Janet K Freburger1, Dongmei Li2, Anna M Johnson2, Erin P Fraher3. 1. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA. Electronic address: janet_freburger@pitt.edu. 2. Department of Epidemiology, University of North Carolina, Chapel Hill, NC. 3. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; Department of Family Medicine, University of North Carolina, Chapel Hill, NC.
Abstract
OBJECTIVE: To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke. DESIGN: Retrospective cohort analysis of Medicare claims (2010-2013) linked to hospital-level and county-level data. SETTING: Acute care hospital and community. PARTICIPANTS: Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical 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. RESULTS: Seventy-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. CONCLUSIONS: Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use.
OBJECTIVE: To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke. DESIGN: Retrospective cohort analysis of Medicare claims (2010-2013) linked to hospital-level and county-level data. SETTING: Acute care hospital and community. PARTICIPANTS: Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical 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. RESULTS: Seventy-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. CONCLUSIONS: Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use.
Authors: Amit Kumar; Linda Resnik; Amol Karmarkar; Janet Freburger; Deepak Adhikari; Vincent Mor; Pedro Gozalo Journal: Arch Phys Med Rehabil Date: 2019-01-24 Impact factor: 3.966
Authors: Cheryl D Bushnell; Pamela W Duncan; Sarah L Lycan; Christina N Condon; Amy M Pastva; Barbara J Lutz; Jacqueline R Halladay; Doyle M Cummings; Martinson K Arnan; Sara B Jones; Mysha E Sissine; Sylvia W Coleman; Anna M Johnson; Sabina B Gesell; Laurie H Mettam; Janet K Freburger; Blair Barton-Percival; Karen M Taylor; Janet Prvu-Bettger; Gladys Lundy-Lamm; Wayne D Rosamond Journal: J Am Geriatr Soc Date: 2018-03-23 Impact factor: 7.538
Authors: Carmen E Capo-Lugo; Robert L Askew; Matthew Boebel; Christine DeLeo; Anne Deutsch; Allen Heinemann Journal: Medicine (Baltimore) Date: 2021-10-08 Impact factor: 1.889