Physical and Occupational Therapy from the Acute to Community Setting Following Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care

Publication date: Available online 4 April 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Janet K. Freburger, Dongmei Li, Anna Johnson, Erin Fraher
ObjectiveTo identify predictors of therapist use (any use, continuity of care, and timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home following stroke.DesignRetrospective cohort analysis of Medicare claims (2010-2013) linked to hospital-level and county-level data.SettingAcute care hospital and community.ParticipantsPatients who survived the first 30 days at home after being discharged from an acute care hospital following stroke (N=23,413).Interventions: Not applicable.Main Outcome MeasuresPhysical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics.ResultsSeventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use.ConclusionsTherapist use following stroke varies in the community and for specific sociodemographic subgroups and may be underutilized. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use.



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