Abstract
Objectives
To determine whether receipt of therapy and number and timing of therapy visits decreased
hospital readmission risk in stroke survivors discharged home.
Design
Retrospective cohort analysis of Medicare claims (2010–2013).
Setting
Acute care hospital and community.
Participants
Patients hospitalized for stroke who were discharged home and survived the first 30
days (N=23,413; mean age ± SD, 77.6±7.5y).
Interventions
Physical and occupational therapist use in the home and/or outpatient setting in the
first 30 days after discharge (any use, number of visits, and days to first visit).
Main Outcome Measures
Hospital readmission 30 to 60 days after discharge. Covariates included demographic
characteristics, proxy variables for functional status, hospitalization characteristics,
comorbidities, and prior health care use. Multivariate logistic regression analyses
were conducted to examine the relation between therapist use and readmission.
Results
During the first 30 days after discharge, 31% of patients saw a therapist in the home,
11% saw a therapist in an outpatient setting, and 59% did not see a therapist. Relative
to patients who had no therapist contact, those who saw an outpatient therapist were
less likely to be readmitted to the hospital (odds ratio, 0.73; 95% confidence interval,
0.59–0.90). Although the point estimates did not reach statistical significance, there
was some suggestion that the greater the number of therapist visits in the home and
the sooner the visits started, the lower the risk of hospital readmission.
Conclusions
After controlling for observable demographic-, clinical-, and health-related differences,
we found that individuals who received outpatient therapy in the first 30 days after
discharge home after stroke were less likely to be readmitted to the hospital in the
subsequent 30 days, relative to those who received no therapy.
Keywords
List of abbreviations:
IRF (inpatient rehabilitation facility), SNF (skilled nursing facility)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 11, 2017
Footnotes
Supported by a cooperative agreement (no. U81HP26495) with the Health Workforce Research Centers, with the National Center for Health Workforce Analysis, Bureau of Health Workforce, Health Resources and Services Administration, and U.S. Department of Health and Human Services; the Pharmacoepidemiology Gillings Innovation Lab for the Population-Based Evaluation of Drug Benefits and Harms in Older US Adults (no. GIL 200811.0010); the Center for Pharmacoepidemiology, Department of Epidemiology, UNC Gillings School of Global Public Health; the CER Strategic Initiative of UNC's Clinical Translational Science Award (no. UL1TR001111); the Cecil G. Sheps Center for Health Services Research, UNC; and the UNC School of Medicine.
The information, conclusions, and opinions expressed in this article are those of the authors, and no endorsement by the National Center for Health Workforce Analysis, Bureau of Health Workforce, Health Resources and Services Administration, or U.S. Department of Health and Human Services is intended or should be inferred.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
