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 - 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 -