Category: Geriatric Rehabilitation; Brain Injury
To examine the effect of patients' beliefs about capability for increased independence with activities of daily living on successful community discharge from a skilled nursing facility (SNF).
Design : Retrospective cohort study of SNF residents using 100% Medicare inpatient claims and Minimum Data Set resident assessment data. Adjusted logistic regression was used to obtain the probability of successful community discharge among patients with positive or negative beliefs adjusted for demographics, comorbidities and facility characteristics. Standard errors were clustered at the SNF-level.
Setting : U.S. skilled nursing facilities.
Participants (or Animals, Specimens, Cadavers) :
Medicare beneficiaries discharged to SNF following hospitalization for hip fracture, stroke or TBI between 2011-2015.
Interventions : Not Applicable.
Main Outcome Measure(s) : Successful community discharge (discharged alive within 90 days of SNF admission and remaining in the community for ≥ 30 days without dying or healthcare facility readmission).
Results : The sample included 720,712 Medicare beneficiaries, 60% with hip fracture, 31% with stroke, and 8% with TBI. Among patients with hip fracture, the adjusted probability of successful community discharge for those with positive beliefs was 68% and for those with negative beliefs was 61% (Difference: 6.6%, 95% CI 5.9%-7.2%). Among patients with stroke, the adjusted probability of successful community discharge for those with positive beliefs was 53% and for those with negative beliefs was 44% (Difference: 9.0%, 95% CI 8.3%-9.8%). Among patients with TBI, the adjusted probability of successful community discharge for those with positive beliefs was 59% and for those with negative beliefs was 50% (Difference: 9.0%, 95% CI 7.1%-10.0%).
Conclusions : Positive beliefs about capability for improvement are significantly associated with increased probability of successful community discharge from SNF for hip fracture, stroke, and TBI patients. Understanding patient belief's maybe an important to discharge planning.