期刊
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
卷 21, 期 12, 页码 1920-1925出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jamda.2020.05.002
关键词
Skilled nursing facility; rehabilitation; post-acute care; group therapy
资金
- 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)
- Foundation for Physical Therapy (Promotion of Doctoral Studies I scholarship)
- Foundation for Physical Therapy (Promotion of Doctoral Studies II scholarship)
- Academy of Geriatric Physical Therapy (Fellowship for Geriatric Research and Adopt-A-Doc)
- National Institute on Aging (underNationalInstitutes ofHealth) Training Grant [T32AG000279]
- Veterans Health Administration Office of Academic Affiliations Advanced Fellowship in Clinical and Health Services Research [TPH 67e000]
- Minneapolis Center of Innovation, Center for Care Delivery and Outcomes Research [CIN 13e406]
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 speedatadmissionand discharge. Unadjusted binomial logistic regressionmodels analyzed the odds ratio for receivingmultiparticipant 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 comparedwithMedicare 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 therapywere 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. (C) 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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