Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States |
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Authors: | Amit Kumar Linda Resnik Amol Karmarkar Janet Freburger Deepak Adhikari Vincent Mor Pedro Gozalo |
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Affiliation: | 1. College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona;2. Department of Health Services, Policy & Practices, School of Public Health, Brown University, Providence, Rhode Island;3. Providence Veterans Affairs Medical Center, Providence, Rhode Island;4. University of Texas Medical Branch, Galveston, Texas;5. School of Health and Rehabilitation Science, University of Pittsburgh, Pennsylvania, United States |
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Abstract: | ObjectiveTo examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke.DesignSecondary analysis of inpatient Medicare claims data using Standard Analytical Files.SettingAcute hospitals across the United States.ParticipantsFrom nationwide data, Medicare fee-for-service beneficiaries (N=88,826) aged 66 years or older hospitalized for ischemic stroke between January to November 2010.InterventionsHospital-based rehabilitation services were quantified using Medicare inpatient claims revenue center codes for evaluation (occupational therapy [OT] and physical therapy [PT]), as well as the number of therapy units delivered. Therapy minutes for both OT and PT services were categorized into none, low, medium, and high.Main Outcome MeasuresAll-cause 30-day hospital readmission. A generalized linear mixed model was used to examine the effect of hospital-based rehabilitation services on 30-day hospital readmission, after adjusting for patient and hospital characteristics.ResultsIn fully adjusted models, compared to patients who received no PT, we observed a monotonic inverse relationship between the amount of PT and hospital readmission. For low PT (30 minutes), the odds ratio (OR) was 0.90 (95% confidence interval [CI], 0.83-0.96). For medium PT (>30 to ≤75 minutes), the OR was 0.89 (95% CI, 0.82-0.95). For high PT (>75 minutes), the OR was 0.86 (95% CI, 0.80-0.93).ConclusionHospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke. |
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Keywords: | Corresponding author Amit Kumar, MPH, PhD, College of Health and Human Services, Northern Arizona University, Building 66, Health Professions 208 East Pine Knoll Drive, Flagstaff, AZ 86011. Hemiplegia Medicare Occupational therapy Rehabilitation CCW chronic condition warehouse CMS Centers for Medicare & Medicaid Services FFS fee-for-service HH home health care ICU intensive care unit IRF inpatient rehabilitation facility OT occupational therapy PT physical therapy SAF Standard Analytical File SNF skilled nursing facility tPA tissue plasminogen activator |
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