Documentation of Functional Goals and Association with Functional Improvement during a Skilled Nursing Facility Stay

Abstract

<h3>Research Objectives</h3> To describe the documentation of discharge goals as required by the Skilled Nursing Facility (SNF) Quality Reporting Program and determine if the number of documented goals is associated with functional improvement during a SNF stay. <h3>Design</h3> Analysis of 100% national Centers for Medicare and Medicaid Services data files from October 1, 2018 to December 31, 2019. <h3>Setting</h3> Skilled nursing facilities in the United States. <h3>Participants</h3> Medicare beneficiaries admitted to a SNF within 3-days of hospital discharge and who had complete functional data at the admission and discharge assessments (N=698,209). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> For each of the 23 self-care and mobility activities, we considered a score of 1 (dependent) – 6 (independent) to be a valid score. The goal scores from the admission assessment were compared to the discharge performance scores to identify residents who met or exceeded their goal. Eight self-care and mobility activities were used to calculate total scores in function at admission and discharge (range 8-48 points). Linear regression was used to model the change in function according to the number of documented goals (0, 1, 2-7, 8 goals). <h3>Results</h3> Nearly all residents had a valid goal score for at least one activity. The percentage of residents with a valid goal score ranged from 25.2% (walk twelve steps) to 80.8% (toileting hygiene). The percentage of residents who met or exceeded their goal ranged from 48.2% (shower/bathe) to 79.2% (eating). The adjusted change in function for residents with 0 goals (-0.63 points, p< 0.05) but not 1 (-0.07, p>0.05) or 2-7 (0.05, p>0.05) goals was significantly lower than residents with 8 goals. <h3>Conclusions</h3> SNFs are routinely documenting functional goals, but the percentage of residents who meet or exceed their goals varies widely by activity. The number of documented goals was not meaningfully associated with functional improvement. <h3>Author(s) Disclosures</h3> No authors have any conflicts to disclose.