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Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States

Published:January 23, 2019DOI:https://doi.org/10.1016/j.apmr.2018.12.028

      Highlights

      • Higher intensity of rehabilitation care was associated with lower risk of 30-day hospital readmission.
      • Hospitals with rehabilitation units were associated with lower risk of 30-day hospital readmission.
      • Hospitals need to integrate rehabilitation care to achieve better outcomes in value-based reimbursement environments.

      Abstract

      Objective

      To examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke.

      Design

      Secondary analysis of inpatient Medicare claims data using Standard Analytical Files.

      Setting

      Acute hospitals across the United States.

      Participants

      From nationwide data, Medicare fee-for-service beneficiaries (N=88,826) aged 66 years or older hospitalized for ischemic stroke between January to November 2010.

      Interventions

      Hospital-based rehabilitation services were quantified using Medicare inpatient claims revenue center codes for evaluation (occupational therapy [OT] and physical therapy [PT]), as well as the number of therapy units delivered. Therapy minutes for both OT and PT services were categorized into none, low, medium, and high.

      Main Outcome Measures

      All-cause 30-day hospital readmission. A generalized linear mixed model was used to examine the effect of hospital-based rehabilitation services on 30-day hospital readmission, after adjusting for patient and hospital characteristics.

      Results

      In fully adjusted models, compared to patients who received no PT, we observed a monotonic inverse relationship between the amount of PT and hospital readmission. For low PT (30 minutes), the odds ratio (OR) was 0.90 (95% confidence interval [CI], 0.83-0.96). For medium PT (>30 to ≤75 minutes), the OR was 0.89 (95% CI, 0.82-0.95). For high PT (>75 minutes), the OR was 0.86 (95% CI, 0.80-0.93).

      Conclusion

      Hospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.

      Keywords

      List of abbreviations:

      CCW (chronic condition warehouse), CMS (Centers for Medicare & Medicaid Services), FFS (fee-for-service), HH (home health care), ICU (intensive care unit), IRF (inpatient rehabilitation facility), OT (occupational therapy), PT (physical therapy), SAF (Standard Analytical File), SNF (skilled nursing facility), tPA (tissue plasminogen activator)
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