ArticleJournal of the American Medical Directors Association2021
Posthospital Nursing Home Utilization and Quality Indicators Among Medicare Beneficiaries in Puerto Rico: Comparison With the United States.
Article in Journal of the American Medical Directors Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 3 citations in OpenAlex.
- Disparities in Total Knee Arthroplasty Outcomes: A Comparison Between Traditional Medicare Beneficiaries in Puerto Rico and the U.S. Mainland.Journal of racial and ethnic health disparities · 2026Article
- Medicare Advantage in the US mainland and Puerto Rico.The American journal of managed care · 2026Observational
- Association of migration with hospitalization and mortality among Medicare beneficiaries with end-stage renal disease in Puerto Rico after Hurricane Maria.Journal of migration and health · 2026Article
- Aging and the Left Behind: Puerto Rico and Its Unconventional Rapid Aging.The Gerontologist · 2022Article
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 1 country.
Funding
Abstract
objectivesThe purpose of the study is to contribute to the literature regarding post-acute nursing home utilization and quality indicators among Medicare beneficiaries in Puerto Rico compared with the US mainland.
designMedicare data from 2015 to 2017 was used to identify new discharges to skilled nursing facilities (SNFs) using the Minimum Data Set and the Medicare Provider Analysis and Review. SETTING AND
participantsPost-acute care patients admitted to SNFs in Puerto Rico and the United States.
methodsOur final cohort included 4,732,222 beneficiaries from Puerto Rico and the United States enrolled in Medicare fee-for-service or Medicare Advantage programs admitted to an SNF (N = 15,197) following an acute hospital stay. We compared demographic, clinical, and facility-level characteristics among patients in Puerto Rico and the United States. We also described 2 quality indicators among these groups: (1) 30-day rehospitalization rates and (2) successful discharge from the facility to the community.
resultsMedicare patients in Puerto Rico were physically and cognitively healthier than patients in the United States. Puerto Ricans were also more likely to be admitted to lower quality nursing homes than US patients (2.5 vs 3.4). Finally, Puerto Ricans had higher rates of successful discharge to the community [17.6, 95% confidence interval (CI) 13.0-22.3], but higher 30-day rehospitalization rates compared with US patients (11.2, 95% CI 6.2-16.3). These differences were consistent even when comparing these quality outcomes among Puerto Ricans to US Hispanics only. CONCLUSIONS AND IMPLICATIONS: SNFs in the United States and Puerto Rico are now receiving financial penalties for high readmission rates. Currently, Medicare does not measure readmission rates for Medicare Advantage patients-even though some states, including Puerto Rico, have a high proportion of Medicare Advantage beneficiaries. As Medicare Advantage enrollment continues to increase, our results highlight the importance of measuring performance among Medicare Advantage patients and assessing disparities in quality of post-acute care among patients in Puerto Rico and the United States.
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