Abstract
Objectives
To examine the association of patient and direct-care staff beliefs about patients’
capability to increase independence with activities of daily living (ADL) and the
probability of successful discharge to the community after a skilled nursing facility
(SNF) stay.
Design
Retrospective cohort study of SNF patients using 100% Medicare inpatient claims and
Minimum Data Set resident assessment data. Linear probability models were used to
estimate the probability of successful discharge based on patient and staff beliefs
about the patient’s ability to improve in function, as well as patient and staff beliefs
together. Estimates were adjusted for demographics, health status, functional characteristics,
and SNF fixed effects.
Participants
Fee-for-service Medicare beneficiaries (N=526,432) aged 66 years or older who were
discharged to an SNF after hospitalization for stroke, hip fracture, or traumatic
brain injury.
Interventions
Not applicable.
Main Outcome Measures
Successful community discharge (discharged alive within 90d of SNF admission and remaining
in the community for ≥30d without dying or health care facility readmission).
Results
Patients with positive beliefs about their capability to increase independence with
ADLs had a higher adjusted probability of successful discharge than patients with
negative beliefs (positive, 63.8%; negative, 57.8%; difference, 6.0%, 95% confidence
interval [CI], 5.4-6.6). This remained true regardless of staff beliefs, but the difference
in successful discharge probability between patients with positive and negative beliefs
was larger when staff had positive beliefs. Conversely, the association between staff
beliefs and successful discharge varied based on patient beliefs. If patients had
positive beliefs, the difference in the probability of successful discharge between
positive and negative staff beliefs was 2.5% (95% CI, 1.0-4.0). If patients had negative
beliefs, the difference between positive and negative staff beliefs was –4.6% (95%
CI, –6.0 to –3.2).
Conclusions
Patients’ beliefs have a significant association with the probability of successful
discharge. Understanding patients’ beliefs is critical to appropriate goal-setting,
discharge planning, and quality SNF care.
Keywords
List of abbreviations:
ADL (activities of daily living), BMI (body mass index), CI (confidence interval), CMS (Centers for Medicare and Medicaid Services), ICU (intensive care unit), MDS (Minimum Data Set 3.0), SNF (skilled nursing facility), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 26, 2020
Footnotes
Supported by the National Institutes of Health (NIH; grant no. P01AG027296), the National Institute on Aging (NIA; grant no. R21AG059120), the Agency for Healthcare Research and Quality (AHRQ; grant no. 5T32HS000011), and the U.S. Department of Veterans Affairs Health Services Research and Development Service (grant no. CDA 14-422). The NIH, NIA, and AHRQ had no role in the design or conduct of the study including management, analysis, or interpretation of the data, or preparation of the manuscript; and the Veterans Administration had no role in the design or conduct of the study. E.E. received support through the Foundation for Physical Therapy–funded Center on Health Services Training and Research.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health, the Department of Veterans Affairs, or the United States government.
Disclosures: none.
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© 2020 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
