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.

Project Products: 

Manuscript

 

Research brief
  • 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.
View the brief

 

Presentations, webinars, and refereed conference papers and posters