A recently published study in the Journal of the American College of Surgeons proposed using the rate of discharge to post-acute care facilities after major surgery as a benchmark for hospital quality.

Five healthcare quality leaders weighed in on the proposal for Becker’s and shared more about the unique considerations and risk factors that influence discharge decisions.

Editor’s note: Responses have been lightly edited for clarity and length.

Question: How do you see the role of post-acute care evolving in light of national efforts to use discharge rates as a quality measure? Are there risks in overemphasizing this metric?

Jose Azar, MD. Executive Vice President, Chief Quality Officer and Network Service Line Officer at Hackensack Meridian Health (Edison, N.J.): Overall, I think the rate of discharge to post-acute care facilities after major surgery is a strong measure of quality, as long as it is risk adjusted like other quality metrics to the type of surgery performed and the complexity of the patient’s condition and existing comorbidities. It would also be helpful to account in the data for social drivers of recovery, including the level of support and resources a patient has at home and in their community.

Additionally, while discharge to post-acute care can be a quality metric for acute care institutions, it is also important to ensure post-acute care facilities are delivering high-quality care by paying attention to and measuring the quality of care these facilities provide. This can be achieved by using the same rigor that acute care quality is measured by.

Jacqueline Gisch. Vice President of Safety, Quality and Patient Experience at Baptist Health (Louisville, Ky.): Baptist Health is fortunate to have strong relationships with numerous local post-acute providers, as post-acute care is necessary for many high-risk patients. Continuity of care, social determinants of health and family support all play an important role in preparing patients for the most appropriate discharge location and achieving lasting, positive outcomes.

Tracey Hoke, MD. Chief of Quality and Performance Improvement, and Acting Chief of Population Health at UVA Health (Charlottesville, Va.): It is my experience that patients and families want to return home as soon as possible after an acute care admission. Working in a place that provides a significant amount of care to rural populations has taught me that this is contingent upon both the health system and the community to develop, provide and connect to the home health care delivery resources that are needed to achieve safe and appropriate home discharge.

To this end, post-acute care discharge rates are a reasonably good proxy measure of holistic thinking and innovation in terms of care delivery across the continuum. Risks include increased lengths of stay while post-discharge care is being arranged and unsafe discharges when discharge to home is inappropriate. These risks can be mitigated through a combination of technical and workforce approaches to ensure adequate monitoring, ongoing care and local follow-up after an acute care admission.

Deborah Rhodes, MD. Chief Quality Officer at Yale New Haven (Conn.) Health and Yale Medicine (New Haven, Conn.): The recent study by Remer et al. highlights the substantial variation across U.S. hospitals in discharge to home rates, which is an important quality metric given the association of post-acute care settings with higher rates of readmission, mortality and higher costs.

As with other quality measures, progress will depend on a combination of research to identify best practices and local quality improvement. Critical areas for further study include selection of patients for prehabilitation, use of robust risk assessment criteria to guide disposition, cost-effective mobilization strategies and enhanced partnerships with home health and community resources.

Just as was done in the Remer study, our hospital system is evaluating risk factors for outlier rates of post-acute utilization to identify patients that would benefit from these strategies and from focused education and expectation setting regarding “Home is Best.” The degree to which social determinants of health influence post-acute utilization is not well understood, so risk adjustment will be important to avoid disproportionately penalizing hospitals serving the most vulnerable patients.

Michael Rinke, MD, PhD. Vice President and Chief Quality Officer at Montefiore Medical Center (New York City): Montefiore Health System is proud to provide best-in-class care for all surgical patients. Part of how we achieve this is by placing the patients and caregivers at the front and center of all care decisions. Just as important is ensuring we’re consistently monitoring all of our processes and patient outcomes. For example, at Montefiore, we closely track discharges to post-acute care through the NSQIP database and work vigorously to ensure we’re always looking to see how this care can be enhanced.

In our view, one of the most critical factors is that patients are discharged to the safest care possible after surgery based on their specific situations. Measures like post-acute care discharges, while developed with the best intentions, can inadvertently encourage teams to discharge patients to home who may not be safe in that setting. Measures like this also have the potential to dissuade surgeons from operating on some of the most vulnerable individuals, who likely require a post-acute care discharge.

No one metric can achieve every goal, but by allowing these measures to be informed by different patient circumstances and evaluating impact over time, the better positioned we all are to achieve our ultimate goal — providing the best and safest care possible.

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