Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States

Amit Kumar, Linda Resnik, Amol Karmarkar, Janet Freburger, Deepak Adhikari, Vincent Mor, Pedro Gozalo

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
JournalArchives of Physical Medicine and Rehabilitation
DOIs
StatePublished - Jan 1 2019

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Patient Readmission
Rehabilitation
Stroke
Medicare
Therapeutics
Occupational Therapy
Odds Ratio
Confidence Intervals
Inpatients
Fee-for-Service Plans
Linear Models
Outcome Assessment (Health Care)

Keywords

  • Hemiplegia
  • Medicare
  • Occupational therapy
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States. / Kumar, Amit; Resnik, Linda; Karmarkar, Amol; Freburger, Janet; Adhikari, Deepak; Mor, Vincent; Gozalo, Pedro.

In: Archives of Physical Medicine and Rehabilitation, 01.01.2019.

Research output: Contribution to journalArticle

Kumar, Amit ; Resnik, Linda ; Karmarkar, Amol ; Freburger, Janet ; Adhikari, Deepak ; Mor, Vincent ; Gozalo, Pedro. / Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States. In: Archives of Physical Medicine and Rehabilitation. 2019.
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