Background Skilled nursing facilities (SNFs) have increasingly been providing more therapy hours to beneficiaries of Medicare. It is not known whether these increases have improved patient outcomes.
Objective The study objectives were: (1) to examine temporal trends in therapy hour volumes and (2) to evaluate whether more therapy hours are associated with improved patient outcomes.
Design This was a retrospective cohort study.
Methods Data sources included the Minimum Data Set, Medicare inpatient claims, and the Online Survey, Certification, and Reporting System. The study population consisted of 481,908 beneficiaries of Medicare fee-for-service who were admitted to 15,496 SNFs after hip fracture from 2000 to 2009. Linear regression models with facility and time fixed effects were used to estimate the association between the quantity of therapy provided in SNFs and the likelihood of discharge to home.
Results The average number of therapy hours increased by 52% during the study period, with relatively little change in case mix at SNF admission. An additional hour of therapy per week was associated with a 3.1-percentage-point (95% confidence interval=3.0, 3.1) increase in the likelihood of discharge to home. The effect of additional therapy decreased as the Resource Utilization Group category increased, and additional therapy did not benefit patients in the highest Resource Utilization Group category.
Limitations Minimum Data Set assessments did not cover details of therapeutic interventions throughout the entire SNF stay and captured only a 7-day retrospective period for measures of the quantity of therapy provided.
Conclusions Increases in the quantity of therapy during the study period cannot be explained by changes in case mix at SNF admission. More therapy hours in SNFs appear to improve outcomes, except for patients with the greatest need.
Dr Jung, Dr Trivedi, and Dr Mor provided concept/idea/research design. Dr Jung provided writing and project management. Dr Jung and Dr Mor provided data analysis. Dr Trivedi and Dr Grabowski provided consultation (including review of manuscript before submission).
The study was approved by the Brown University Institutional Review Board.
This study was supported by the Agency for Healthcare Research and Quality (R36 Health Services Research Dissertation Grant Award HS20756 to Dr Jung) and the National Institute on Aging (Program Project Grant 1P01AG027296, Shaping Long-Term Care in America, Principal Investigator: Dr Mor). The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the US Department of Veterans Affairs or the US Government.
- Received February 18, 2015.
- Accepted November 5, 2015.
- © 2016 American Physical Therapy Association