The Role of Physical and Occupational Therapists in the Acute to Post-Acute Care Transition

Investigators: Janet K. Freburger, PT, PhD; Anna Johnson, PhD; Dongmei Li.

Background: Medicare spending for post-acute care has increased considerably in the past decade with evidence of significant geographic variation in the use of these services. Acute care hospitals and each post-acute setting also have their own separate payment system, which provides little incentive for providers to coordinate care across settings. These trends have raised a number of questions about alternative care delivery and payment models for acute and post-acute care and the workforce needs for these models.

Objective/Aims: The primary objective of this study is to gain a more comprehensive understanding of the use and effectiveness of physical and occupational therapists in the post-acute care of Medicare beneficiaries discharged home following hip or knee joint replacement or stroke. The specific aims are:

1) Describe the use of physical and occupational therapists and their services in the home and outpatient setting following joint replacement or stroke and to identify demographic, clinical, and non-clinical factors (e.g., acute hospital characteristics, supply of providers, geography) associated with variation in its use.

2) Examine the association between the use of physical and occupational therapists and their services in the home and outpatient setting and:

a) risk of 30-day and 90-day hospital readmission, and b) number of community days post-hospitalization.

Methods: Retrospective cohort analysis using a 20% sample of Medicare data merged with other data sources. Descriptive, bivariate, and multivariate analyses will be conducted.

Policy Relevance: Findings from this study will inform the need for new training curriculum around interprofessional communication and care coordination between home, ambulatory, and acute settings and will likely highlight the need for more home/community-based placements for allied health workers.

 

Project Products: 

Manuscripts

  • Freburger J, Li D, Johnson A, Fraher E. Community Use of Physical and Occupational Therapists After Stroke and Risk of Hospital Readmission. Submitted to Journal of the American Geriatrics Society, 2016.
  • Freburger J, Li D, Johnson A. Physical and Occupational Therapy in Acute and Community Settings After Stroke: Are Patients Getting the Care They Need? Submitted to Archives of Physical Medicine & Rehabilitation, 2016.

Research Briefs

Presentations, webinars, and refereed conference papers

  • Freburger JK, Johnson A, Li D, Fraher E. Use of Physical and Occupational Therapists Following Stroke: Transitioning from the Acute Care to Community Setting. Presentation, Academy Health Annual Research Meeting. June 2016. Boston, MA.
  • Freburger JK, Johnson A, Li D, Fraher E. Use of Physical and Occupational Therapists Following Stroke: Understanding the Care Pathway From The Acute Care Hospital To The Community. Presentation, AAMC Health Workforce Research Conference. May 2016. Chicago, IL
  • Freburger JK, Li D, Fraher E. Physical and Occupational Therapy Following Stroke and Risk of Re-Hospitalization. Poster. CoHSTAR Summer Institute Meeting. June 2016. Boston, MA.
  • Freburger JK, Li D, Fraher E. Use of Physical and Occupational Therapists Following Stroke: Transitioning from the Acute Care to Community Setting. Poster. CoHSTAR Summer Institute Meeting. June 2016. Boston, MA.