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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 23, 2019
Footnotes
Supported by the National Institutes of Health (grant nos. R03 AG060345, R03 HD096372, P01 AG027296, K01 HD086290) and a grant from the Foundation for Physical Therapy's Center on Excellence in Health Services and Health Policy Research and Training. The views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Army, the United States Department of Defense, the United States Department of Veterans Affairs, or the United States government.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
