Positive Beliefs and the Likelihood of Successful Community Discharge From Skilled Nursing Facilities.
Emily Evans, Cyrus M Kosar, Kali S Thomas
PMID 32991871WHAT IT FOUND
Patients who believed they could become more independent were 6.0% more likely to return home successfully than those who did not.
Staff optimism only helped if the patient also believed. If patients were pessimistic, staff optimism was linked to lower discharge success.
Key findings
01Positive patient beliefs were associated with a 6.0% increase in the probability of successful discharge compared to negative beliefs.
02Positive staff beliefs only increased the probability of successful discharge when patients also held positive beliefs; if patients had negative beliefs, positive staff beliefs were associated with a lower probability of discharge.
03The study defined successful discharge as returning home and remaining there without readmission, hospice use, or death for 30 continuous days.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study used administrative data and could not account for factors like staff training, patient-centered approaches, family support, or pre-injury functional status. Information about health care utilization after the SNF stay was not included. The study could not assess awareness of deficits, which may bias self-reported beliefs in patients with cognitive impairment. Data on injury severity for stroke and TBI patients was limited. Findings may not generalize to non-Medicare beneficiaries or those enrolled in Medicare Advantage.
Declared interests
The study was supported by research grants from the National Institutes of Health (N.I.H., Extramural; Non-U.S. Gov't; U.S. Gov't, P.H.S.). No other conflicts of interest are reported in the provided text.
The easy way to misread this
Do not interpret the association as causation. The study shows that patients who believe they can improve are more likely to be discharged, but it does not prove that simply changing a patient's belief will change the outcome. The negative association between staff optimism and patient pessimism suggests complex interactions that administrative data cannot fully explain.