Abstract
Objective
To investigate whether indicators of patient need (comorbidity burden, fall risk)
predict acute care rehabilitation utilization, and whether this relation varies across
patient characteristics (ie, demographic characteristics, insurance type).
Design
Secondary analysis of electronic health records data.
Setting
Five acute care hospitals.
Participants
Adults (N=110,209) admitted to 5 regional hospitals between 2014 and 2018.
Interventions
Not applicable.
Main Outcome Measures
Occupational therapy (OT) and physical therapy (PT) utilization. Logistic regression
models determined whether indicators of patient need predicted OT and PT utilization.
Interactions between indicators of need and both demographic factors (eg, minority
status, presence of significant other) and insurance type were included to investigate
whether the relation between patient need and therapy access varied across patient
characteristics.
Results
Greater comorbidity burden was associated with a higher likelihood of receiving OT
and PT. Relative to those with low fall risk, those with moderate and high fall risk
were more likely to receive OT and PT. The relation between fall risk and therapy
utilization differed across patient characteristics. Among patients with higher levels
of fall risk, those with a significant other were less likely to receive OT and PT;
significant other status did not explain therapy utilization among patients with low
fall risk. Among those with high fall risk, patients with VA insurance and minority
patients were more likely to receive PT than those with private insurance and nonminority
patients, respectively. Insurance type and minority status did not appear to explain
PT utilization among those with lower fall risk.
Conclusions
Patients with greater comorbidity burden and fall risk were more likely to receive
acute care rehabilitation. However, the relation between fall risk and utilization
was moderated by insurance type, having a significant other, and race/ethnicity. Understanding
the implications of these utilization patterns requires further research.
Keywords
List of abbreviations:
EHR (electronic health record), ICC (intraclass correlation coefficient), MDC (major diagnostic categories), OT (occupational therapy), PFS (Poudre Fall Scale), PT (physical therapy), VA (Department of Veterans Affairs)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: December 26, 2020
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
