Care Transitions and Mortality among Skilled Nursing Facility Residents with Opioid Use Disorder

TL;DR

People with opioid use disorder in skilled nursing facilities have higher readmission rates but similar mortality compared to others.

Contribution

This study identifies care transition patterns and outcomes for opioid use disorder patients in skilled nursing facilities using Medicare claims data.

Findings

Residents with OUD had higher readmission and home health use rates but lower mortality risk initially.

After adjustment, OUD residents still had higher readmission and home health use risks but no mortality difference.

Findings highlight the need for improved post-acute care practices for OUD patients.

Abstract

There is growing demand for skilled nursing facility (SNF) services among individuals with opioid use disorder (OUD) for reasons including rising rates of chronic medical conditions and serious infections. Little is known about the characteristics and outcomes of people with OUD admitted to SNFs. We examined differences in health service use and mortality between SNF residents with and without OUD. Using 2016-2020 100% Medicare inpatient claims, we identified hospitalizations with discharge to SNFs. We matched each beneficiary with OUD with up to 5 without OUD based on age, sex, low-income subsidy status, and residential county. Outcomes were hospital readmissions, home health service use, and all-cause mortality within 180 days following hospital discharge. Inverse-probability weighting (IPW) adjusted for demographics, state, year of SNF admission, comorbidity burden, hospital length of stay, intensive care, and select principal diagnoses. Unadjusted and IPW-adjusted risk differences (RDs) were calculated. Among 30,922 beneficiaries with OUD matched to 137,454 without OUD (mean age: 71 years), those with OUD had higher unadjusted risks for readmissions (44.5% vs. 27.9%) and home health use (43.2% vs. 35.4%) but lower mortality risk (16.5% vs. 17.8%). After IPW adjustment, beneficiaries with OUD remained at higher risk for readmissions (RD = 15.8%; 95% CI:15.1%,16.5%) and home health use (RD = 9.6%; 95% CI:9.1%,10.2%) but had no difference in mortality risk (RD=-0.4%; 95% CI:-0.8%,0.1%). Best practices for providing care to individuals with OUD and co-occurring skilled nursing needs must be a near-term focus for post-acute and long-term care practice and policy to help reduce concerning differences in readmission rates.