Use of Physical and Occupational Therapists in the Acute Care to Community Transition Following Stroke
Investigators: Janet K. Freburger, PT, PhD, Dongmei Li, MS, Anna Johnson, PhD, Erin Fraher, PhD
Objectives: Little is known about the use of therapists in the acute to post-acute transition for patients discharged home following stroke. The objectives of this study were: 1) to describe the use of physical and occupational therapists in the acute and post-acute settings (i.e., home, outpatient department) and 2) to identify predictors of therapist use in these settings.
Design: Retrospective cohort design using Medicare claims data linked to American Hospital Association data and Area Health Resource File data.
Setting: Short-term acute care hospitals (N=3,128).
Sample: Patients 66 years or older admitted to the hospital for stroke who survived the inpatient stay, were discharged home, and survived the first 30 days at home (N=42,955).
Methods: Descriptive analyses of the use of physical and occupational therapists in the acute and postacute settings. Multivariate logistic regression analyses to identify sociodemographic, clinical, hospital-level, and county-level variables associated with physical and occupational therapist during the inpatient hospitalization and during the 30 days following discharge home. Analyses were conducted for any therapist use and for specific use of a physical or occupational therapist
Results: 70 percent of the sample saw a therapist in the inpatient setting, but only 33 percent saw a therapist in their home or outpatient setting. Several hospital and county-level factors were associated with therapist use. Of particular note, patients treated at hospitals with higher RN FTEs/admissions were more likely to receive care from therapists in the acute and post-acute setting and therapist supply was associated with the timeliness and intensity of therapist use. The association between physician supply and therapist use varied depending on physician type. We also found evidence of socioeconomic and geographic disparities in therapist use.
Conclusions: There is an under-utilization of therapists in the acute and post-acute settings for patients discharged home following stroke.
- Khoja SS, Almeida GJ, Freburger JK. Recommendation Rates for Physical Therapy, Lifestyle Counseling, and Pain Medications for Managing Knee Osteoarthritis in Ambulatory Care Settings: A Cross-Sectional Analysis of the National Ambulatory Care Survey (2007-2015). Arthritis Care Res (Hoboken). 2020 Feb;72(2):184-192. doi: 10.1002/acr.24064.
- Freburger JK, Li D, Fraher EP. Community use of physical and occupational therapy after stroke and risk of hospital readmission. Archives of Physical Medicine and Rehabilitation. 2018 Jan 1;99(1):26-34.
- Freburger JK, Li D, Johnson AM, Fraher EP. Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care. Arch Phys Med Rehabil. 2018;99(6):1077-1089.e7.
- Freburger JK, Li D, Johnson A, Fraher E. 2016 April. Physical and Occupational Therapy in the Acute and Community Settings Following Stroke: Are Patients Getting the Care They Need? Carolina Health Workforce Research Center. Cecil G. Sheps Center for Health Services Research. The University of North Carolina at Chapel Hill.
- Freburger JK, Johnson A, Li D, Fraher E. Use of Physical and Occupational Therapists Following Stroke: Transitioning from the Acute Care to Community Setting. Podium presentation. Academy Health Annual Research Meeting. June 2016. Boston, MA.
- 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 J, Dongmei L, Fraher E. 2016 June. Use of Physical and Occupational Therapy Following Stroke and Risk of Re-Hospitalization. 2016 CoHSTAR Summer Institute on Health Services Research.
- Freburger J, Dongmei L, Fraher E. 2016 June 29. Use of Physical and Occupational Therapy Following Stroke and Risk of Re-Hospitalization. 2016 AcademyHealth Annual Research Meeting.
- Freburger JK, Li D, Johnson A, Fraher E. Use of Physical & Occupational Therapists Following Stroke: Understanding the Care Pathway from the Acute Care to Community Setting. Podium presentation. Association of American Medical Colleges Health Workforce Research Conference. Chicago, IL. May 6, 2016.