The Association between Patients’ Physical Function in the Hospital and Their Outcomes in Skilled Nursing Facilities
Study Design. Retrospective observational study. Background. Shifting policies incentivize the appropriate use of skilled nursing facilities (SNFs) by linking reimbursement to patient outcomes. An appropriate recommendation for SNF care following hospitalization is limited by inadequate knowledge of the relationships between clinical presentation in the hospital and the expected outcomes in the SNF. Objectives. The primary objective was to test for relationships between physical function (PF) in the hospital and outcomes in a SNF. Methods and Measures. Data were collected from one academic medical center, five SNFs, and a state all-payer claims database. Primary predictor variables, tested in separate multivariate regression analyses, were PF at hospital admission or discharge. SNF outcomes were PF change, length of stay (LOS), discharge to community, and hospital events occurring within 30 days of hospital discharge. Results. Higher PF at hospital discharge was associated with a 2.3% decrease in SNF LOS (95% confidence interval [CI]=-4.2, -0.3; p=0.025). Trends indicate that those with higher levels of PF at hospital discharge had attenuated PF gains in the SNF (b=-0.13; 95% CI=-0.29, 0.02; p=0.091). No associations were observed between hospital PF and SNF discharge to the community or 30day hospital events. Conclusions. Patients with higher PF in the hospital may expect shorter LOS and potentially attenuated PF gains in the SNF and therefore may not benefit from care in that setting. In larger samples, similar analyses and prospective studies should further explore the associations observed in this study and inform future clinical application.
