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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 04, 2017
Footnotes
Supported through cooperative agreement U81HP26495, Health Workforce Research Centers, with the National Center for Health Workforce Analysis (NCHWA), Bureau of Health Workforce (BHW), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS). The information, conclusions, and opinions expressed in this manuscript are those of the authors, and no endorsement by NCHWA, BHW, HRSA, or HHS is intended or should be inferred. The data used for this project was partially funded by the Pharmacoepidemiology Gillings Innovation Lab for the Population-Based Evaluation of Drug Benefits and Harms in Older US Adults (grant no. GIL 200811.0010), the Center for Pharmacoepidemiology, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health; the CER Strategic Initiative of the University of North Carolina's Clinical Translational Science Award (no. UL1TR001111); the Cecil G. Sheps Center for Health Services Research, University of North Carolina; and the University of North Carolina School of Medicine.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
