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Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care

Published:April 04, 2017DOI:https://doi.org/10.1016/j.apmr.2017.03.007

      Abstract

      Objective

      To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke.

      Design

      Retrospective cohort analysis of Medicare claims (2010–2013) linked to hospital-level and county-level data.

      Setting

      Acute care hospital and community.

      Participants

      Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke.

      Interventions

      Not applicable.

      Main Outcome Measures

      Physical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics.

      Results

      Seventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use.

      Conclusions

      Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use.

      Keywords

      List of abbreviations:

      PCP (primary care physician), PMR (physical medicine and rehabilitation), RN (registered nurse)
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