Therapy Intensity in SNF
Jette,D., Warren, R. and Wirtalla, C. (2005) The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities. Archives of Physical Medicine and Rehabilitation; 86:373-379
Objective: To examine the relationship between therapy intensity, including physical, occupational and speech and language therapy, provided in a skilled nursing facility (SNF) setting and patients’ outcomes as measured by length of stay and scores on the functional independence measure(FIM™).
Design: 7, 273 patients with stroke, orthopedic, cardiovascular/pulmonary and ‘other disabling conditions’ in 68 SNFs, covered by Medicare+Choice plans, and admitted to a SNF in 2002 were investigated. Length of stay, total FIM score at discharge, and achievement of stage 4 independence in the mobility (FIS), activities of daily living and executive control domains of function as measured by the FIM were used as outcome measures.
Results: Higher therapy intensity was associated with shorter lengths of stay and higher discharge FIM. The relationship between therapy intensity and independence stage varied across medical condition, domain of function, and type of therapy. Therapy intensity accounted for small proportions of model variances in all outcomes. Odds of improving at least one FIS stage varied across PT, OT and SLP depending upon impaiment group
Conclusions: Greater therapy intensity tends to be associated with better functional outcomes and reduced length of stay (cost).
Relevance: Health plans should require a minimum therapy hours/day rate when contracting with SNF providers: at 7 days/wk: 1.5 hours; at 6 days/wk: 1.8 hours and at 5 days/wk: 2 hours daily. This is the first study to show a significant and useful relationship between therapy intensity and outcome.
