The Association between Patients’ Physical Function in the Hospital and Their Outcomes in Skilled Nursing Facilities
Abstract
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.
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Joshua Kurt Johnson
As a physical therapist researcher, I seek to better understand and improve rehabilitation care delivery using the learning health system framework. This prompts overlap in my work between data science and implementation science. I have the opportunity to use various sources of health data and engage in multiple quantitative and qualitative research methods. My work also lends naturally to partnership with healthcare leaders and clinicians. To facilitate this work, I have several roles at Duke University. In the School of Medicine, I am an Assistant Professor in the Division of Physical Therapy, Department of Orthopaedic Surgery, and Department of Population Health Sciences. I am also the Clinical Research Lead for the Duke University Health System Department of Rehabilitation and a member of the Duke Clinical Research Institute. Prior to joining the faculty at Duke, I was the Director of PM&R Outcomes Research at Cleveland Clinic. My PhD training was at the University of Utah. I hold a Doctor of Physical Therapy degree from Arcadia University and Bachelors degree in Athletic Training from Brigham Young University.
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