TY - JOUR
T1 - Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States
AU - Kumar, Amit
AU - Resnik, Linda
AU - Karmarkar, Amol
AU - Freburger, Janet
AU - Adhikari, Deepak
AU - Mor, Vincent
AU - Gozalo, Pedro
N1 - Funding Information:
Supported by the National Institutes of Health (grant nos. R03 AG060345, R03 HD096372, P01 AG027296, K01 HD086290) and a grant from the Foundation for Physical Therapy's Center on Excellence in Health Services and Health Policy Research and Training. The views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Army, the United States Department of Defense, the United States Department of Veterans Affairs, or the United States government. Supported by the National Institutes of Health (grant nos. R03 AG060345, R03 HD096372, P01 AG027296, K01 HD086290) and a grant from the Foundation for Physical Therapy's Center on Excellence in Health Services and Health Policy Research and Training. The views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Army, the United States Department of Defense, the United States Department of Veterans Affairs, or the United States government.
Publisher Copyright:
© 2019 American Congress of Rehabilitation Medicine
PY - 2019/7
Y1 - 2019/7
N2 - Objective: To examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke. Design: Secondary analysis of inpatient Medicare claims data using Standard Analytical Files. Setting: Acute hospitals across the United States. Participants: From nationwide data, Medicare fee-for-service beneficiaries (N=88,826) aged 66 years or older hospitalized for ischemic stroke between January to November 2010. Interventions: Hospital-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 Measures: All-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. Results: In 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). Conclusion: Hospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.
AB - Objective: To examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke. Design: Secondary analysis of inpatient Medicare claims data using Standard Analytical Files. Setting: Acute hospitals across the United States. Participants: From nationwide data, Medicare fee-for-service beneficiaries (N=88,826) aged 66 years or older hospitalized for ischemic stroke between January to November 2010. Interventions: Hospital-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 Measures: All-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. Results: In 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). Conclusion: Hospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.
KW - Hemiplegia
KW - Medicare
KW - Occupational therapy
KW - Rehabilitation
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U2 - 10.1016/j.apmr.2018.12.028
DO - 10.1016/j.apmr.2018.12.028
M3 - Article
C2 - 30684485
AN - SCOPUS:85062325473
SN - 0003-9993
VL - 100
SP - 1218
EP - 1225
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 7
ER -