Improving Nursing Facility Outcomes using Real-Time Metrics

An increasing number of patients are being discharged to skilled nursing facilities (SNFs) following acute care admissions, but a large proportion of these patients experience a delayed return, or do not return, to the community. In fact, more than 25% of post-acute care admissions to SNFs result in unplanned hospital readmissions. 

Our mission is to improve the health of patients receiving specialized post-acute care following hospitalization. The transitional period is essential to improving healthcare for the increasing proportion of patients requiring SNFs following discharge from the hospital. The multi-disciplinary INFORM collaborative is evaluating the variability in patient, structural, and process factors that contribute to patient-centered outcomes. Through research and quality improvement initiatives for benchmarking standards of care, INFORM is decreasing variability in care delivery and improving the outcomes that matter most to patients.

INFORM partners with the UW Medicine Post-Acute Care (PAC) department to support ongoing practice transformation. UW Medicine PAC represents four hospitals and works directly with a formal network of SNFs in Washington State. As INFORM develops best practices and quality improvement tools, UW Medicine PAC assists in wide scale testing and implementation. Together, we are collaborating to improve care for patients in the post-acute care period.