title: Does More Therapy in Skilled Nursing Facilities Lead to Better Outcomes in Patients With Hip Fracture?
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: H-Y. Jung, PhD, Department of Healthcare Policy and Research, Weill Cornell Medical College, 425 East 67th St, New York, NY 10065 (USA). arj2005@med.cornell.edu.
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Jung
authors.affiliation: A.N. Trivedi, MD, MPH, Providence VA Medical Center, Providence, Rhode Island, and Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
authors.affiliation: D.C. Grabowski, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.affiliation: V. Mor, PhD, Department of Health Services, Policy and Practice, Alpert Medical School of Brown University and Providence VA Medical Center.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D005260:Female; D006302:Health Services Research; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D010043:Outcome and Process Assessment, Health Care; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D014481:United States