Highlights
- •Sixty minutes per week of combined therapy was associated with community discharge.
- •Less than 60 minutes of therapy was associated with hospital discharge, placement, and death.
- •A minimum of 60 minutes of therapy was associated with 2 fewer days in a skilled nursing facility.
Abstract
Objectives
To determine the association between therapy intensity and discharge outcomes for
aged Medicare skilled nursing facilities (SNFs) fee-for-service beneficiaries and
to determine the association between therapy intensity and time to community discharge.
Design
Retrospective observational design.
Setting
SNFs.
Participants
Aged Medicare fee-for-service beneficiaries (N=311,338) in 3605 SNFs.
Interventions
The total minutes of physical therapy, occupational therapy, and speech therapy per
day were divided into intensity groups: high (≥60min); medium-high (45–<60min); medium-low
(30–<45min); and low (<30min).
Main Outcome Measures
Four discharge outcomes—community, hospitalization, permanent placement, and death—were
examined using a multivariate competing hazards model. For those associated with community
discharge, a Poisson multivariate model was used to determine whether length of stay
differed by intensity.
Results
High intensity therapy was associated with more community discharges in comparison
to the remaining intensity groups (hazard ratio, .84, .68, and .433 for medium-high,
medium-low, and low intensity groups, respectively). More hospitalizations and deaths
were found as therapy intensity decreased. Only high intensity therapy was associated
with a 2-day shorter length of stay (incident rate ratio, .95).
Conclusions
High intensity therapy was associated with desirable discharge outcomes and may shorten
SNF length of stay. Despite growing reimbursements to SNFs for rehabilitation services,
there may be desirable benefits to beneficiaries who receive high intensity therapy.
Keywords
List of abbreviations:
CI (confidence interval), HR (hazard ratio), LOS (length of stay), MDS (Minimum Data Set), OT (occupational therapy), PPS (prospective payment system), PT (physical therapy), SNF (skilled nursing facility), ST (speech therapy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 28, 2017
Footnotes
Current affiliation for O'Brien, Department of Physical Therapy, School of Health and Human Services, Nazareth College, Rochester, NY; Zhang, Department of Public Health Sciences, School of Public Health, University of Massachusetts Amherst, MA.
Supported by the Agency of Healthcare Research and Quality (grant no. 5 T32 HS 44-22).
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
