The data were restricted to only year 2000 and 2004, and pooled so that each facility-year was a 

separate record. A dichotomous variable (“time”) indicated whether the observation was from 2000 

or 2004. Two dummy variables were constructed indicating whether the facility was present in the 

data file in 2000 but not in 2004 (“2000 only”) or if the facility was present in the data file in 2004 but 

not in 2000 (“2004 only”). The reference group was facilities present at both time points. “Presence” 

required at least 25 observations (excluding deaths) for which the outcome was known (i.e., not 

missing). 

A series of OLS regressions were run to assess the impact of various facility measures on outcome 

rates. The first regression model included only the time variable as an independent variable. The 

second model included time as well as the two dummy variables. The third model included time, 

the two dummy variables, and a set of case mix variables. Each subsequent model then added one 

variable (in some cases a set of variables) to the third model. The procedure is shown schematically 

below: 

Step 1: observed rate = f(time) 

Step 2: observed rate = f(time, 2000 only indicator, 2004 only indicator) 

Step 3: observed rate = f(time, 2000 only indicator, 2004 only indicator, case mix variables) 

Step 4: observed rate = f(time, 2000 only indicator, 2004 only indicator, case mix, hospital LOS) 

Step 5: observed rate = f(time, 2000 only indicator, 2004 only indicator, case mix, region) 

 etc. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 5 

The model adjusted R2, the estimated coefficient of the variable being tested, the estimated 

coefficient of time, and the estimated coefficient of the two dummy variables were assessed for each 

model. If the coefficient of time decreased as additional variables were added to the model, then the 

effect of time could be at least partially explained by the additional variable. Similarly, changes in 

the coefficients of the dummy variables indicated the influence of the added variable. Variables 

tested in this manner included: hospital length of stay, region, staffing levels, hospital-based versus 

freestanding, urban versus rural, ownership, chain membership, managed care penetration, and 

hospital, SNF, NF, and HHA providers, admissions, and beds. A final model was fit using all tested 

variables together. 

Because RN hours are a large component of licensed nursing hours (correlation=0.81), an additional 

version of the final model was fit using only RN hours per resident-day and CNA hours per 

resident-day (i.e., leaving out licensed nursing hours per resident-day) as the staffing measures in 

the final model. This model was then compared with the model that included all three staffing level 

measures. 

To investigate differences between states, the state with the lowest risk-adjusted outcome rate was 

identified, and dummy variables for the remaining states were then entered into the final model. 

 

2.4.2 Relationship between rates of community discharge and rehospitalization 

The unadjusted facility-level rates of community discharge within 30 days and rehospitalization 

within 100 days were compared to examine whether facilities that performed well on one outcome 

also performed well on the other outcome. A simple correlation of the two rates was conducted at 

the facility-level. In addition, the distribution of facility-level rates for each outcome was divided 

into quartiles, and facility quartile membership for the two outcomes was compared. This analysis 

was restricted to 2004 data to assess the relationship using the most recent data. 

2.4.3 Relationship between the NHQI post-acute care QMs and rates of community 

discharge and rehospitalization 

The relationship of the three NHQI post-acute care QMs (percent of resident with delirium, percent 

of resident with moderate to severe pain, percent of resident with new or worsening pressure sores) 

to both outcomes was assessed, restricted to only facilities present in 2004. A stepwise regression 

was run on the 2004 data to select from the full set of aggregated resident characteristics the facility 

case mix variables that most influenced the outcome. Each of the NHQI QMs was then added to the 

model in separate regressions, and an additional model containing all three together was also fit. 

3 Results 

3.1 Change in facility outcomes from 2000 to 2004 

Unadjusted facility observed rates of the four outcome measures from 2000 through 2004 are 

presented in Table 1. The average rate, the difference in average rate between years, and the relative 

difference in average rate between years is shown for each outcome. In addition, the difference and 

relative difference in rates between 2000 and 2004 is shown. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 6 

Observed rates of community discharge within 30 days declined over time, while rates of 

community discharge within 100 days were more stable. Between 2000 and 2004, the average rate of 

community discharge within 30 days decreased by 1.8% (relative difference of 7.6%), while the 

average rate of community discharge within 100 days decreased by 0.3% (relative difference of 

0.8%). 

In contrast, observed rates of rehospitalization within 30 days and within 100 days increased over 

time. Between 2000 and 2004, the average rate of rehospitalization within 30 days increased by 2.1% 

(relative difference of 18.2%), and the average rate of rehospitalization within 100 days increased by 

2.8% (relative difference of 19.0%). The increase in rehospitalization rates was smallest in the most 

recent year. 

Observed outcome rates for community discharge within 30 days and rehospitalization within 100 

days for 2000 and 2004 by facility type are provided in Appendix Table A. Observed outcome rates 

for all four outcomes for 2000, 2004, and the difference between 2000 and 2004 are shown by state, 

region, and market characteristics in Appendix Table B. 

3.2 Changes in resident outcome from 2000 to 2004 

The observed rates of community discharge within 30 and 100 days in aggregate declined over time. 

In 2000, the aggregate community discharge rate within 30 days was 34.4%, which dropped to 29.2% 

in 2004, a decline of 5.2%. The aggregate rate of community discharge within 100 days dropped 

from 41.9% in 2000 to 39.0% in 2004, a decline of 2.9%. 

The rates of rehospitalization within 30 and 100 days in aggregate increased over time. In 2000, the 

aggregate rehospitalization rate within 30 days was 10.8%, which rose to 13.7% in 2004, an increase 

of 2.9%. The aggregate rate of rehospitalization within 100 days rose from 13.5% in 2000 to 17.4% in 

2004, an increase of 3.9%. 

The length of time until residents were rehospitalized was also examined. Of those residents 

rehospitalized within 100 days, half (49%) were rehospitalized within 12 days of SNF admission, 

32% within 7 days, and 15% within 3 days (Appendix Table C). These figures differed by no more 

than a percentage point when rehospitalizations in 2000 were assessed separately from 

rehospitalizations in 2004. 

3.3 Changes in case mix and facility and market characteristics from 2000 to 2004 

A comparison of all independent variables between 2000 and 2004 is shown in Table 2. The 

measures include case mix (e.g., average resident age, or percent of residents with DNR orders), 

staffing levels, facility characteristics, characteristics of the market in which the SNF is located (e.g., 

number of hospitals, number of home health agencies), and the 2004 NHQI post-acute care QMs. 

In aggregate, changes in resident case mix between 2000 and 2004 appear somewhat modest. The 

larger changes include increases in the percent of residents with DNR orders, receiving parenteral IV 

feeding, with genitourinary conditions, with hypertension, or with musculoskeletal disorders, and 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 7 

decreases in the percent of resident being tube-fed, or with fractures. Average length of stay of 

residents’ prior qualifying hospital stay declined by half a day, from 9.3 to 8.7 days. Average 

staffing levels dropped for RN and licensed nursing, and increased slightly for CNAs. There were 

small shifts in geographic distribution, with the South and Midwest experiencing slight increases 

and the Northeast and West experiencing slight decreases. The percentage of SNFs that were 

hospital-based dropped by more than a third, from 13.3% to 8.7%, chain membership declined from 

61.3% to 56.9%, and urban facilities decreased from 71.2% to 69.0%. The percentage of SNFs that 

were for-profit increased modestly. Market characteristics showed a significant decline in Medicare 

managed care penetration; other measures changed only modestly. The NHQI post-acute care QMs 

were either not reported in 2000 or were reported using a different algorithm, thus only 2004 values 

are shown in the table.

3.4 Facilities that experienced the largest changes in outcome rates

On average, SNFs in which observed community discharge rates decreased by 5% or more admitted 

more residents with significantly greater acuity in 2004 than in 2000 (Appendix Table D). SNFs in 

which observed community discharge rates increased by 5% or more admitted more residents with 

lower acuity. SNFs in which case mix did not change significantly over time had observed 

community discharge rates that were relatively unchanged over time. For example, the average 

Barthel Index decreased by 3 points (residents more dependent) in facilities with significant decline 

in community discharge, increased by .3 points in facilities with no change in community discharge, 

and increased by 3 points (residents more independent) in facilities with significant increase in 

community discharge. 

On average, SNFs in which observed rehospitalization rates increased by 5% or more admitted more 

residents with significantly greater acuity in 2004 than they had in 2000 (Appendix Table E). SNFs 

in which observed rehospitalization rates decreased by 5% or more admitted more residents with 

less acuity. SNFs in which case mix did not change significantly over time had observed 

rehospitalization rates that were relatively unchanged over time. For example, the average Barthel 

Index increased by 3 points (residents more independent) in facilities with significant decline in 

rehospitalization, increased by .5 points in facilities with no change in rehospitalization, and 

declined by 1 point (residents more dependent) in facilities with significant increase in 

rehospitalization. 

These associations between changes in case mix and both outcome measures would be expected 

affirming the importance of risk adjustment in examining temporal trends in outcome and the 

relationship between facility characteristics and outcome. 

3.5 Community discharge within 30 days 

 

Table 3 presents results from the sequence of regression models for community discharge within 30 

days. In step 1, the only variable in the model was the time variable, indicating either 2000 or 2004. 

The coefficient of time was -0.0179, which is consistent with the earlier finding that observed rates of 

community discharge declined 1.79% between 2000 and 2004. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 8 

In step 2, the two dummy variables 2000 only and 2004 only were entered, and the model adjusted 

R2 increased slightly. The coefficient of the 2000 only indicator was 0.1749, indicating that facilities 

present only in 2000 had community discharge rates in 2000 that were 17.5% higher than facilities 

present at both time points. The coefficient of the 2004 only indicator was -0.0739, indicating that 

facilities present in 2004 only had community discharge rates in 2004 that were 7.4% lower than 

facilities present at both time points. These findings are corroborated by the unadjusted differences 

in observed rates between these groups, shown in Appendix Table F. That the coefficient of time 

changed from -0.0179 to 0.009 indicates that the rate of community discharge actually increased by 

0.9% for those facilities present at both time points, also shown in Appendix Table F. 

In step 3, a set of facility case mix variables were entered, vastly increasing the model adjusted R2 as 

expected. Controlling for facility case mix significantly affected the coefficients of the other three 

variables. The coefficients for both 2000 only and 2004 only decreased substantially in magnitude, 

indicating that there were substantial differences in case mix in these two groups. Indeed, Appendix 

Table F shows significant differences across facilities present only in 2000, present only in 2004, and 

present in both years in average Barthel scores, and the percentages of residents with DNR orders, 

with catheters, with dementia, and with nervous system disorders. The coefficient of time became 

negative, indicating that once differences in facility case mix are accounted for, the community 

discharge rates for facilities present at both time points declined. 

In step 4, acute length of stay was entered, which had a negligible effect on the model adjusted R2. 

The small coefficient and minimal impact on the other estimates suggests that acute length of stay 

does not explain much of the variance in community discharge rates after controlling for case mix. 

In step 5, three dummy variables for Northeast, Midwest, and South region were entered, leaving 

out the Western region as the reference group (it had the highest community discharge rate). 

Adding region improved the model adjusted R2 and showed that after adjusting for case mix, SNFs 

in the rest of the country had community discharge rates 4.3% to 7.6% lower than SNFs in the West. 

Staffing levels were entered in steps 6 through 8, separately for RN hours/resident-day, licensed 

nursing hours/resident-day, and CNA hours/resident-day. Compared to the Step 3 model, RN and 

licensed nursing staffing levels had substantial effects on the model R2; CNA staffing levels had a 

smaller effect. On average, for every one-hour increase in RN hours/resident-day, the community 

discharge rate increased by almost 8%; for licensed nursing the average increase was just over 5%; 

for CNA the average increase was less than 2%. The magnitude of the coefficient of 2000 only 

indicator dropped substantially with the addition of RN or licensed nursing staffing levels, 

suggesting that a large part of the differences in rates for facilities present in 2000 only versus both 

time points was associated with large differences in staffing. This is shown dramatically in 

Appendix Table F, where facilities present in 2000 only had RN and licensed nursing staffing levels 

1.8 to 2.5 times higher than facilities present at both time points. The magnitude of the coefficient of 

time also dropped significantly, suggesting that much of the observed decrease in community 

discharge rates over time can be explained by differences in staffing levels. In step 9, all three 

staffing level variables were entered together, with consistent results. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 9 

In step 10, hospital-based versus freestanding was entered, with a significant increase in model 

adjusted R2 as compared to the Step 3 model. Furthermore, the coefficient was 0.191, indicating that 

even after adjusting for case mix, hospital-based SNFs had community discharge rates 19.1% higher 

than freestanding SNFs. The magnitude of the coefficient of time dropped substantially, indicating 

that differences in community discharge rates over time were substantially related to the proportion 

of SNFs that were hospital-based. The coefficient of the 2000 only indicator also dropped 

significantly, suggesting that the differences in rates for facilities present in 2000 only versus both 

time points were associated with differences in the proportion of facilities that were hospital-based. 

As shown in Appendix Table F, more than half the facilities present only in 2000 were hospitalbased, whereas only about 9% of facilities present at both time points and 5% of facilities present in 

2004 only were hospital-based. (Facilities not present in 2004 could be no longer in business at that 

time or could have fewer than 25 stays in 2004.) 

The magnitude of the hospital-based coefficient is influenced by significant differences between 

hospital-based and freestanding facilities on various important measures, as shown in Appendix 

Table G. Hospital-based facilities had significantly higher staffing levels than freestanding SNFs. 

Case mix measures were mixed, with some measures indicating more complex residents in hospitalbased SNFs, and other measures indicating more complex residents in freestanding SNFs. Of note, 

the average acute length of stay was the same for residents in either type of facility. 

Steps 11 through 13 tested the impact of ownership (for-profit versus not for-profit), urban versus 

rural setting, and chain membership. On average, for-profit SNFs had community discharge rates 

3.7% lower than not for-profit SNFs, and urban facilities had community discharge rates 2.7% higher 

than those in rural areas. Chain membership had a modest effect. Market characteristics were 

assessed in steps 14 through 21 and had minimal effects on community discharge rates. 

The final community discharge model is shown in Table 4. The model adjusted R2 was 0.6951. The 

coefficient of time was -0.004, much smaller in magnitude that it was initially, suggesting that much 

of the decline in observed community discharge rates can be explained by variables in the model. 

That it remained significant indicates that there was still an independent effect of time. The 

coefficient of the 2000 only indicator was not significant in the final model, indicating that other 

variables in the model (most likely hospital-based and staffing) accounted for this effect. The 

coefficient of the 2004 only indicator was -0.02557, smaller in magnitude than it was initially, and 

somewhat smaller than it was when only case mix was in the model. This suggests that some, but 

not all, of the differences between facilities present in 2004 only versus at both time points can be 

explained by differences in case mix and other facility measures. 

Based on the coefficients (for dichotomous variables) and standardized estimates (for continuous 

variables), the variables with the largest negative effect on the facility community discharge rate 

were: percentage of residents with DNR orders, mean Cognitive Performance Scale score (higher 

scores=more cognitive impairment), and mean bowel incontinence scale (higher scores=more 

frequent incontinence). Variables with the largest positive effect were: mean Barthel Index score 

(higher scores=more independent), licensed nursing hours/resident-day, and hospital-based. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 10 

When the final model was re-fit leaving out licensed nursing hours per resident-day, there was a 

slight decline in the model adjusted R2 (from 0.6951 to 0.6920) and inconsequential changes to the 

magnitudes of the coefficients of other variables in the model. No variable changed sign or changed 

in significance. The coefficients for the staffing variables did change: RN hours per resident-day 

increased from 0.026 to 0.046 (with p-value<0.0001), and CNA hours per resident-day increased from 

0.009 to 0.004 (with p-value<0.0001). 

3.6 Rehospitalization within 100 days 

Table 5 presents results from the sequence of regression models run for rehospitalization within 100 

days. With only the time variable (indicating 2000 or 2004) in the model, the adjusted R2 was low as 

expected. The coefficient of time was 0.02790, consistent with the earlier finding that observed rates 

of rehospitalization increased by 2.79% between 2000 and 2004. 

In step 2, the two dummy variables 2000 only and 2004 only were entered, and the model adjusted 

R2 increased slightly. The coefficient of the 2000 only indicator was -0.0402, indicating that facilities 

present only in 2000 had rehospitalization rates in 2000 that were 4.0% lower than facilities present 

at both time points. The coefficient of the 2004 only indicator was -0.0096, indicating that facilities 

present in 2004 only had rehospitalization rates in 2004 that were 0.96% lower than facilities present 

at both time points. These findings are corroborated by the unadjusted differences in observed rates 

between these groups, shown in Appendix Table F. That the coefficient of time changed from 0.028 

to 0.026 indicates that the rate of rehospitalization increased by 2.6% for those facilities present at 

both time points, also seen in Appendix Table F. 

In step 3, facility case mix variables were entered, vastly increasing the model adjusted R2 as 

expected. Controlling for case mix substantially affected the coefficients of the other three variables. 

The coefficients for both the 2000 only indicator and the 2004 only indicator decreased substantially 

in magnitude, indicating that there were substantial differences in case mix between facilities in 

these two groups. Indeed, significant differences were found in average Barthel score, and the 

percentage of residents with DNR orders, with catheters, with dementia, and with nervous system 

disorders among these facilities (Appendix Table F). The coefficient of time dropped to 0.0205, 

indicating that even after accounting for differences in facility case mix, the rehospitalization rates 

for facilities present at both time points increased by approximately 2%. 

In step 4, acute length of stay was entered, but was not significant and had minimal effect on model 

adjusted R2 or the other estimates. This suggests that acute length of stay does not explain variance 

in rehospitalization rates after adjusting for case mix. 

In step 5, three dummy variables for Northeast, Midwest, and South region were entered, leaving 

out the Western region as the reference group (it had the lowest rehospitalization rate). Adding 

region improved the model adjusted R2 from step 3 and showed that after adjusting for case mix, 

SNFs in the rest of the country had rehospitalization rates 1.1% to 4.2% higher than SNFs in the 

West. 

Staffing levels were entered in steps 6 through 8, separately for RN hours/resident-day, licensed 

nursing hours/resident-day, and CNA hours/resident-day. Compared to the Step 3 model, RN and 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 11 

licensed nursing staffing levels had significant effects on the model adjusted R2; CNA staffing levels 

had a smaller effect. On average, for every one hour increase in RN hours/resident-day, the 

rehospitalization rate decreased by almost 2%; for licensed nursing the average decrease was be just 

over 1%; for CNA the average decrease was less than 1%. The magnitude of the coefficient of the 

2000 only indicator dropped by more than half with the addition of RN and licensed nursing levels, 

suggesting that a large part of the differences in rates for facilities present in 2000 only versus both 

time points was associated with large differences in staffing. As shown in Appendix Table F, 

facilities present in 2000 only had RN and licensed nursing staffing levels 1.8 to 2.5 times higher than 

facilities present at both time points. The magnitude of the coefficient of time also dropped, 

suggesting that much of the observed increase in rehospitalization rates over time can be explained 

by differences in RN and licensed nursing staffing levels. In step 9, all three staffing level variables 

were entered together, with consistent results. 

In step 10, hospital-based versus freestanding was entered, with a significant increase in model 

adjusted R2 compared to the Step 3 model. Furthermore, the coefficient was -0.057, indicating that 

even after adjusting for case mix, hospital-based SNFs had rehospitalization rates that were 5.7% 

lower than freestanding SNFs. The magnitude of the coefficient of time dropped, indicating that 

differences in rehospitalization rates over time were related to the proportion of SNFs that were 

hospital-based. The coefficient of the 2000 only indicator dropped substantially, suggesting that the 

differences in rates for facilities present in 2000 only versus both time points were associated with 

differences in the proportion of facilities that were hospital-based. Appendix Table F shows that 

more than half of the facilities present only in 2000 were hospital-based, while only approximately 

9% of facilities present at both time points and 5% of facilities present in 2004 only were hospitalbased. Facilities not present in 2004 could be no longer in business at that time or could have fewer 

than 25 stays in 2004. 

The magnitude of the hospital-based coefficient is influenced by significant differences between 

hospital-based and freestanding facilities on various important measures, as shown in Appendix 

Table G. Hospital-based facilities had significantly higher staffing levels than freestanding SNFs. 

Case mix differences were mixed, with some measures indicating more complex residents in 

hospital-based SNFs, and other measures indicating more complex residents in freestanding SNFs. 

Of note, the average acute length of stay was the same for residents in either type of facility. 

Steps 11 through 13 tested the impact of ownership (for-profit versus not for-profit), urban versus 

rural setting, and chain membership. On average, for-profit facilities had a 2.3% higher rate of 

rehospitalization than non-profit facilities; urban versus rural and chain membership had little to no 

effect on the model. Market characteristics were assessed in steps 14 through 17 and had no impact 

on rehospitalization rates. 

The final rehospitalization model is shown in Table 6; the model adjusted R2 was 0.5363. The 

coefficient of time was 0.0203, about a third lower in magnitude that it had been initially, suggesting 

that some of the increase in observed rehospitalization rates can be explained by variables in the 

model. That it remained significant indicates that there was still an independent effect of time. The 

coefficient of 2000 only was -0.0057, substantially lower than it was initially, indicating that other 

variables in the model (most likely hospital-based and staffing) accounted for this effect. The 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 12 

coefficient of 2004 only was -0.0078, smaller in magnitude than it was initially, and approximately 

the same as it was when only case mix was in the model. This suggests that some, but not all, of the 

differences between facilities present at 2004 only versus at both time points can be explained by 

differences in case mix and facility characteristics. 

Based on the coefficients (for dichotomous variables) and standardized estimates (for continuous 

variables), the variables with the largest inverse association with facility rehospitalization rate were: 

percentage of residents with DNR orders, average Barthel Index score (higher scores=more 

independence), and percentage of residents with fractures. Variables with the largest positive 

association with rehospitalization were: average bowel incontinence score (higher scores=more 

frequent incontinence), percentage of residents being tube fed, and average resident comorbidity 

index. The time variable also was positively associated with rehospitalization rate, suggesting that 

differences in time are not fully explained by variables present in the model. 

When the final model was re-fit leaving out licensed nursing hours per resident-day, there was a 

slight decline in the model adjusted R2 (from 0.5363 to 0.5356) and inconsequential changes to the 

magnitudes of the coefficients of other variables in the model. No variable changed sign or changed 

in significance. The coefficients and significance of the staffing variables did change: RN hours per 

resident-day changed from -0.002 to -0.007 (with p-value<0.0001), and CNA hours per resident-day 

changed from -0.0007 with p-value=0.1572 to -0.001 with p-value=0.0370. 

3.7 Variation by state 

Table 7 shows the differences between states in the risk-adjusted rate of community discharge 

within 30 days. Alaska had the lowest risk-adjusted rate of community discharge (Note that Alaska 

had the lowest risk-adjusted rate; the observed rate for SNFs in Alaska is shown in Appendix Table 

B) and therefore was used as the reference state. After adjusting for case mix, SNFs in Hawaii had 

an average rate of community discharge 25.1% greater than SNFs in Alaska. South Carolina, 

Oregon, and Montana also had average rates more than 20% greater. South Dakota’s average riskadjusted rate was only 5.4% higher than Alaska’s; Oklahoma’s (6.0%) and North Dakota’s (6.6%) 

rates were also within 7% of Alaska’s rate. 

 A similar graph for risk-adjusted rates of rehospitalization within 100 days is given in Table 8. In 

this case, Hawaii had the lowest risk-adjusted rate of rehospitalization and was used as the reference 

state. The range of risk-adjusted rehospitalization rates was much smaller than for community 

discharge. Generally, SNFs in Western states had lower risk-adjusted rates of rehospitalization, 

while higher rates were seen in Eastern and Midwestern states. SNFs in Utah, Oregon, California, 

and Washington all had rates within 3% of Hawaii’s rates, while SNFs in Connecticut had a 

rehospitalization rate 7.5% higher than Hawaii’s, with rates in Illinois, New York and West Virginia 

also more than 7% higher. 

3.8 Relationship between rates of community discharge and rehospitalization 

Unadjusted facility rates of community discharge within 30 days and rehospitalization within 100 

days for year 2004 had a correlation of -0.483 (p<0.0001). The inverse correlation means that facilities 

with higher rates of community discharge generally had lower rates of rehospitalization, and 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 13 

facilities with lower rates of community discharge generally had higher rates of rehospitalization. 

Comparison of the quartiles gave similar results. Half of the facilities in the highest quartile for 

community discharge were also in the lowest quartile for rehospitalization, and 43% of the facilities 

in the lowest quartile for community discharge were also in the highest quartile for 

rehospitalization. These rates and comparisons were not risk-adjusted. 

3.9 Nursing Home Quality Initiative (NHQI) post-acute care QMs 

The relationship between the NHQI post-acute care QMs and both community discharge and 

rehospitalization is shown in Table 9. The quality measures are constructed such that higher values 

indicate poorer facility quality. 

The adjusted R2 for the community discharge model containing only case mix variables was 0.5847. 

After adjusting for case mix, each of the three quality measures was positively associated with 

community discharge. Such an association indicates that low values of the quality measures 

(indicating better facility quality) were associated with low rates of community discharge (an poor 

outcome), whereas high values of the quality measures (indicating poorer facility quality) were 

associated with high rates of community discharge (a good outcome). When all three quality 

measures were tested simultaneously, the relationships of pain and pressure sores with 

rehospitalization were preserved, but delirium became insignificant. 

The adjusted R2 for the rehospitalization model containing only case mix variables was 0.4865. After 

accounting for aggregate resident characteristics, each of the three quality measures was inversely 

associated with rehospitalization. An inverse relationship indicates that low values of the quality 

measure (better quality) were associated with high rates of rehospitalization (poor outcome), and 

high values of the quality measures (poorer quality) were associated with low rates of 

rehospitalization (good outcome). These relationships persisted when all three quality measures 

were tested simultaneously. 

4 Discussion 

Community discharge and potentially avoidable rehospitalization rates are SNF outcomes that are 

gaining traction as performance measures. With 78% of SNF patients receiving rehabilitation 

services(20) and 43% expected to be discharged within 90 days(4), discharge is clearly a major goal of 

SNF care. Community discharge has been widely used in studies of rehabilitation and has been 

shown to be related to process quality measures in SNFs(14;15;18;24). For many other SNF patients, the 

goal is to stabilize, monitor, and prevent complications following acute medical or surgical care, 

avoiding the need for rehospitalization. Hospitalization has been used to measure quality of 

ambulatory care using ambulatory care sensitive conditions(25-27), as a publicly reported measure for 

home health care(28-30), and will be used in the CMS nursing home value based purchasing 

demonstration(31). Thus, these two outcome measures correspond to two of the major goals of SNF 

care and are used for multiple purposes. 

This study was prompted by prior research that found increases in risk-adjusted SNF 

rehospitalization rates for potentially avoidable causes and decreases in risk-adjusted SNF 

community discharge rates between calendar year 2000 and calendar year 2004(4). In this previous 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 14 

research, the rehospitalization rate measure included hospitalizations for five conditions: heart 

failure, respiratory infection, urinary tract infection, sepsis, and electrolyte imbalance. The riskadjusted measures were calculated at 30 days and 100-days after SNF admission. About 10% of 

residents were excluded from the measures due to death before the end point or missing admission 

MDS data. The measures were found to be stable with a denominator of at least 25 admissions, so 

facilities with less than 25 admissions in a year were excluded. About 90% of facilities had 25 or 

more SNF admissions and these facilities were responsible for about 99% of the SNF stays. 

To better understand these trends, we studied the resident, facility, and community factors that were 

associated with SNF rehospitalization and community discharge rates during this time period, and 

the extent to which these explained the temporal changes in rates. We also examined the 

relationship among these two outcome measures and between these two outcome measures and the 

three publicly reported QMs for post-acute care that are based on 14-day MDS data. In this study, 

we began with facility observed rates and then adjusted for facility case mix and other variables in 

the model to assess the effect of facility case mix and other factors on these rates. The initial trend 

analysis used rates that were risk adjusted using the method that is used by CMS to risk adjust for 

Nursing Home Compare(4;32). This method is designed to compare rates among facilities at the same 

point in time and does not lend itself well to studying temporal trends or the association of rates 

with other factors. We focused on 100-day rehospitalization and 30-day community discharge in the 

present analysis because these measures changed the most between 2000 and 2004. 

For community discharge, the rate declined in part because facilities in business and with 25 SNF 

admissions only in 2000 had higher community discharge rates than facilities present in both time 

periods or only in 2004. As expected, case mix was strongly associated with community discharge 

rates particularly ADL functional independence, cognitive functioning, and the percentage of 

residents with DNR orders (negatively associated). After case mix adjustment, hospital-based 

facilities had community discharge rates that were 19% higher on average, which may result in part 

from unaccounted for case mix differences. After adjusting for other facility characteristics that are 

highly associated with being hospital-based (i.e., hospital-based facilities tend to be non-profit and 

have much higher staffing levels), the hospital-based effect was reduced to 11%. However, facilities 

present only in 2000, which had higher case mix-adjusted community discharge rates, were much 

more likely to be hospital-based than were facilities present in both periods or 2004 only. For-profit 

facilities had lower community discharge rates, and urban facilities had higher community 

discharge rates after case mix adjustment. 

Staffing levels were strongly associated with case mix-adjusted community discharge rates: on 

average, rates increased by 8% for every additional hour of RN time, 5% for every additional 

licensed staff hour, and 1.6% for every additional CNA hour. As expected, these effects were 

diminished in the final model after adjusting for characteristics such as hospital-based that are 

highly associated with staffing; however, we emphasize staffing without adjusting for other facility 

characteristics because the underlying reasons that facilities staff differently are secondary. Our 

findings are consistent with previous research on the relationship between nurse staffing levels and 

community discharge(18). In addition, SNFs that were present only in 2000, which had higher casemix adjusted community discharge rates, had substantially higher staffing levels. In fact, after 

controlling for staffing, hospital-based, and other facility characteristics there was no longer an 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 15 

independent effect of presence only in 2000. Thus, part of the reason for the temporal decline in 

community discharge rates is that facilities that either went out of business or treated fewer SNF 

residents over time were disproportionately hospital-based and higher staffed facilities. 

SNFs in the Western region had 3-5% higher case-mix adjusted community discharge rates on 

average than other regions of the country, after adjusting for facility and community characteristics. 

The western states where this was most pronounced were Hawaii, Oregon and Montana. By 

adjusting for case mix, facility characteristics, staffing, geographic region, and community 

characteristics (model adjusted R2=0.69), the temporal change in community discharge rates was 

almost fully explained. 

For rehospitalization, the rate increased in part because facilities in business and with 25 SNF 

admissions only in 2000 had lower rehospitalization rates than facilities in both time periods or only 

in 2004. As expected, case mix was strongly associated with rehospitalization rates, particularly 

ADL functional independence (negatively associated), DNR orders (negatively associated), feeding 

tube, comorbidity, bowel incontinence, and fracture diagnosis (negatively associated). After case 

mix adjustment, hospital-based facilities had rehospitalization rates that were 6% lower on average, 

which may result in part from unaccounted for case mix differences. However, facilities present 

only in 2000, which had lower case mix-adjusted rehospitalization rates, were much more likely to 

be hospital-based than facilities present in both periods or 2004 only. For-profit facilities had higher 

rehospitalization rates after case mix adjustment. 

Staffing levels were associated with case mix-adjusted rehospitalization rates: on average, rates 

decreased by 1.9% for every additional hour of RN time, 1.2% for every additional licensed staff 

hour, and 0.5% for every additional CNA hour. These effects were diminished in the final model 

after controlling for characteristics that are highly associated with staffing (e.g., hospital-based and 

for profit); however, we emphasize staffing without adjusting for other facility characteristics 

because of the underlying reasons that facilities staff differently are secondary. This is consistent 

with previous research on the relationship between nurse staffing levels and hospitalizations for 

SNF patients where staffing data were obtained from Medicaid cost reports(8;9). In addition SNFs 

that were present only in 2000, which had lower case mix-adjusted rehospitalization rates, had 

substantially higher staffing levels. In fact, after controlling for staffing, hospital-based, and other 

facility characteristics there was only a negligible independent effect of presence only in 2000. Thus, 

part of the reason for the temporal increase in rehospitalization rates is that facilities that either went 

out of business or treated fewer SNF patients over time were disproportionately hospital-based and 

higher staffed facilities. 

SNFs in the Western region had 1.6-2.5% lower case-mix adjusted rehospitalization rates on average 

than in other regions of the country, after adjusting for facility and community characteristics. The 

western states where this was most pronounced were Hawaii, Utah, Oregon, California and 

Washington. Even after adjusting for case mix, facility characteristics, staffing, and geographic 

region, and community characteristics (model adjusted R2=0.54), the temporal increase in 

rehospitalization rates was about 2.0%. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 16 

The relationship that we found between good quality on these performance measures (i.e., low 

rehospitalization rate or high community discharge rate) and poor quality on the publicly reported 

post-acute care QMs is concerning. Only about 50% of SNF admissions have a 14-day MDS 

completed, so half of SNF admissions are not included in the post-acute care QMs(20;21). If a facility 

discharges their healthiest patients to the community and/or provides treatment in the facility rather 

than the hospital for patients who have severe pain, delirium, or pressure sores, they will score 

worse on the post-acute care QMs. The QMs provide an incomplete picture of quality that does not 

address two of the major goals of SNF care. Thus, we recommend that community discharge and 

rehospitalization for potentially avoidable causes be added to the post-acute care QMs for public 

reporting. Furthermore, we recommend that revisions to the post-acute care measures be 

considered such as adding discharge MDS data for residents who are discharged or rehospitalized, 

refining the measure definitions, and improving risk adjustment procedures. 

In summary, community discharge and rehospitalization for potentially avoidable causes appear to 

be robust performance measures for Medicare SNFs. They are correlated with one another at the 

facility level, as you would expect among different quality constructs. After controlling for case mix, 

these measures are strongly associated with whether a facility is hospital-based and licensed staffing 

levels, as well as geographic factors. The temporal decline in community discharge rates appears to 

be explained largely by these factors, particularly the loss of hospital-based and higher staffed 

facilities. The temporal increase in rehospitalization rates appears to be partially explained by loss 

of hospital-based and higher staffed facilities and changes in these factors. The loss of better 

performing facilities on both of these measures between 2000 and 2004 is concerning. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 17 

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Division of Health Care Policy and Research, UCDHSC, Aurora, CO 20 

TABLES
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 21 

Table 1: Change in mean facility observed rates1 of outcome measures for 2000 - 2004 SNF 

admissions 

 2000

(n=12,247)2

2001

(n=12,650)

2002

(n=12,973)

2003

(n=13,245)

2004

(n=13,373)

2000 to 

20043

Community discharge in 30 days 23.66 22.81 22.30 21.79 21.87 

 Difference4

 -0.85 -0.51 -0.51 0.08 -1.79 

 Relative difference5 -3.59 -2.24 -2.29 0.37 -7.57 

 

Community discharge in 100 days 31.17 30.52 30.45 30.44 30.92 

 Difference -0.65 -0.07 -0.01 0.48 -0.25 

 Relative difference -2.09 -0.23 -0.03 1.58 -0.80 

Rehospitalization in 30 days 11.35 12.19 12.64 13.27 13.42 

 Difference 0.84 0.45 0.63 0.15 2.07 

 Relative difference 7.40 3.69 4.98 1.13 18.24 

Rehospitalization in 100 days 14.69 15.79 16.40 17.23 17.48 

 Difference 1.10 0.61 0.83 0.25 2.79 

 Relative difference 7.49 3.86 5.06 1.45 18.99 

1

 Rates shown are percentages. Rates are not adjusted of differences in case mix. 

2

 Slight differences in sample size for each outcome. Sample size shown for each year is the maximum of any of the 

four outcomes for that year.

3

 Repeated measures ANOVA conducted on the subset of facilities present at all time points (n=10,812). All 

comparisons between 2000 and 2004 have p-values <0.0001. All comparisons between sequential years have pvalues <0.0001 except: community discharge in 30 days 2000 vs. 2001 (0.1816), community discharge in 30 days 

2001 vs. 2002 (0.0039), community discharge in 30 days 2002 vs. 2003 (0.0196), community discharge in 100 days 

2000 vs. 2001 (0.0004), rehospitalization in 30 days 2003 vs. 2004 (0.001). 

4

 Given year’s rate minus previous year’s rate. 

5

 Given year’s rate minus previous year’s rate, divided by previous year’s rate, multiplied by 100.

 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 22 

Table 2: Comparison of mean facility measures between 2000 and 2004 

 2000 (n=12,206)1 2004 (n=13,332)2

 Mean3 (Stdev) Mean (Stdev)

Case mix indicators4 

 Age (years) 80.39 (3.3) 79.68 (3.9) 

 DNR orders 38.45 (22.9) 41.10 (22.2) 

 Do not hospitalize orders 1.85 (6.1) 1.78 (5.3) 

 Barthel Index (0-90)5 36.70 (9.5) 36.51 (8.6) 

 Cognitive Performance Scale (0-6)6 2.02 (0.7) 1.94 (0.7) 

 Bowel incontinence scale (1-4) (MDS item H1a)6 1.37 (0.7) 1.33 (0.7) 

 Indwelling catheter (MDS item H3d) 22.06 (11.3) 22.99 (11.4) 

 Feeding tube (MDS item K5b) 9.40 (8.7) 7.20 (6.9) 

 Parenteral/IV feeding (MDS item K5a) 6.94 (12.6) 11.33 (16.7) 

 Pressure ulcer (MDS item M2a, any stage) 23.36 (11.4) 22.99 (10.8) 

 Rehabilitation RUG 76.25 (17.2) 77.43 (16.8) 

 Community discharge comorbidity index (-3.5 to 3.3) -0.48 (0.1) -0.49 (0.1) 

 Rehospitalization comorbidity index (-3.3 to 3.1) 0.38 (0.1) 0.41 (0.1) 

 Cardiac arrhythmia 25.89 (7.5) 27.40 (7.6) 

 COPD 22.53 (7.7) 24.04 (7.7) 

 Dementia 24.01 (11.2) 24.88 (10.9) 

 Fluid/Electrolyte disorder 29.64 (8.8) 32.28 (8.2) 

 Fracture 16.21 (7.4) 14.30 (6.8) 

 Genitourinary condition 33.20 (8.3) 38.30 (8.3) 

 Uncomplicated hypertension 37.60 (8.7) 43.03 (8.5) 

 Musculoskeletal disease 27.93 (9.6) 30.35 (9.6) 

 Nervous system disorder 25.27 (7.8) 25.92 (7.7) 

 Respiratory disease 25.53 (7.6) 26.99 (7.4) 

 Skin disorder 12.44 (6.3) 13.25 (6.0) 

 Valvular disease 7.76 (5.0) 8.80 (5.3) 

 LOS of qualifying hospital stay (days) 9.25 (2.7) 8.74 (2.3) 

 

Staffing levels 

 RN hours/resident-day 0.59 (0.8) 0.45 (0.6) 

 Licensed nursing hours/resident-day 1.75 (1.2) 1.62 (1.0) 

 CNA hours/resident-day 2.30 (0.8) 2.42 (0.8) 

 

Facility characteristics 

 Northeast 20.84 - 19.23 - 

 Midwest 30.75 - 31.89 - 

 South 32.89 - 34.11 - 

 West 15.51 - 14.77 - 

 Hospital-based 13.33 - 8.66 - 

 Freestanding 86.67 - 91.34 - 

 Urban 71.15 - 68.95 - 

 Rural 28.85 - 31.05 - 

 For-profit 67.00 - 68.26 - 

 Non-profit 28.38 - 27.40 - 

 Chain 61.32 - 56.92 - 

 Not chain 38.68 - 43.08 - 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 23 

Table 2: Comparison of mean facility measures between 2000 and 2004 (continued) 

 2000 (n=12,206)1 2004 (n=13,332)2

 Mean3 (Stdev) Mean (Stdev)

Market characteristics 

 Medicare managed care penetration rate in SNF’s 

 county 

14.75 (14.8) 10.26 (12.8) 

 Number of hospitals7 2.60 (3.0) 2.68 (3.3) 

 Number of hospital admissions7 12,654.57 (7580.8) 12,712.18 (7945.2) 

 Number of hospital beds7 373.80 (281.5) 362.39 (290.7) 

 Number of SNFs7 7.27 (5.47) 7.42 (6.0) 

 Number of SNF certified beds7 711.74 (400.3) 717.01 (410.9) 

 Number of NF total beds7 69.0 (174.4) 62.24 (166.6) 

 Number of home health agencies7 3.12 (3.4) 3.07 (3.5) 

 

NHQI post-acute care QMs 

 Delirium score6 - - 3.23 (4.7) 

 Pain score6 - - 22.00 (19.0) 

 Pressure sores score6 - - 20.70 (9.9) 

1

 Sample for 2000 is facilities with non-missing data in 2000 for rehospitalization in 100 days and community 

 discharge in 30 days 

2

 Sample for 2004 is facilities with non-missing data in 2004 for rehospitalization in 100 days and community 

 discharge in 30 days 

3

 Values are percentages unless otherwise noted 

4

 Values are interpreted as “Mean % of residents in the facility with this condition”, or as “Mean resident value 

 for this item” 

5

 Higher values indicate better status 

6

 Lower values indicate better status 

7

 In SNF’s county, per 100,000 population. Data for 2004 were not available; 2002 data were substituted.
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 24 

Table 3: Community discharge within 30 days regression model series 

Step Variables in model

Model 

adj R2

Coefficient of 

tested variable

Coefficient 

of time

Coefficient 

of 2000 only

Coefficient 

of 2004 only

1 Time .0022 - -.01792 - - 

2 Time, presence at 2000 only and 

2004 only indicators 

.0457 - .00922 .17487 -.07389 

3 Time, presence at 2000 only and 

2004 only indicators, case mix 

.6058 - -.01316 .07342 -.02974 

4 Step 3 and hospital LOS .6059 .00085 -.01223 .07374 -.02950 

5 Step 3 and region (Northeast, 

Midwest, South) 

.6209 -.05355 NE 

-.07579 MW 

-.04318 S 

-.01607 .07221 -.03010 

6 Step 3 and RN hours/resident-day .6486 .07977 -.00188 .01493 -.02838 

7 Step 3 and licensed nursing 

hours/resident-day 

.6514 .05036 -.00689 .01115 -.02951 

8 Step 3 and CNA hours/resident-day .5919 .01600 -.01489 .05586 -.02963 

9 Step 3 and RN hours/resident-day, 

licensed nursing hours/residentday, CNA hours/resident-day 

.6584 .04127 RN 

.02955 lic nsg

.00598 CNA 

-.00458 .00779 -.02891 

10 Step 3 and hospital-based .6730 .19099 -.00909 .02209 -.03082 

11 Step 3 and for-profit .6130 -.03693 -.01312 .06798 -.03069 

12 Step 3 and urban .6093 .02667 -.01047 .07309 -.02768 

13 Step 3 and chain .6072 -.01466 -.01348 .07302 -.03171 

14 Step 3 and Medicare managed 

care penetration rate 

.6139 .00131 -.00751 .07187 -.02891 

15 Step 3 and # hospitals .6101 -.00449 -.00983 .07488 -.02745 

16 Step 3 and # hospital admissions .6054 <.00001 -.01283 .07329 -.03004 

17 Step 3 and # hospital beds .6058 -.00001 -.01286 .07376 -.03008 

18 Step 3 and # SNFs .6162 -.00374 -.00998 .07476 -.02588 

19 Step 3 and # SNF certified beds .6189 -.00006 -.01109 .07186 -.02846 

20 Step 3 and # NF beds .6080 -.00006 -.01269 .07483 -.02633 

21 Step 3 and # home health agencies .6094 -.00358 -.01116 .07400 -.02858 

22 Final model .6921 See Table 4 -.00416 non-signif., 

dropped 

-.02578 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 25 

Table 4: Community discharge within 30 days final regression model 

Variable Coefficient

Standardized 

coefficient1 p-value

 

Intercept 0.20505 - <0.0001 

Time -0.00363 - 0.0367 

2000 only indicator 0.00127 - 0.7416 

2004 only indicator -0.02557 - <0.0001 

 

Age (years) 0.00096 0.01939 0.0008 

Female -0.05018 -0.02799 <0.0001 

DNR orders -0.09405 -0.11696 <0.0001 

Do not hospitalize orders 0.00522 0.00165 0.6631 

Barthel Index score (0-90)2

 0.00248 0.12245 <0.0001 

Cognitive Performance Scale score (0-6)3 -0.03088 -0.12113 <0.0001 

Bowel incontinence scale (1-4) (MDS item H1a)3 -0.03233 -0.11971 <0.0001 

Indwelling catheter (MDS item H3d) 0.03507 0.02194 <0.0001 

Feeding tube (MDS item K5b) -0.04621 -0.02052 0.0003 

Parenteral/IV feedings (MDS item K5a) 0.05411 0.04532 <0.0001 

Pressure ulcer (MDS item M2a, any stage) 0.00728 0.00445 0.3370 

Rehabilitation RUG 0.06019 0.05665 <0.0001 

Community discharge comorbidity index 

 (-3.5 to 3.3) 

0.08637 0.05870 <0.0001 

Cardiac arrhythmia 0.03394 0.01426 0.0017 

COPD -0.04745 -0.02036 <0.0001 

Dementia -0.15164 -0.09265 <0.0001 

Fluid/Electrolyte disorder 0.01091 0.00518 0.2442 

Fracture 0.03454 0.01354 0.0060 

Genitourinary condition -0.10929 -0.05220 <0.0001 

Uncomplicated hypertension 0.07783 0.03870 <0.0001 

Musculoskeletal disease 0.16787 0.08825 <0.0001 

Nervous system disorder -0.02246 -0.00974 0.0417 

Respiratory disease -0.02409 -0.01011 0.0217 

Skin disorder -0.09578 -0.03277 <0.0001 

Valvular disease 0.07363 0.02112 <0.0001 

LOS of qualifying hospital stay (days) 0.00084 0.01166 0.0018 

 

RN hours/resident-day 0.02550 0.09550 <0.0001 

Licensed nursing hours/resident-day 0.01899 0.11408 <0.0001 

CNA hours/resident-day 0.00208 0.00910 0.0190 

 

Northeast -0.04200 - <0.0001 

Midwest -0.05513 - <0.0001 

South -0.02616 - <0.0001 

Hospital-based 0.11493 - <0.0001 

Urban 0.00231 - 0.2383 

For-profit 0.00141 - 0.4099 

Chain -0.00064 - 0.6614 

 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 26 

Table 4: Community discharge within 30 days final regression model (continued) 

Variable Coefficient

Standardized 

coefficient1 p-value

 

Medicare managed care penetration rate in 

 SNF’s county 

0.00051 0.03922 <0.0001 

Number of hospitals4

 -0.00079 -0.01383 0.0216 

Number of hospital admissions4

 <0.00001 0.02134 0.0001 

Number of hospital beds4 -0.00002 -0.03650 <0.0001 

Number of SNFs4

 -0.00075 -0.02424 0.0103 

Number of SNF certified beds4

 -0.00001 -0.02158 0.0127 

Number of NF total beds4 -0.00003 -0.02400 <0.0001 

Number of home health agencies4

 -0.00061 -0.01186 0.0133 

 

Model adjusted R2

 = 0.6951 

1

 Coefficient of the standardized (mean=0, variance=1) variable 

2

 Higher values indicate better status 

3

 Lower values indicate better status 

4

 In SNF’s county, per 100,000 population. Data for 2004 were not available; 2002 data were substituted. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 27 

Table 5: Rehospitalization within 100 days regression model series 

Step Variables in model

Model 

adj R2

Coefficient of 

tested variable

Coefficient 

of time

Coefficient 

of 2000 only

Coefficient 

of 2004 only

1 Time .0296 - .02790 - - 

2 Time, presence at 2000 only and 

2004 only indicators 

.0399 - .02595 -.04022 -.00956 

3 Time, presence at 2000 only and 

2004 only indicators, case mix 

.4945 - .02049 -.02560 -.00664 

4 Step 3 and hospital LOS .4945 .00008 

(non-signif.) 

.02039 -.02561 -.00659 

5 Step 3 and region (Northeast, 

Midwest, South) 

.5028 .02806 NE 

.02291 MW

.01872 S 

.02198 -.02467 -.00661 

6 Step 3 and RN hours/resident-day .5082 -.01896 .01794 -.01216 -.00928 

7 Step 3 and licensed nursing 

hours/resident-day 

.5101 -.01228 .01912 -.01079 -.00912 

8 Step 3 and CNA hours/resident-day .4925 -.00484 .02093 -.02211 -.00868 

9 Step 3 and RN hours/resident-day, 

licensed nursing hours/resident-day, 

CNA hours/resident-day 

.5119 -.00857 RN 

-.00777 lic nsg

-.00237 CNA 

.01881 -.01017 -.00920 

10 Step 3 and hospital-based .5278 -.05691 .01916 -.00986 -.00675 

11 Step 3 and for-profit .5095 .02269 .01967 -.02223 -.00608 

12 Step 3 and urban .4949 -.00363 .02019 -.02557 -.00686 

13 Step 3 and chain .4960 .00660 .02047 -.02548 -.00564 

14 Step 3 and Medicare managed care 

penetration rate 

.4959 -.00035 .01915 -.02516 -.00711 

15 Step 3 and # hospital beds .4928 <.00001 

(non-signif.) 

.02024 -.02571 -.00687 

16 Step 3 and # SNFs .4934 .00040 .02019 -.02581 -.00732 

17 Step 3 and # SNF certified beds .4954 .00001 .02037 -.02534 -.00722 

18 Final model .5362 See Table 6 .01982 -.00591 -.00788 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 28 

Table 6: Rehospitalization within 100 days final regression model 

Variable Coefficient

Standardized 

coefficient1 p-value

 

Intercept 0.03077 - 0.0224 

Time 0.02029 - <0.0001 

2000 only indicator -0.00569 - 0.0071 

2004 only indicator -0.00783 - <0.0001 

Age (years) 0.00014 0.00630 0.3745 

Female 0.00468 0.00586 0.3059 

DNR orders -0.03779 -0.10504 <0.0001 

Do not hospitalize orders -0.01621 -0.01135 0.0153 

Barthel Index (0-90)2

 -0.00096 -0.10617 <0.0001 

Cognitive Performance Scale (0-6)3 -0.00266 -0.02325 0.0059 

Bowel incontinence scale (1-4) (MDS item H1a)3 0.01381 0.11406 <0.0001 

Indwelling catheter (MDS item H3d) -0.00691 -0.00962 0.0600 

Feeding tube (MDS item K5b) 0.18704 0.18124 <0.0001 

Parenteral/IV feeding (MDS item K5a) -0.00441 -0.00824 0.1062 

Pressure ulcer (MDS item M2a, any stage) 0.05610 0.07659 <0.0001 

Rehabilitation RUG 0.02540 0.05340 <0.0001 

Rehospitalization case mix index (-3.3 to 3.1) 0.15930 0.15770 <0.0001 

Cardiac arrhythmia 0.01832 0.01728 0.0023 

COPD 0.00805 0.00774 0.1459 

Dementia 0.00610 0.00834 0.2788 

Fluid/Electrolyte disorder 0.06856 0.07307 <0.0001 

Fracture -0.10042 -0.08852 <0.0001 

Genitourinary condition 0.03653 0.03920 <0.0001 

Uncomplicated hypertension 0.01038 0.01157 0.0294 

Musculoskeletal disease -0.03566 -0.04214 <0.0001 

Nervous system disorder -0.05016 -0.04877 <0.0001 

Respiratory disease 0.03812 0.03561 <0.0001 

Skin disorder 0.06683 0.05118 <0.0001 

Valvular disease -0.06245 -0.04018 <0.0001 

LOS of qualifying hospital stay (days) 0.00013 0.00398 0.3872 

 

RN hours/resident-day -0.00224 -0.01877 0.0399 

Licensed nursing hours/resident-day -0.00410 -0.05506 <0.0001 

CNA hours/resident-day -0.00069 -0.00678 0.1572 

 

Northeast 0.02426 - <0.0001 

Midwest 0.01940 - <0.0001 

South 0.01569 - <0.0001 

Hospital-based -0.03325 - <0.0001 

Urban -0.00290 - 0.0073 

For-profit 0.01429 - <0.0001 

Chain 0.00260 - 0.0012 

 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 29 

Table 6: Rehospitalization within 100 days final regression model (continued) 

Variable Coefficient

Standardized 

coefficient1 p-value

 

Medicare managed care penetration rate in 

 SNF’s county 

-0.00012 -0.02048 0.0010 

Number of hospitals4

 0.00004 0.00151 0.8394 

Number of hospital admissions4 <0.00001 0.00564 0.4152 

Number of hospital beds4

 <0.00001 0.00995 0.1809 

Number of SNFs4

 -0.00065 -0.04658 <0.0001 

Number of SNF certified beds4 0.00001 0.04150 0.0001 

Number of NF total beds4

 <-0.00001 -0.00651 0.1821 

Number of home health agencies4

 0.00008 0.00328 0.5785 

 

Model adjusted R2

 = 0.5363 

1

 Coefficient of the standardized (mean=0, variance=1) variable 

2

 Higher values indicate better status 

3

 Lower values indicate better status 

4

 In SNF’s county, per 100,000 population. Data for 2004 were not available; 2002 data were substituted. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 30 

Table 7: Differences between states in adjusted rates of community discharge within 30 days1

0.000

0.054

0.060

0.066

0.079

0.082

0.084

0.090

0.091

0.091

0.094

0.095

0.097

0.098

0.100

0.101

0.103

0.108

0.111

0.113

0.116

0.118

0.119

0.120

0.126

0.130

0.133

0.133

0.135

0.136

0.137

0.139

0.141

0.141

0.142

0.142

0.144

0.147

0.148

0.162

0.165

0.173

0.175

0.183

0.184

0.190

0.194

0.219

0.219

0.220

0.251

0 0.05 0.1 0.15 0.2 0.25 0.3

AK

SD

OK

ND

IL

MO

VT

IN

NE

WY

IA

WI

LA

UT

KS

MN

MI

PA

NJ

NH

TX

RI

FL

NY

AR

ID

KY

OH

NC

GA

WV

WA

NV

CT

CO

DE

DC

MS

VA

MA

CA

TN

NM

ME

MD

AZ

AL

MT

OR

SC

HI

1

 Values shown are the coefficients of each state’s dummy variable forced into the risk-adjusted model. 

Values can be interpreted as the difference between each state’s rate and Alaska’s rate, after risk-adjustment 

for variables found in Table 4 with the exception of region. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 31 

Table 8: Differences between states in adjusted rates of rehospitalization within 100 days1

0.000

0.024

0.028

0.029

0.030

0.032

0.033

0.034

0.039

0.041

0.041

0.041

0.041

0.042

0.043

0.043

0.044

0.045

0.046

0.047

0.047

0.047

0.047

0.047

0.048

0.048

0.048

0.049

0.049

0.050

0.050

0.053

0.054

0.054

0.054

0.055

0.057

0.058

0.059

0.059

0.061

0.063

0.063

0.064

0.065

0.067

0.069

0.071

0.071

0.073

0.075

0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08

HI

UT

OR

CA

WA

NM

NV

IA

DC

LA

ND

ME

SD

CO

AL

KS

SC

AZ

WI

NE

GA

TX

OH

FL

PA

MT

AK

ID

VT

DE

AR

VA

NC

IN

NH

MO

OK

MD

MN

RI

MA

NJ

WY

TN

KY

MS

MI

WV

NY

IL

CT

1

 Values shown are the coefficients of each state’s dummy variable forced into the risk-adjusted model. 

Values can be interpreted as the difference between each state’s rate and Hawaii’s rate, after risk-adjustment 

for variables found in Table 6 with the exception of region.
Division of Health Care Policy and Research, UCDHSC, Aurora, CO 32 

Table 9: Relationship of 2004 NHQI post-acute care QMs1 to 2004 risk-adjusted2 outcome rates 

Outcome NHQI quality measure Coefficient Model Adj R2

Community discharge 

in 30 days (n=10,561) 

 

 Delirium .00051 .6308 

 Pain .00111 .6358 

 Pressure sore .00122 .6434 

 Delirium, pain, and pressure sore .00030 Delirium (non-signif.) 

.00109 Pain 

.00115 Pressure sore 

.6495 

 

Rehospitalization 

in 100 days (n=10,554) 

 

 Delirium -.00045 .5162 

 Pain -.00040 .5186 

 Pressure sore -.00067 .5238 

 Delirium, pain, and pressure sore -.00029 Delirium 

-.00037 Pain 

-.00062 Pressure sore 

.5271 

1

 Higher values indicate worse performance 

2 Case mix variables in the model for community discharge were: DNR orders, do not hospitalize orders, Barthel 

Index, Cognitive Performance Scale, bowel incontinence scale, catheter, feeding tube, parenteral/IV feeding, 

pressure ulcer, rehabilitation RUG, community discharge comorbidity index, cardiac arrhythmia, COPD, dementia, 

fracture, genitourinary condition, uncomplicated hypertension, musculoskeletal disease, nervous system disorder, 

skin disorder, and valvular disease. 

 Case mix variables in the model for rehospitalization were: DNR orders, do not hospitalize orders, Barthel Index, 

Cognitive Performance Scale, bowel incontinence scale, feeding tube, parenteral/IV feeding, pressure ulcer, 

rehabilitation RUG, rehospitalization comorbidity index, cardiac arrhythmia, fluid/electrolyte disorder, fracture, 

genitourinary condition, uncomplicated hypertension, musculoskeletal disease, nervous system disorder, 

respiratory disease, skin disorder, and valvular disease.
Division of Health Care Policy and Research, UCDHSC, Aurora, CO A1 

APPENDIX 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO A2 

Table A: Change in mean facility observed rates1 of outcome measures for 2000 - 2004 SNF 

admissions, by facility type 

2000 

(n=12,225)2

2004 

(n=13,373)

Difference

2000 to 20043

Relative difference 

2000 to 20044

Community discharge in 30 days 

 

 Hospital-based 56.10 52.38 -3.72 -6.63 

 Freestanding 18.67 18.98 0.31 1.66 

 Urban 24.44 22.80 -1.64 -6.71 

 Rural 21.75 19.81 -1.94 -8.92 

 For-profit 19.40 18.67 -0.73 -3.76 

 Non-profit 33.15 29.35 -3.80 -11.46 

 Chain 22.51 20.81 -1.70 -7.55 

 Not chain 25.49 23.27 -2.22 -8.71 

 Northeast 22.14 23.16 1.02 4.61 

 Midwest 23.07 20.99 -2.08 -9.02 

 South 21.64 19.15 -2.49 -11.51 

 West 31.09 28.47 -2.62 -8.43 

 

Rehospitalization in 100 days 

 Hospital-based 7.44 9.05 1.61 21.64 

 Freestanding 15.81 18.28 2.47 15.62 

 Urban 15.12 18.08 2.96 19.58 

 Rural 13.66 16.15 2.49 18.23 

 For-profit 16.43 19.19 2.76 16.80 

 Non-profit 11.18 13.89 2.71 24.24 

 Chain 15.15 18.05 2.90 19.14 

 Not chain 13.97 16.74 2.77 19.83 

 Northeast 15.73 17.71 1.98 12.59 

 Midwest 13.52 16.18 2.66 19.67 

 South 16.38 19.37 2.99 18.25 

 West 11.91 15.45 3.54 29.72 

1

 Values shown are percentages. 

2

 Slight differences in sample size for each outcome. Sample size shown for each year is the maximum of the two 

outcomes for each year. 3

 2004 rate minus 2000 rate. 

4

 2004 rate minus 2000 rate, divided by 2000 rate, multiplied by 100.
Division of Health Care Policy and Researc

Table B: Mean outcome rates1 for 2000, 2004, and within-facility change2 by state, region, and market characterist

Community discharge 

in 30 days

Community discharge 

in 100 days 

Rehospitalization 

in 30 days

 2000 2004 Change 2000 2004 Change 2000 2004 Change Alabama 19.64 23.10 4.15 23.95 28.09 4.95 12.50 14.79 2.43 Alaska 34.30 36.46 7.24 50.16 51.87 4.76 6.17 7.37 1.11 Arizona 41.33 36.87 -0.68 49.33 47.49 1.40 8.84 12.85 3.97 Arkansas 18.87 15.24 -1.43 25.73 21.95 -1.72 11.42 13.88 2.26 California 26.84 24.01 0.46 32.68 32.41 3.08 11.01 13.71 2.53 Colorado 29.14 28.92 4.05 37.67 40.40 6.75 7.56 10.10 2.69 Connecticut 25.89 28.85 2.66 37.17 41.55 4.12 11.43 12.73 1.45 Delaware 26.79 24.33 -2.04 35.32 32.95 -1.83 9.86 14.96 5.11 District of Columbia 27.87 24.54 0.37 32.83 31.30 1.49 15.84 16.34 0.71 Florida 29.70 26.66 -0.24 38.19 37.62 1.75 11.84 14.35 2.27 Georgia 13.12 13.55 0.86 17.77 19.05 1.77 13.92 15.21 1.54 Hawaii 30.69 31.02 2.37 41.27 41.71 3.21 6.94 8.05 0.79 Idaho 29.14 29.09 2.12 40.26 42.39 3.53 6.65 7.16 0.57 Illinois 22.03 19.01 0.52 28.24 26.59 1.88 12.99 15.56 2.48 Indiana 21.73 18.72 0.19 30.63 30.10 2.62 10.03 11.77 1.49 Iowa 25.53 21.25 -1.57 32.09 25.88 -3.50 7.98 8.91 1.06 Kansas 24.14 20.83 2.05 30.72 30.50 4.44 9.34 10.23 0.66 Kentucky 17.32 16.98 2.20 22.42 24.10 4.24 13.10 14.46 1.49 Louisiana 16.52 10.01 0.18 19.89 14.71 1.44 13.80 15.95 1.01 Maine 39.42 33.50 -2.75 49.28 43.46 -1.91 8.06 10.24 1.86 Maryland 28.90 29.01 2.56 35.73 37.65 4.01 13.68 16.56 2.75 Massachusetts 26.59 27.32 2.24 33.55 36.36 4.34 10.90 12.43 1.44 Michigan 16.75 18.27 1.53 27.35 30.14 2.50 12.28 14.89 2.74 Minnesota 21.80 25.06 3.53 29.42 34.48 5.14 8.67 10.68 2.02 Mississippi 19.14 13.54 -0.10 24.26 19.58 0.73 13.45 14.84 0.04 Missouri 22.87 17.93 -1.13 29.76 25.83 -0.55 10.80 12.95 2.14 Montana 47.22 45.33 -2.54 59.85 58.66 -2.60 6.51 6.89 0.11 Nebraska 22.54 21.58 2.93 29.22 29.53 4.24 8.51 9.12 0.94 Nevada 28.38 21.47 1.55 37.11 31.80 2.40 9.21 12.29 2.74 New Hampshire 29.81 25.72 0.54 42.39 37.77 0.59 8.12 8.98 1.28 
Division of Health Care Policy and Researc

Table B: Mean outcome rates1 for 2000, 2004, and within-facility change2 by state, region, and market characterist

Community discharge 

in 30 days

Community discharge 

in 100 days 

Rehospitalization 

in 30 days

 2000 2004 Change 2000 2004 Change 2000 2004 Change New Jersey 23.24 24.12 0.96 28.48 31.42 2.65 15.63 17.30 1.91 New Mexico 28.89 29.81 4.62 38.03 41.03 6.57 7.43 9.46 1.43 New York 13.50 17.88 4.47 22.00 27.42 5.54 13.22 15.25 2.13 North Carolina 19.21 19.84 2.21 27.14 29.16 3.40 11.76 13.14 1.40 North Dakota 10.78 12.51 1.68 15.25 19.38 3.84 9.12 8.94 -0.15 Ohio 27.69 23.96 -1.90 37.05 35.34 -0.28 12.02 14.16 2.26 Oklahoma 20.45 15.06 2.52 25.25 21.64 4.40 12.00 14.59 1.76 Oregon 45.30 42.15 -1.03 52.49 54.86 4.35 7.02 10.00 2.53 Pennsylvania 22.27 21.15 1.29 28.90 29.65 2.96 11.30 13.03 1.66 Rhode Island 20.24 23.16 4.91 25.28 29.87 6.77 13.04 13.61 0.78 South Carolina 24.81 21.76 0.29 38.25 34.45 -0.68 11.96 14.10 2.25 South Dakota 22.87 19.11 -2.43 32.56 26.61 -4.47 8.20 8.96 0.91 Tennessee 22.65 20.03 1.88 31.26 29.08 2.54 12.00 15.08 2.68 Texas 18.43 14.96 1.05 23.50 21.43 2.14 12.11 14.88 2.31 Utah 36.31 32.96 -0.53 52.02 50.64 1.26 6.42 7.91 1.61 Vermont 26.59 26.77 2.93 38.29 39.22 4.79 7.98 8.91 1.18 Virginia 25.68 24.07 0.75 36.39 35.77 1.84 12.22 14.12 1.69 Washington 34.51 31.10 -2.45 42.58 43.07 1.52 7.79 10.72 2.81 West Virginia 26.93 23.20 0.00 35.70 31.52 -0.17 12.81 13.31 0.01 Wisconsin 24.31 24.33 -0.44 33.28 35.36 1.76 7.95 10.04 2.27 Wyoming 31.03 28.15 -0.57 41.79 41.51 2.80 7.71 8.66 0.89 Northeast 22.14 23.16 2.28 29.76 32.36 3.80 12.09 13.76 1.72 Midwest 23.08 20.99 0.13 31.20 30.51 1.48 10.66 12.57 2.01 South 21.65 19.15 1.10 28.50 27.14 2.22 12.41 14.64 1.96 West 31.10 28.45 0.34 38.66 38.73 3.01 9.32 11.87 2.41 Rural 21.75 19.81 0.63 29.41 28.34 1.67 10.44 12.20 1.59 Urban 24.44 22.80 1.04 31.88 32.08 2.74 11.71 13.98 2.16 Number of hospitals3 - low4 23.60 23.61 1.33 31.26 33.36 3.21 11.97 14.56 2.41 Number of hospitals - mid4 24.72 23.90 0.83 32.24 33.33 2.43 11.35 13.62 2.06 Number of hospitals - high4 21.56 20.93 0.73 28.87 29.43 1.70 10.64 12.27 1.40 Number of hospital beds3 - low 23.33 23.44 1.39 31.17 33.33 3.23 10.89 13.13 2.03 Number of hospital beds - mid 24.13 23.19 0.59 31.68 32.51 2.08 11.39 13.77 2.15 Number of hospital beds - high 23.01 22.56 1.17 30.08 31.15 2.38 11.64 13.45 1.62 
Division of Health Care Policy and Researc

Table B: Mean outcome rates1 for 2000, 2004, and within-facility change2 by state, region, and market characterist

Community discharge 

in 30 days

Community discharge 

in 100 days 

Rehospitalization 

in 30 days

 2000 2004 Change 2000 2004 Change 2000 2004 Change Number of SNFs3 - low 24.63 23.82 1.04 31.99 33.37 2.96 12.39 15.19 2.51 Number of SNFs - mid 24.00 23.58 1.12 31.57 32.89 2.57 11.28 13.43 1.96 Number of SNFs - high 21.97 21.41 0.46 29.49 30.36 1.67 10.37 12.07 1.51 Number of SNF certified beds3 - low 26.49 25.11 0.97 33.67 34.55 2.93 11.29 14.10 2.45 Number of SNF certified beds - mid 23.57 23.26 1.12 31.23 32.60 2.52 11.56 13.73 1.97 Number of SNF certified beds - high 20.94 20.77 0.52 28.43 29.78 1.82 10.89 12.55 1.57 Number of NFs3 - low 23.10 23.22 1.28 31.01 32.80 2.77 11.10 13.14 1.90 Number of NFs - mid 24.46 23.67 1.10 31.46 32.82 2.92 11.95 14.38 2.15 Number of NFs - high 23.91 22.27 0.04 31.12 31.06 1.28 11.16 13.46 2.00 Number of NF total beds3 - low 23.10 23.22 1.28 31.01 32.80 2.77 11.10 13.14 1.90 Number of NF total beds - mid 24.85 24.17 1.12 31.93 33.43 2.98 11.84 14.21 2.10 Number of NF total beds - high 23.52 21.77 0.02 30.66 30.46 1.23 11.27 13.63 2.05 Number of home health agencies3 - low 22.73 22.63 1.18 30.07 32.02 3.09 12.02 14.46 2.18 Number of home health agencies - mid 24.73 24.10 0.90 32.48 33.72 2.46 11.35 13.52 2.01 Number of home health agencies - high 22.40 21.53 0.75 29.59 30.03 1.76 10.59 12.59 1.73 Medicare managed care penetration rate in SNF’s county - low 20.80 20.58 0.86 28.77 29.75 1.86 10.53 12.39 1.69 Medicare managed care penetration rate in SNF’s county - mid 23.49 23.09 0.96 31.27 32.73 2.55 11.76 13.89 1.93 Medicare managed care penetration rate in SNF’s county - high 26.89 25.79 0.95 33.35 34.43 2.85 11.25 13.97 2.43 

1 Entries in cell are the value of the observed rate for facilities in that stratum and have not been adjusted for differences in case mix. V

percentages. 2 “Change” is within facility change (not the simple subtraction of the two columns) and is defined only for the subset of facilities present 

3 In SNF’s county, per 100,000 population 4 “low” indicates the market characteristic’s bottom 25th percentile in 2000, “mid” indicates the 26th to 74th percentile in 2000, “high” indic

 in 2000 
Division of Health Care Policy and Researc

Table C: Distribution of days until rehospitalization within 100 days of SNF admission for years 2000 through 2004 

012345

0 7 14 21 28 35 42 49 56 63 70 77 84 

Days

Percent of residents
Division of Health Care Policy and Research, UCDHSC, Aurora, CO A7 

Table D: Comparison of mean facility measures1 for facilities that experienced large decreases, 

large increases, or were unchanged in rate of community discharge within 30 days 

between 2000 and 2004 

Characteristic

Decreased 

more than 

0.05 (n=2665)

Changed 0.05 

or less 

(n=4977)

Increased 

more than 

0.05 (n=3534)

Observed community discharge in 30 days for 2000 34.07 19.73 16.61 

Observed community discharge in 30 days for 2004 21.56 19.93 28.68 

Difference in community discharge in 30 days 2000 to 2004 -12.51 0.20 12.07 

Northeast 18.13 20.74 24.01 

Midwest 33.50 30.31 29.80 

South 29.98 35.34 31.45 

West 18.39 13.62 14.74 

Hospital-based 10.81 9.48 9.28 

Non-profit 0.26 0.24 0.31 

Number of NFs2

 for 2000 0.92 0.82 0.74 

Number of NF beds2

 for 2000 75.97 68.27 56.03 

RN hours/resident-day for 2000 0.57 0.52 0.52 

RN hours/resident-day for 2004 0.50 0.48 0.45 

Difference in RN hours/resident-day 2000 to 2004 -0.07 -0.05 -0.05 

Age (years) for 2000 80.32 80.27 81.09 

Age (years) for 2004 79.61 79.25 80.01 

Difference in age 2000 to 2004 -0.72 -1.03 -1.09 

DNR orders for 2000 37.10 38.39 43.08 

DNR orders for 2004 40.37 39.06 40.97 

Difference in DNR orders 2000 to 2004 3.24 0.65 -2.14 

Barthel Index (0-90)3

 for 2000 39.57 35.20 35.10 

Barthel Index (0-90)3 for 2004 36.89 35.54 37.83 

Difference in Barthel Index 2000 to 2004 -2.70 0.33 2.74 

Cognitive Performance Scale (0-6)4

 for 2000 1.80 2.14 2.12 

Cognitive Performance Scale (0-6)4 for 2004 1.86 2.02 1.80 

Difference in Cognitive Performance Scale 2000 to 2004 0.06 -0.12 -0.33 

Bowel incontinence scale (1-4)4

 for 2000 1.17 1.49 1.42 

Bowel incontinence scale (1-4)4 for 2004 1.27 1.43 1.21 

Difference in bowel incontinence scale 2000 to 2004 0.10 -0.06 -0.21 

Rehabilitation RUG for 2000 80.69 74.86 75.62 

Rehabilitation RUG for 2004 78.83 75.84 79.93 

Difference in rehabilitation RUG 2000 to 2004 -1.85 0.97 4.32 

Dementia for 2000 21.48 25.42 25.70 

Dementia for 2004 23.52 25.62 23.02 

Difference in dementia 2000 to 2004 2.05 0.20 -2.70 

Genitourinary disease for 2000 32.01 33.90 33.93 

Genitourinary disease for 2004 38.11 38.84 37.51 

Difference in genitourinary disease 2000 to 2004 6.10 4.95 3.58 

Musculoskeletal disease for 2000 29.48 26.98 27.70 

Musculoskeletal disease for 2004 30.67 29.28 32.05 

Difference in musculoskeletal disease 2000 to 2004 1.19 2.29 4.37 

1

 Values are interpreted as “Mean % of residents in the facility with this condition”, or as “Mean resident value 

 for this item” 

2

 In SNF’s county, per 100,000 population 

3

 Higher values indicate better status 

4

 Lower values indicate better status
Division of Health Care Policy and Research, UCDHSC, Aurora, CO A8 

Table E: Comparison of mean facility measures1 for facilities that experienced large decreases, 

large increases, or were unchanged in rate of rehospitalization within 100 days between 

2000 and 2004 

Characteristic

Decreased 

more than 

0.05

(n=1428)

Changed 

0.05 or less 

(n=5818)

Increased 

more than 

0.05 

(n=3908)

Observed rehospitalization in 100 days for 2000 23.84 14.80 12.19 

Observed rehospitalization in 100 days for 2004 14.35 15.39 22.19 

Difference in rehospitalization in 100 days 2000 to 2004 -9.49 0.59 10.00 

Northeast 22.30 22.65 18.67 

Midwest 30.70 30.21 32.05 

South 34.86 32.34 32.72 

West 12.14 14.80 16.55 

Hospital-based 4.14 14.88 4.18 

Number of hospital beds2 for 2000 383.80 373.55 360.77 

Number of SNFs2

 for 2000 7.88 7.17 7.08 

Number of SNF certified beds2

 for 2000 759.16 713.74 696.98 

Medicare managed care penetration rate in SNF’s county for 2000 13.76 14.27 15.34 

RN hours/resident-day for 2000 0.39 0.65 0.42 

RN hours/resident-day for 2004 0.34 0.58 0.37 

Difference in RN hours/resident-day 2000 to 2004 -0.04 -0.06 -0.05 

Qualifying hospital LOS (days) for 2000 9.37 9.25 9.30 

Qualifying hospital LOS (days) for 2004 8.74 8.78 8.80 

Difference in qualifying hospital LOS 2000 to 2004 -0.64 -0.47 -0.50 

Barthel Index (0-90)3

 for 2000 32.54 37.63 36.03 

Barthel Index (0-90)3 for 2004 35.73 38.17 34.99 

Difference in Barthel Index 2000 to 2004 3.20 0.54 -1.03 

Cognitive Performance Score (0-6)4

 for 2000 2.37 1.93 2.08 

Cognitive Performance Score (0-6)4 for 2004 2.12 1.78 2.00 

Difference in Cognitive Performance Score 2000 to 2004 -0.25 -0.15 -0.09 

Bowel incontinence scale (1-4)4

 for 2000 1.66 1.29 1.41 

Bowel incontinence scale (1-4)4 for 2004 1.44 1.21 1.42 

Difference in bowel incontinence scale 2000 to 2004 -0.22 -0.08 0.01 

Catheter for 2000 23.41 21.66 20.34 

Catheter for 2004 21.33 23.52 23.35 

Difference in catheter 2000 to 2004 -2.08 1.86 3.02 

Pressure ulcer for 2000 25.54 22.71 23.16 

Pressure ulcer for 2004 22.33 22.42 24.73 

Difference in pressure ulcer % 2000 to 2004 -3.22 -0.30 1.56 

Dementia for 2000 27.53 23.06 25.62 

Dementia for 2004 27.88 22.85 24.96 

Difference in dementia 2000 to 2004 0.36 -0.21 -0.67 

Genitourinary disease for 2000 35.94 32.72 33.42 

Genitourinary disease for 2004 38.25 37.10 39.74 

Difference in genitourinary disease 2000 to 2004 2.30 4.37 6.32 

Musculoskeletal disease for 2000 24.77 28.85 27.68 

Musculoskeletal disease for 2004 28.90 32.03 28.99 

Difference in musculoskeletal disease 2000 to 2004 4.12 3.19 1.32 

Respiratory disease for 2000 27.28 25.04 25.12 

Respiratory disease for 2004 26.31 26.16 28.01 

Difference in respiratory disease 2000 to 2004 -0.99 1.11 2.88 

1

 Values are interpreted as “Mean % of residents in the facility with this condition”, or as “Mean resident value 

 for this item” 

2

 In SNF’s county, per 100,000 population 

3

 Higher values indicate better status 

4

 Lower values indicate better status 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO A9 
Division of Health Care Policy and Research

Table F: Differences between facilities present in 20001 versus 20042

Present in 2000 

regardless of 

2004 status 

(n=12,224) 

Present in 2004 

regardless of 

2000 status 

(n=13,351) 

Present in both 2000 & 2004 

(n=11,118) 

Present 

in 2

(n=1

 Means for 

2000 

Means for 

2004 

Means for 

2000 

Means for 

2004 

Mean

20

Observed outcome rates  Community discharge in 30 days 23.66 21.87 22.18 23.09 39.88  Rehospitalization in 100 days 14.69 17.48 15.05 17.64 10.9Mean resident characteristics3 Age (years) 80.39 79.68 80.54 79.57 78.72  DNR orders 38.48 41.11 39.56 39.94 26.68  Do not hospitalize orders 1.86 1.78 1.93 1.79 1.03  Barthel Index (0-90)4 36.70 36.50 36.22 36.58 41.97  Cognitive Performance Scale (0-6)5 2.02 1.94 2.05 1.91 1.69  Bowel incontinence scale (1-4) (MDS item H1a)5 1.37 1.33 1.39 1.32 1.14  Indwelling catheter (MDS item H3d) 22.05 23.00 21.66 23.36 26.2 Feeding tube (MDS item K5b) 9.41 7.21 9.47 7.18 8.62  Parenteral/IV feeding (MDS item K5a) 6.94 11.34 6.70 11.53 9.50  Pressure ulcer (MDS item M2a, any stage) 2.33 22.99 23.52 23.42 21.38  Rehabilitation RUG 76.23 77.42 76.50 77.85 73.54  Community discharge comorbidity index  (-3.5 to 3.3) 

-0.48 -0.49 -0.49 -0.48 -0.43 

 Rehospitalization comorbidity index  (-3.3 to 3.1) 

0.38 0.41 0.38 0.41 0.37 

 Cardiac arrhythmia 25.89 27.41 26.02 27.56 24.5 COPD 22.53 24.04 22.45 24.17 23.46  Dementia 24.02 24.88 24.57 24.29 18.00  Fluid/Electrolyte disorder 29.63 32.28 29.76 32.21 28.32  Fracture 16.21 14.30 16.33 14.19 14.89  Genitourinary condition 33.20 38.30 33.46 38.24 30.45  Uncomplicated hypertension 37.60 43.03 37.69 42.97 36.76  Musculoskeletal disease 27.92 30.34 27.81 30.49 29.18  Nervous system disorder 25.27 25.93 25.57 25.68 21.90  Respiratory disease 25.54 27.00 25.46 26.91 26.29  Skin disorder 12.44 13.25 12.37 13.37 13.22  Valvular disease 7.76 8.8 7.81 8.98 7.18  LOS of qualifying hospital stay (days) 9.25 8.74 9.28 8.78 8.90 
Division of Health Care Policy and Research

Table F: Differences between facilities present in 20001 versus 20042 (continued) 

Present in 2000 

regardless of 

2004 status 

(n=12,224) 

Present in 2004 

regardless of 

2000 status 

(n=13,351) 

Present in both 2000 & 2004 

(n=11,118) 

Present 

in 2

(n=1

 Means for 

2000 

Means for 

2004 

Means for 

2000 

Means for 

2004 

Mean

20

Staffing levels  RN hours/resident-day 0.59 0.45 0.53 0.47 1.33  Licensed nursing hours/resident-day 1.75 1.62 1.65 1.66 2.99  CNA hours/resident-day 2.30 2.42 2.29 2.43 2.39 Facility characteristics  Northeast 20.81 19.21 21.20 21.20 17.17  Midwest 30.79 31.90 30.93 30.94 29.49  South 32.89 34.10 32.80 32.82 33.66  West 15.51 14.79 15.07 15.04 19.69  Hospital-based 13.33 8.66 9.75 9.36 51.83  Urban 71.11 68.91 71.02 71.02 72.60  For-profit 67.01 68.24 68.77 68.50 47.98  Chain 61.31 56.89 61.57 59.11 58.65 Market characteristics  Medicare managed care penetration rate in  SNF’s county 

14.74 10.25 14.58 10.61 16.46 

 Number of hospitals6 2.60 2.68 2.56 2.52 3.03  Number of hospital admissions6 12,651.62 12,710.49 12,549.24 12,846.28 13,803. Number of hospital beds6 374.01 362.52 290.58 370.43 408.92  Number of SNFs6 7.28 7.42 7.23 7.12 7.75  Number of SNF certified beds6 712.07 717.11 713.61 706.36 691.38  Number of NF total beds6 69.10 62.22 66.23 50.07 99.36  Number of home health agencies6 3.12 3.07 3.09 2.93 3.42 1 Sample for 2000 is facilities with non-missing data in 2000 for rehospitalization in 100 days and community 

 discharge in 30 days 2 Sample for 2004 is facilities with non-missing data in 2004 for rehospitalization in 100 days and community  discharge in 30 days 3 Values are percentages unless otherwise noted. Values are interpreted as “Mean % of residents in the facility with this condition”, or a

 for this item” 

4 Higher values indicate better status 5 Lower values indicate better status 6 In SNF’s county, per 100,000 population. Data for 2004 were not available; 2002 data were substituted. 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO A12 

Table G: Comparison of mean facility measures1 for freestanding and hospital-based SNFs 

 

Freestanding

(n=12,176)

Hospital-based

(n=1154) p-value

Mean resident characteristics2

 

 DNR orders 42.12 26.34 <0.0001 

 Barthel Index (0-90)3

 35.84 45.40 <0.0001 

 Cognitive Performance Scale (0-6)4

 2.00 1.19 <0.0001 

 Bowel incontinence scale (1-4) (MDS item H1a)4

 1.37 0.79 <0.0001 

 Indwelling catheter (MDS item H3d) 22.26 28.76 <0.0001 

 Feeding tube (MDS item K5b) 7.32 4.86 <0.0001 

 Parenteral/IV feeding (MDS item K5a) 10.65 18.02 <0.0001 

 Pressure ulcer (MDS item M2a, any stage) 22.96 20.93 <0.0001 

 Rehabilitation RUG 77.73 75.14 0.0117 

 Cardiac arrhythmia 27.40 26.75 0.0002 

 COPD 23.98 24.47 0.0080 

 Dementia 25.98 12.69 <0.0001 

 Fluid/Electrolyte disorder 32.57 28.19 <0.0001 

 Fracture 14.19 15.74 <0.0001 

 Genitourinary condition 38.80 32.16 <0.0001 

 Uncomplicated hypertension 42.94 44.97 <0.0001 

 Musculoskeletal disease 29.78 37.24 <0.0001 

 Nervous system disorder 26.48 19.97 <0.0001 

 Respiratory disease 26.98 26.11 0.0001 

 Skin disorder 13.23 12.74 <0.0001 

 Valvular disease 8.75 9.17 0.0031 

 LOS of qualifying hospital stay (days) 8.75 8.7 0.4678 

 

Staffing levels 

 RN hours/resident-day 0.35 1.72 <0.0001 

 LPN/LVN hours/resident-day 0.82 1.40 <0.0001 

 CNA hours/resident-day 2.40 2.66 <0.0001 

 Licensed nursing hours/resident-day 1.44 3.72 <0.0001 

 Total nursing hours/resident-day 4.09 6.54 <0.0001 

 PT hours/resident-day 0.09 0.42 <0.0001 

 OT hours/resident-day 0.11 0.39 <0.0001 

 Speech therapy hours/resident-day 0.03 0.07 <0.0001 

 Total therapy hours/resident-day 0.23 0.88 <0.0001 

 

Facility characteristics 

 Northeast 19.56 15.69 0.0013 

 Midwest 32.00 30.78 0.4074 

 South 34.05 34.79 0.6251 

 West 14.39 18.74 0.0001 

 Urban 69.68 61.27 <0.0001 

 For-profit 73.45 13.52 <0.0001 

 Non-profit 23.36 69.93 <0.0001 

 Chain 58.95 35.53 <0.0001 

 Total beds in facility 120.98 77.01 <0.0001 
Division of Health Care Policy and Research, UCDHSC, Aurora, CO A13 

Table G: Comparison of mean facility measures1 for freestanding and hospital-based SNFs 

(continued) 

 

Freestanding

(n=12,176)

Hospital-based

(n=1154) p-value

Market characteristics 

 Medicare managed care penetration rate in SNF’s county 10.32 9.95 0.1426 

 Number of hospitals5

 2.60 3.42 <0.0001 

 Number of hospital admissions5

 12,531.89 14,168.15 <0.0001 

 Number of hospital beds5

 348.10 498.04 <0.0001 

 Number of SNFs5

 7.42 7.76 0.0017 

 Number of SNF certified beds5

 721.59 708.83 0.3771 

 Number of NFs5

 0.71 0.72 0.9765 

 Number of NF total beds5

 54.99 67.26 0.6719 

 Number of home health agencies5

 2.99 3.55 <0.0001 

 

NHQI post-acute care QMs 

 Delirium score 3.09 4.39 <0.0001 

 Pain score 20.81 34.26 <0.0001 

 Pressure sores score 20.12 26.40 <0.0001 

1

 Values are percentages unless otherwise noted 

2

 Values are interpreted as “Mean % of residents in the facility with this condition”, or as “Mean resident value 

 for this item” 

3

 Higher values indicate better status 

4

 Lower values indicate better status 

5

 In SNF’s county, per 100,000 population. Data for 2004 were not available; 2002 data were substituted.