Is More Always Better? Financially Motivated Therapy and Patient Outcomes in Skilled Nursing Facilities.
Rachel A Prusynski, Bianca K Frogner, Sean D Rundell and 2 others
PMID 37541357WHAT IT FOUND
Therapy minutes just over payment thresholds were linked to slightly higher chances of functional improvement and community discharge.
The community discharge association was strongest for patients receiving under 500 weekly therapy minutes.
Key findings
01The cohort included 934,677 SNF stays in 13,949 SNFs, and thresholding occurred in 56.4% of patients.
02Thresholding was associated with 1.07 times higher odds of functional improvement (95% CI 1.06, 1.09), a 1.5% higher predicted probability.
03Thresholding was associated with 1.03 times higher odds of community discharge (95% CI 1.02, 1.05), a 0.5% higher predicted probability, and 1.27 times higher odds among patients receiving under 500 weekly therapy minutes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is an observational study of administrative records. It shows associations between thresholding and outcomes, not proof that extra minutes caused better function or discharge. The data did not include hospital readmission outcomes or upstream factors from hospitalization, inpatient rehabilitation before the SNF stay, or hospitalizations during the SNF stay. The records did not differentiate acuity or severity within active diagnoses, so effects for specific groups such as acute fracture or stroke may be masked. Speech therapy minutes were used only to detect thresholding and were not included in therapy intensity adjustment or weekly therapy stratification, so the study does not isolate speech therapy effects. The reported predicted probability differences were small: 1.5% for functional improvement and 0.5% for community discharge.
Declared interests
All authors declared no conflicts of interest.
The easy way to misread this
Do not read these positive results as proof that extra therapy minutes caused better function or discharge. The study is observational and the authors state it demonstrates associations, not causality.