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Multiparticipant Rehabilitation in Skilled Nursing Facilities: An Observational Comparison Study
Allison M Gustavson1, Jeri E Forster2, Cherie V LeDoux3
1Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.
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.
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