LAUSR

OBJECTIVE Examine the association of patient and direct-care staff beliefs about patients' capability to increase independence with activities of daily living (ADLs) and the probability of successful discharge to the community following a skilled nursing facility (SNF) stay. DESIGN Retrospective cohort study of SNF patients using 100% Medicare inpatient claims and Minimum Data Set resident assessment data. Linear probability models were used to estimate the probability of successful discharge based on patient and staff beliefs about the patient's ability to improve in function and patients and staff beliefs together. Estimates were adjusted for demographic, health status, functional characteristics, and SNF fixed effects. PARTICIPANTS Fee-for-service Medicare beneficiaries aged ≥66 years who were discharged to a SNF following hospitalization for stroke, hip fracture or TBI. INTERVENTIONS Not Applicable MAIN OUTCOME MEASURES: Successful community discharge (discharged alive within 90 days of SNF admission and remaining in the community for ≥ 30 days without dying or health care facility readmission). RESULTS Patients with positive beliefs about their capability to increase independence with ADLs had a higher adjusted probability of successful discharge than patients with negative beliefs (positive: 63.8%, negative: 57.8%, difference: 6.0%, 95%CI=5.4, 6.6%). This remained true regardless of staff beliefs, but the difference in successful discharge probability between patients with positive and negative beliefs was larger when staff had positive beliefs. Conversely, the association between staff beliefs and successful discharge varied based on patient beliefs: if patients had positive beliefs, the difference in the probability of successful discharge between positive and negative staff beliefs was 2.5% (95%CI=1.0, 4.0). If patients had negative beliefs, the difference between positive and negative staff beliefs was -4.6% (95%CI=-6.0, -3.2). CONCLUSIONS Patients' beliefs have a significant association with the probability of successful discharge. Understanding patients' beliefs is critical to appropriate goal-setting, discharge planning and quality SNF care.