• Robert E Burke, Chelsea Leonard, Marcie Lee, Roman Ayele, Ethan Cumbler, Rebecca Allyn, and S Ryan Greysen.
• Center for Health Equity Research and Promotion (CHERP); Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania.
• J Hosp Med. 2020 Jan 1; 15 (1): 222722-27.

BackgroundDecisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions.ObjectiveTo understand whether cognitive biases play an important role in patient and clinician decision-making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases.DesignSecondary analysis of 105 semistructured interviews with patients, caregivers, and clinicians.SettingThree hospitals and three SNFs in a single metropolitan area.PatientsAdults over age 65 discharged to SNFs after hospitalization as well as patients, caregivers, and multidisciplinary frontline clinicians in both hospital and SNF settings.MeasurementsWe identified potential cognitive biases from prior systematic and narrative reviews and conducted a team-based framework analysis of interview transcripts to identify potential biases.ResultsAuthority bias/halo effect and framing bias were the most prevalent and seemed the most impactful, while default/status quo bias and anchoring bias were also present in decision-making about SNFs.ConclusionsCognitive biases play an important role in decision-making about postacute care in SNFs. The combination of authority bias/halo effect and framing bias may synergistically increase the likelihood of patients accepting SNFs for postacute care. As postacute care undergoes a transformation spurred by payment reforms, it is increasingly important to ensure that patients understand their choices at hospital discharge and can make high-quality decisions consistent with their goals.

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