Abstract
Objectives
Post-acute care reform creates an impetus for skilled nursing facilities (SNFs) to
reevaluate care delivery to promote value. One method to contain costs is to deliver
rehabilitation with multiple individuals and 1 therapist. Our preliminary investigation
proposed to identify clinical prescribing patterns for multiparticipant therapy and
evaluate the impact on functional change.
Design
The study design was observational with prospective data collection.
Setting and Participants
Data were collected on 458 individuals admitted to 1 SNF.
Measures
Therapists administered the Short Physical Performance Battery (SPPB) and gait speed
at admission and discharge. Unadjusted binomial logistic regression models analyzed
the odds ratio for receiving multiparticipant therapy. Linear regression models analyzed
the impact of multiparticipant therapy on functional outcomes.
Results
The odds of receiving multiparticipant therapy were greater with private pay or managed
care compared with Medicare A [odds ratio (OR) 2.542; 95% confidence interval (CI)
1.631–3.960 and OR 2.182; 95% CI 1.812–2.629] or a Medicare priority diagnosis (OR
1.333; 95% CI 1.176–1.511). The odds of not receiving multiparticipant therapy were
greater with pain that affects activity and sleep (OR 0.836; 95% CI 0.710–0.984; OR
0.809; 95% CI 0.662–0.989). The amount of multiparticipant therapy sessions did not
affect adjusted functional change in the SPPB or gait speed (P > .195). Irrespective of care delivery mode, individuals demonstrated levels of function
predictive of adverse events at discharge.
Conclusions and Implications
Payer source, diagnosis, and presence of significant pain may play a role in selection
for multiparticipant therapy, with no differences in functional outcomes related to
rehabilitation delivery. Importantly, individuals discharge from the SNF at alarmingly
low levels of function, prompting the need to assess SNF rehabilitation and transition
to the community, regardless of care delivery mode. Further research will inform an
evidence-based decision guide regarding different modes and quality of SNF rehabilitation
care delivery.
Keywords
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Article info
Publication history
Published online: July 06, 2020
Footnotes
The authors declare no conflicts of interest.
This work was supported in part by a Small Projects in Rehabilitation Research grant from the U.S. Department of Veterans Affairs Rehabilitation Research and Development Services (I21 RX002193); Foundation for Physical Therapy (Florence P. Kendall Award, Promotion of Doctoral Studies I and II scholarships); Academy of Geriatric Physical Therapy (Fellowship for Geriatric Research and Adopt-A-Doc); National Institute on Aging (under National Institutes of Health) Training Grant (T32 AG000279); the Veterans Health Administration Office of Academic Affiliations Advanced Fellowship in Clinical and Health Services Research (TPH 67–000), and the Minneapolis Center of Innovation, Center for Care Delivery and Outcomes Research (CIN 13–406). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.
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© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
