Rehabilitation Providers' Prediction of the Likely Success of the SNF-to-Home Transition Differs by Discipline.
Adam Simning, Thomas V Caprio, Christopher L Seplaki and 1 others
PMID 30630726WHAT IT FOUND
Occupational and physical therapists’ concerns about a patient’s ability to live independently after skilled nursing facility discharge were linked with failed return home.
Medical providers’ and social workers’ concerns were not linked. Treat therapist predictions as a possible warning sign, not proof.
Key findings
01Occupational therapists’ and physical therapists’ neutral or negative predictions after discharge were significantly associated with increased risk of a failed transition to home.
02Medical providers’ and social workers’ neutral or negative predictions did not show an association with failed transition to home.
03Living alone, more medical conditions, lower physical functioning scores, and greater depression scores were associated with increased risk of a failed transition to home.
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
The study was not designed specifically to test predictive capabilities, so the prediction findings are exploratory. The study did not ask each rehabilitation team member about each patient, and provider experience was not collected. Small numbers in some groups mean the risk estimates should be read cautiously. The failed transition outcome combined long-term care placement, facility readmission, prolonged hospitalization, becoming too ill, and death, so it may not match other discharge outcomes. Only two skilled nursing facilities in Monroe County, New York, were studied, and patients with known dementia or unable to consent were excluded. This may limit generalizability. The study did not have information on functional impairment. Speech and language pathologist predictions could not be examined because there were only 15 cases. 11 patients were lost to follow-up.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that therapist predictions caused failed transitions or should replace objective discharge planning. The study is observational, exploratory, and only found associations for occupational and physical therapists; medical providers and social workers did not show the same association.