Volume 54 | Number 3 | June 2019

Abstract List

Kira L. Ryskina, Yihao Yuan MS, Rachel M. Werner M.D., Ph.D.


To measure the association between clinician specialization in nursing home () practice and outcomes of patients who received postacute care in skilled nursing facilities (s).

Data Sources

Medicare claims and assessments for 2 118 941 hospital discharges to 14 526 s in January 2012‐October 2014 and ‐ data for 52 379 clinicians.

Study Design

Generalist physicians and advanced practitioners with ≥ 90 percent of claims for ‐based care were considered specialists. The primary clinician during each stay was determined based on plurality of claims during that stay. We estimated the effect of being treated by a specialist on 30‐day rehospitalizations, successful discharge to community, and 60‐day episode‐of‐care Medicare payments (Parts A and B). All models included patient demographics, clinical variables, and fixed effects.

Principal Findings

Nursing home specialists' patients were less likely to be rehospitalized (14.71 percent vs 16.23 percent; adjusted difference, −1.51 percent, 95% −1.78 to −1.24), more likely to be successfully discharged to community (56.33 percent vs 55.49 percent; adjusted difference, 0.84 percent, 95% 0.54 to 1.14), but had higher 60‐day Medicare payments ($31 628 vs $31 292; adjusted difference, $335; 95% $242 to $429).


Clinicians who specialize in practice may achieve better postacute care outcomes at slightly higher costs.