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The Relationship Between Fall Risk and Hospital-Based Therapy Utilization Is Moderated by Demographic Characteristics and Insurance Type

Published:December 26, 2020DOI:https://doi.org/10.1016/j.apmr.2020.12.005

      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)
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