Department of Rehabilitation Medicine, University of Washington, Seattle.
Am J Speech Lang Pathol. 2024 Mar 7;33(2):912-936. doi: 10.1044/2023_AJSLP-23-00025. Epub 2024 Jan 12.
Skilled nursing facility (SNF) care has historically been influenced by systemic issues that could impact speech-language pathology (SLP) service provision. However, there has been little study specifically on factors associated with SLP service provision in SNFs. Large administrative data sets are rarely analyzed in SLP research but can be used to understand real-world SLP services. This study investigated associations between patient and facility characteristics and SLP services.
Mixed-effects logistic regression models were used to evaluate factors associated with SLP service provision in 2018 Medicare administrative data representing 833,653 beneficiaries.
Beneficiaries had higher odds of receiving SLP services when they had neurologic diagnosis (odds ratio [OR] = 3.32), had SLP-related functional impairments (ORs = 1.19-3.41), and received other rehabilitative services (ORs = 3.11-3.78). Beneficiaries had lower odds of receiving SLP services when they received care from SNFs located in hospitals versus freestanding (OR = 0.45), with need for interpreter services (OR = 0.76) and with thresholding (OR = 0.68), a financially motivated practice. Direction of association varied across racial and ethnic groups and measures of location. Odds of being provided SLP services decreased with increasing communication impairment severity.
The results suggest that clinicians are identifying patients with diagnoses most likely to warrant SLP services. However, association disparities and weakening association of service provision with increasing impairment severity have concerning clinical implications. Health services research methods can be used to further explore SLP practices in SNFs to support equitable service provision.
长期以来，熟练护理机构（SNF）的护理受到可能影响言语语言病理学（SLP）服务提供的系统问题的影响。然而，专门研究与 SNF 中 SLP 服务提供相关的因素的研究很少。大型行政数据集在 SLP 研究中很少被分析，但可以用于了解真实世界的 SLP 服务。本研究调查了患者和设施特征与 SLP 服务之间的关联。
使用混合效应逻辑回归模型来评估 2018 年医疗保险行政数据中与 SLP 服务提供相关的因素，该数据代表了 833653 名受益人。
当受益人具有神经诊断（优势比 [OR] = 3.32）、具有 SLP 相关的功能障碍（ORs = 1.19-3.41）和接受其他康复服务（ORs = 3.11-3.78）时，他们接受 SLP 服务的可能性更高。当受益人从医院附属的 SNF 接受护理而不是独立的 SNF 接受护理时（OR = 0.45），需要口译服务（OR = 0.76）和阈值（OR = 0.68）时，他们接受 SLP 服务的可能性较低，这是一种基于财务动机的做法。关联的方向在不同的种族和族裔群体以及位置测量中有所不同。接受 SLP 服务的可能性随着沟通障碍严重程度的增加而降低。
结果表明，临床医生正在识别最有可能需要 SLP 服务的患者。然而，关联差异和服务提供与损伤严重程度增加之间关联的减弱具有令人关切的临床意义。健康服务研究方法可用于进一步探讨 SNF 中的 SLP 实践，以支持公平的服务提供。
