Multiparticipant Rehabilitation in Skilled Nursing Facilities: An Observational Comparison Study

Allison M. Gustavson; Jeri E. Forster; Cherie V. LeDoux; Jennifer E. Stevens-Lapsley

doi:10.1016/j.jamda.2020.05.002

Multiparticipant Rehabilitation in Skilled Nursing Facilities: An Observational Comparison Study

Allison M. Gustavson
, Jeri E. Forster
, Cherie V. LeDoux
, Jennifer E. Stevens-Lapsley

Medicine - Veteran's Administration Medical Center

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1920-1925
Number of pages	6
Journal	Journal of the American Medical Directors Association
Volume	21
Issue number	12
DOIs	https://doi.org/10.1016/j.jamda.2020.05.002
State	Published - Dec 2020

Bibliographical note

Funding Information:
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.

Publisher Copyright:
© 2020

Keywords

group therapy
post-acute care
rehabilitation
Skilled nursing facility

PubMed: MeSH publication types

Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

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10.1016/j.jamda.2020.05.002

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@article{66baa6aeb7b3453f9f60c8e18757a558,

title = "Multiparticipant Rehabilitation in Skilled Nursing Facilities: An Observational Comparison Study",

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 = "group therapy, post-acute care, rehabilitation, Skilled nursing facility",

author = "Gustavson, \{Allison M.\} and Forster, \{Jeri E.\} and LeDoux, \{Cherie V.\} and Stevens-Lapsley, \{Jennifer E.\}",

note = "Funding Information: 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. Publisher Copyright: {\textcopyright} 2020",

year = "2020",

month = dec,

doi = "10.1016/j.jamda.2020.05.002",

language = "English (US)",

volume = "21",

pages = "1920--1925",

journal = "Journal of the American Medical Directors Association",

issn = "1525-8610",

publisher = "Elsevier Inc.",

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}

TY - JOUR

T1 - Multiparticipant Rehabilitation in Skilled Nursing Facilities

T2 - An Observational Comparison Study

AU - Gustavson, Allison M.

AU - Forster, Jeri E.

AU - LeDoux, Cherie V.

AU - Stevens-Lapsley, Jennifer E.

N1 - Funding Information: 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. Publisher Copyright: © 2020

PY - 2020/12

Y1 - 2020/12

N2 - 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.

AB - 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.

KW - group therapy

KW - post-acute care

KW - rehabilitation

KW - Skilled nursing facility

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ER -

Multiparticipant Rehabilitation in Skilled Nursing Facilities: An Observational Comparison Study

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

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